Opioids are class of drugs includes pain relievers, synthetic opioids, and illegal substances.
Excessive opioid consumption leads to overdose that causes severe life threating symptoms or death.
Medical professionals use short and long-acting opiates to treat poorly managed pain.
Opiates drugs approved to relieve pain for last 70 years and generally considered safe. Opioids are chemicals that bind to receptors in the brain to decrease pain signals.
Prescription opioids are authorized in the treatment of acute to chronic pain and post-surgery or injury. Use opioids only when required in cases of acute pain.
Common drugs involved in opioid overdose deaths are:
Drug enforcement agency and centers for disease control and prevention report shows a significant rise in opiate prescriptions and deaths in the United States from 2001 to 2010.
Opioid overdose has global prevalence but shows high impact in US, Canada, and Europe.
Males have more chance to die from an opioid overdose than females.
Non-Hispanic whites and American Indian natives shows the highest overdose rates. Mental health disorders also increase opioid risk.
Anatomy
Pathophysiology
Opioids target mu, delta, and kappa receptors are responsible for analgesia, dysphoria, emotional responses, and respiratory depression.
Opioid peptides bind to receptors to regulate pain and stress response. Opioids result in sedation that cause confusion and cognitive impairment.
Opioids block pain signals and change emotional pain response. Euphoria activates a reward pathway for pleasure, while sedation causes drowsiness.
Etiology
Opioids target mu, delta, and kappa receptors are responsible for analgesia, dysphoria, emotional responses, and respiratory depression.
Opioid peptides bind to receptors to regulate pain and stress response. Opioids result in sedation that cause confusion and cognitive impairment.
Opioids block pain signals and change emotional pain response. Euphoria activates a reward pathway for pleasure, while sedation causes drowsiness.
Genetics
Prognostic Factors
Early naloxone administration reverses opioid overdose effects and increases survival chances. Rapid EMS arrival and resuscitative efforts improve outcomes.
Prognosis depends on respiratory compromise severity during intervention. Severe respiratory depression can cause brain injury or death.
Younger people show better outcomes than older adults overall. Mental health impacts treatment adherence and overdose risk in prognosis.
Clinical History
Opioid overdose occurs in the highest rates between the age group of 25 to 55 years old.
Physical Examination
Neurological Examination
Gastrointestinal Examination
Respiratory Examination
Skin Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
For Mild to Moderate Overdose:
Drowsiness, pinpoint pupils, slurred speech, confusion, and decreased respiratory rate
For Severe Overdose:
Profound respiratory depression, unconsciousness, cyanosis, bradycardia, and hypotension
Differential Diagnoses
Stroke
Intracranial Hemorrhage
Myocardial Infarction
Severe Depression
Hypoglycemia
Sepsis
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Comatose patients in respiratory distress need immediate airway control for treatment.
Highly recommend endotracheal intubation for airway protection in patients.
Naloxone given in lowest dose in drug abuser cases to reverse respiratory apnea.
Naloxone counteracts opioids receptor, and it is administered in various routes including IV, IM, subcutaneous or intranasal.
Activated charcoal can decontaminate the gastrointestinal tract in opiate overdose patients who are alert.
Alert patients may not need airway protection, but those who are not alert need intubation first.
Effectiveness of whole bowel irrigation in opiate packet ingestion unclear due to lack of controlled studies on benefits or outcomes.
Most opiate overdose patients reversed with naloxone are observed in hospital for 12 to 24 hours.
Asymptomatic heroin overdose patients may not need 24-hour monitoring, but they require minimum 6 to 12 hours monitoring.
Use bag-valve-mask ventilation if the patient is not breathing adequately or if respiratory depression persists despite naloxone administration.
Administer IV fluids if hypotension is present to improve blood pressure and circulation.
use-of-phases-in-managing-opioid-overdose
In the immediate response phase, assess consciousness level and check proper working of airway, breathing, circulation of patient.
Pharmacologic therapy is effective in the treatment phase as it includes use of naloxone drug as opioid reversal agent and some therapy intervention.
