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Immediate priorities
Resuscitation priorities
Airway patency
Gurgling
Stridor
Vomitus
Breathing adequacy
Respiratory rate <10/min
Apnea
SpO2 <90% on room air
Circulation status
SBP <90 mmHg
Shock index >1
Bradycardia
Neurologic status
GCS <13
Unresponsive
Opioid toxidrome recognition
Miosis
Pinpoint pupils not required
Normal pupils possible with hypoxia or coingestants
CNS depression
Somnolence
Coma
Respiratory depression
Hypoventilation
Hypercapnia
Immediate stabilization actions
Bag valve mask ventilation for hypoventilation
Two person technique
Oropharyngeal or nasopharyngeal airway
Oxygen supplementation
Nasal cannula
Nonrebreather
High flow nasal cannula
Naloxone for respiratory depression
Titrated reversal strategy
Full reversal not required if ventilation adequate
Point of care glucose for altered mental status
Treat hypoglycemia per local protocol
Monitoring and escalation
Monitoring bundle
Continuous pulse oximetry
SpO2 target 92% to 96%
Cardiac monitoring
Bradyarrhythmia
QT prolongation concern
Frequent respiratory reassessment
Respiratory rate
Work of breathing
Mental status trajectory
Capnography when available
Rising ETCO2 as early hypoventilation marker
Escalation triggers
Persistent apnea despite naloxone
Immediate airway control
Inability to protect airway
Early intubation strategy
Recurrent respiratory depression
Continuous naloxone infusion pathway
Suspected polysubstance ingestion
Expanded tox workup
Higher level of care
Key concepts
Core principles
Primary lethal mechanism is hypoventilation with hypoxia and hypercapnia
Ventilation support is definitive in the moment
Naloxone duration often shorter than opioid duration
Renarcotization risk after initial response
Goal is adequate spontaneous ventilation
Withdrawal precipitation avoided when possible
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.