Overdose (Responder) Scenario

As you enter the room, you are surprised to find the patient is receiving CPR. You have not been informed of this on route. What are your first priorities?

You find the patient is actually groaning, has a resp rate of 6 and pulse of 105. They seem to be snoring when they are taking their short shallow breaths. You attempts manual manoeuvres but this has little effect. Following next airway steps, what airway would be more appropriate to attempt in this patient?

You place an OPA with good effect and the snoring has gone. With the airway currently patent, what should be your next priority?

Outside what ranges should you consider ventilating a patient? 

You start supporting the patient with ventilations and 15L/min oxygen but now you’re unable to do anything else. You know the crew will arrive shortly so should you try to get other observations/assessments completed or just keep ventilating the patient?

You decide to keep ventilating the patient and while doing so, try to get more of a history from the flatmate before the crew arrive. You are told the patient suffers from a bipolar disorder and struggles a lot in her low moments. She has been alone drinking all day and you can see there is an empty 1L bottle of vodka. 

There are also lots of empty packets of co-codamol 30/500 scattered around the bed she is on. Co-codamol is a combination of codeine and paracetamol, what part would be more suspect to have caused this patients’ condition? 

What type of medication is codeine?

What three main symptoms do you usually find with opiate overdose patients?

What medication is frequently used to combat the effects of opioid medication?

How does Naloxone work to combat the effects of any opioid medication taken?

The crew arrive and are happy you have good control of the ventilations, so they get initial observations completed and draw up their own Naloxone. Should the Paramedics only get IV access, or can they give the drug IM for quicker administration?

Community Naloxone injections are becoming more prevalent to try and tackle community opiate overdoses. Are community first responders able to administer this medication if it is on scene and in a lifesaving context?

The crew have given Naloxone and the patients GCS starts to improve after a short while. Which medication has a longer half-life and therefore has a longer effect on the patient’s symptoms?

The crew explain that as the opiate lasts longer, the patient can go back into respiratory depression once the Naloxone fades, so ideally requires observation and transport to hospital. All intentional doses due to mental health should require further assessment unless there are Trust specific pathways/centres are in place?

Opioid medication effects are usually more severe when taken with alcohol? 

What tool can be used to look up the specific effects of individual medications or recreational drugs?