For long-acting opioids extended monitoring for up to 24 hours is needed. While for short-acting opioids monitor for minimum 4 to 6 hours post-naloxone administration.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Non–opioid-dependent patients:
0.5 mg; if further medication is required, it may be given 2 to 5 minutes later at a dose of 1 mg
It is doubtful that continuous administration of nalmefene would be effective if there is no clinical response after 1.5 mg in total
Once an adequate initial reversal has been established, stop giving nalmefene Recurrent respiratory depression:
Patients who obtained satisfactory reversal with the initial dose regimen but continue to have respiratory depression may be given additionally nalmefene using the same dosing method as recommended for initial treatment
Opioid-dependent patients:
Initial dosage is 0.1 mg
if withdrawal symptoms are not present, increase to 0.5 mg
2 to 5 minutes later, a repeat dosage of 1 mg may be given if necessary
it is doubtful that continuous administration of nalmefene would be effective if there is no clinical response after 1.6 mg in total. Once an adequate initial reversal has been established, stop giving nalmefene. Recurrent respiratory depression:
Patients who had recurring respiratory depression but had a sufficient response to the original dose regimen may be given more nalmefene following the same dosing schedule as recommended for initial treatment
Administer 0.4 to 2 mg Intravenous/Intramuscularly/Subcutaneously.
Repeat every 2 to 3min whenever necessary.
Do not exceed 10 mg.
• If the desired reaction is not obtained after providing 10 mg cumulative total, consider alternative reasons for respiratory depression.
• Endotracheal (the least acceptable delivery method, with limited anecdotal evidence): 2-2.5 times the original intravenous dosage (0.8 to 5 mg). Until minimize abrupt withdrawal, use the lowest dosages (0.1 to 0.2 mg) for chronic opioid misuse; titrate until reversal of respiratory depression.
Continuous Intravenous infusion
Alternatively, deliver two-thirds of the original effective naloxone bolus hourly (0.25-6.25 mg/hr); administer half of the initial bolus dosage 15 minutes after starting the continuous intravenous (IV) infusion to prevent naloxone levels from dropping.
Zimhi High Dose
Administer 5 mg intramuscularly or subcutaneously into the anterolateral portion of the thigh (through clothes if required); if the kid is under one year old, compress the thigh muscle while you inject the dosage.
Additional dosages may be given every 2 to 3 minutes until EMS arrives.
Reversal of post-anesthesia (acute) opioid
Neonates: Administer 0.01 mg/kg intravenously into the umbilical vein, Intramuscularly or Subcutaneously; if necessary, provide a repeat dose of 0.1 mg/kg.
Children: Administer 0.1 mg/kg Intravenously given once; this dose may be repeated.
Therapeutic opioid dosage reverses respiratory depression
Dosage from the manufacturer: Administer 0.005 to 0.01 mg; repeat every 2 to 3min whenever necessary dependent on reaction.
Dosage of AAP: 0.001 to 0.015 mg/kg/dose intravenously, titrated to effect
Acute opioid overdose
≤20 kg or <5 years: Administer 0.1 mg/kg/dose
Intravenously/Intramuscularly/Subcutaneously/Endotracheally; if needed, repeat every 2 to 3min whenever necessary; Do not exceed 2 mg/dose
>20 kg or ≥ five years: Administer 2 mg
Intravenously/Intramuscularly/Subcutaneously/Endotracheally; if needed, repeat every 2 to 3min whenever necessary
Zimhi High-Dose
Inject 5 mg intramuscularly or subcutaneously into the anterolateral portion of the thigh (through clothes if required); if the kid is under one year old, compress the thigh muscle while you inject the dosage.
Opioids are class of drugs includes pain relievers, synthetic opioids, and illegal substances.
Excessive opioid consumption leads to overdose that causes severe life threating symptoms or death.
Medical professionals use short and long-acting opiates to treat poorly managed pain.
Opiates drugs approved to relieve pain for last 70 years and generally considered safe. Opioids are chemicals that bind to receptors in the brain to decrease pain signals.
Prescription opioids are authorized in the treatment of acute to chronic pain and post-surgery or injury. Use opioids only when required in cases of acute pain.
Common drugs involved in opioid overdose deaths are:
Drug enforcement agency and centers for disease control and prevention report shows a significant rise in opiate prescriptions and deaths in the United States from 2001 to 2010.
Opioid overdose has global prevalence but shows high impact in US, Canada, and Europe.
Males have more chance to die from an opioid overdose than females.
Non-Hispanic whites and American Indian natives shows the highest overdose rates. Mental health disorders also increase opioid risk.
