Question

You respond to the residence of a known heroin abuser. The patient, a 30-year-old man, is unconscious and unresponsive. He is hypoventilating, bradycardic, and hypotensive. Administration of 10 mg of naloxone has had no effect, and your transport time to the hospital is approximately 30 minutes. You should:

a) Hyperventilate him with high-flow oxygen to minimize tissue hypoxia
b) Administer 25g of 50% dextrose and reassess his level of consciousness
c) Check his blood glucose level as your partner prepares to intubate.
d) Transport at once and administer additional naloxone while enroute.

Answer 1

The best course of action is to check the patient's blood glucose level immediately and prepare for intubation, administer dextrose if hypoglycemia is present, provide respiratory support, and transport to the hospital.

Step-by-step explanation:

In this scenario, the patient is showing signs of life-threatening opioid overdose, suggested by the unconsciousness, hypoventilation, bradycardia, and hypotension. The appropriate next step after unsuccessful administration of naloxone would be to check his blood glucose level as hypoglycemia could mimic opioid overdose and require a different treatment. Concurrently, preparation for intubation should be made by your partner. If hypoglycemia is present, administering 25g of 50% dextrose could be lifesaving. Additionally, continued respiratory support with oxygen and transport to the hospital is critical.