Opioids target mu, delta, and kappa receptors are responsible for analgesia, dysphoria, emotional responses, and respiratory depression.
Opioid peptides bind to receptors to regulate pain and stress response. Opioids result in sedation that cause confusion and cognitive impairment.
Opioids block pain signals and change emotional pain response. Euphoria activates a reward pathway for pleasure, while sedation causes drowsiness.
Opioids target mu, delta, and kappa receptors are responsible for analgesia, dysphoria, emotional responses, and respiratory depression.
Opioid peptides bind to receptors to regulate pain and stress response. Opioids result in sedation that cause confusion and cognitive impairment.
Opioids block pain signals and change emotional pain response. Euphoria activates a reward pathway for pleasure, while sedation causes drowsiness.
Early naloxone administration reverses opioid overdose effects and increases survival chances. Rapid EMS arrival and resuscitative efforts improve outcomes.
Prognosis depends on respiratory compromise severity during intervention. Severe respiratory depression can cause brain injury or death.
Younger people show better outcomes than older adults overall. Mental health impacts treatment adherence and overdose risk in prognosis.
Opioid overdose occurs in the highest rates between the age group of 25 to 55 years old.
Neurological Examination
Gastrointestinal Examination
Respiratory Examination
Skin Examination
For Mild to Moderate Overdose:
Drowsiness, pinpoint pupils, slurred speech, confusion, and decreased respiratory rate
For Severe Overdose:
Profound respiratory depression, unconsciousness, cyanosis, bradycardia, and hypotension
Stroke
Intracranial Hemorrhage
Myocardial Infarction
Severe Depression
Hypoglycemia
Sepsis
Comatose patients in respiratory distress need immediate airway control for treatment.
Highly recommend endotracheal intubation for airway protection in patients.
Naloxone given in lowest dose in drug abuser cases to reverse respiratory apnea.
Naloxone counteracts opioids receptor, and it is administered in various routes including IV, IM, subcutaneous or intranasal.
Activated charcoal can decontaminate the gastrointestinal tract in opiate overdose patients who are alert.
Alert patients may not need airway protection, but those who are not alert need intubation first.
Effectiveness of whole bowel irrigation in opiate packet ingestion unclear due to lack of controlled studies on benefits or outcomes.
Most opiate overdose patients reversed with naloxone are observed in hospital for 12 to 24 hours.
Asymptomatic heroin overdose patients may not need 24-hour monitoring, but they require minimum 6 to 12 hours monitoring.
Emergency Medicine
Endocrinology, Metabolism
Standardize opioid overdose protocols with naloxone and resuscitation.
Provide naloxone to at-risk individuals and their families for overdoses.
Create supervised opioid consumption sites for safer use, overdose prevention, and immediate naloxone access.
Promote policies for addiction treatment, including medication-assisted treatment and behavioural therapies.
Encourage care models for substance use and mental health to enhance outcomes for at-risk individuals.
Proper education and awareness about opioid overdose should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Emergency Medicine
Naloxone:
It is used to reverse opioid intoxication or overdose. It reverses the effects of opioids including respiratory depression, sedation, and hypotension.
Emergency Medicine
Use bag-valve-mask ventilation if the patient is not breathing adequately or if respiratory depression persists despite naloxone administration.
Administer IV fluids if hypotension is present to improve blood pressure and circulation.
Emergency Medicine
In the immediate response phase, assess consciousness level and check proper working of airway, breathing, circulation of patient.
Pharmacologic therapy is effective in the treatment phase as it includes use of naloxone drug as opioid reversal agent and some therapy intervention.
For long-acting opioids extended monitoring for up to 24 hours is needed. While for short-acting opioids monitor for minimum 4 to 6 hours post-naloxone administration.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Opioids are class of drugs includes pain relievers, synthetic opioids, and illegal substances.
Excessive opioid consumption leads to overdose that causes severe life threating symptoms or death.
Medical professionals use short and long-acting opiates to treat poorly managed pain.
Opiates drugs approved to relieve pain for last 70 years and generally considered safe. Opioids are chemicals that bind to receptors in the brain to decrease pain signals.
Prescription opioids are authorized in the treatment of acute to chronic pain and post-surgery or injury. Use opioids only when required in cases of acute pain.
Common drugs involved in opioid overdose deaths are:
Drug enforcement agency and centers for disease control and prevention report shows a significant rise in opiate prescriptions and deaths in the United States from 2001 to 2010.
Opioid overdose has global prevalence but shows high impact in US, Canada, and Europe.
Males have more chance to die from an opioid overdose than females.
Non-Hispanic whites and American Indian natives shows the highest overdose rates. Mental health disorders also increase opioid risk.
Opioids target mu, delta, and kappa receptors are responsible for analgesia, dysphoria, emotional responses, and respiratory depression.
Opioid peptides bind to receptors to regulate pain and stress response. Opioids result in sedation that cause confusion and cognitive impairment.
Opioids block pain signals and change emotional pain response. Euphoria activates a reward pathway for pleasure, while sedation causes drowsiness.
Opioids target mu, delta, and kappa receptors are responsible for analgesia, dysphoria, emotional responses, and respiratory depression.
Opioid peptides bind to receptors to regulate pain and stress response. Opioids result in sedation that cause confusion and cognitive impairment.
Opioids block pain signals and change emotional pain response. Euphoria activates a reward pathway for pleasure, while sedation causes drowsiness.
Early naloxone administration reverses opioid overdose effects and increases survival chances. Rapid EMS arrival and resuscitative efforts improve outcomes.
Prognosis depends on respiratory compromise severity during intervention. Severe respiratory depression can cause brain injury or death.
Younger people show better outcomes than older adults overall. Mental health impacts treatment adherence and overdose risk in prognosis.
Opioid overdose occurs in the highest rates between the age group of 25 to 55 years old.
Neurological Examination
Gastrointestinal Examination
Respiratory Examination
Skin Examination
For Mild to Moderate Overdose:
Drowsiness, pinpoint pupils, slurred speech, confusion, and decreased respiratory rate
For Severe Overdose:
Profound respiratory depression, unconsciousness, cyanosis, bradycardia, and hypotension
Stroke
Intracranial Hemorrhage
Myocardial Infarction
Severe Depression
Hypoglycemia
Sepsis
Comatose patients in respiratory distress need immediate airway control for treatment.
Highly recommend endotracheal intubation for airway protection in patients.
Naloxone given in lowest dose in drug abuser cases to reverse respiratory apnea.
Naloxone counteracts opioids receptor, and it is administered in various routes including IV, IM, subcutaneous or intranasal.
Activated charcoal can decontaminate the gastrointestinal tract in opiate overdose patients who are alert.
Alert patients may not need airway protection, but those who are not alert need intubation first.
Effectiveness of whole bowel irrigation in opiate packet ingestion unclear due to lack of controlled studies on benefits or outcomes.
Most opiate overdose patients reversed with naloxone are observed in hospital for 12 to 24 hours.
Asymptomatic heroin overdose patients may not need 24-hour monitoring, but they require minimum 6 to 12 hours monitoring.
Emergency Medicine
Endocrinology, Metabolism
Standardize opioid overdose protocols with naloxone and resuscitation.
Provide naloxone to at-risk individuals and their families for overdoses.
Create supervised opioid consumption sites for safer use, overdose prevention, and immediate naloxone access.
Promote policies for addiction treatment, including medication-assisted treatment and behavioural therapies.
Encourage care models for substance use and mental health to enhance outcomes for at-risk individuals.
Proper education and awareness about opioid overdose should be provided and its related causes with management strategies.
Appointments with a physician and preventing recurrence of disorder is an ongoing life-long effort.
Emergency Medicine
Naloxone:
It is used to reverse opioid intoxication or overdose. It reverses the effects of opioids including respiratory depression, sedation, and hypotension.
Emergency Medicine
Use bag-valve-mask ventilation if the patient is not breathing adequately or if respiratory depression persists despite naloxone administration.
Administer IV fluids if hypotension is present to improve blood pressure and circulation.
Emergency Medicine
In the immediate response phase, assess consciousness level and check proper working of airway, breathing, circulation of patient.
Pharmacologic therapy is effective in the treatment phase as it includes use of naloxone drug as opioid reversal agent and some therapy intervention.
For long-acting opioids extended monitoring for up to 24 hours is needed. While for short-acting opioids monitor for minimum 4 to 6 hours post-naloxone administration.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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