ASAM Opioid Addiction Treatment GUIDELINES Apps and Pocket Guides brought to you courtesy of Guideline Central. Enjoy!
Issue link: https://eguideline.guidelinecentral.com/i/1019954
19 Figure 3. Overdose • Extreme sleepiness, inability to awaken verbally or upon sternal rub. • Breathing problems can range from slow to shallow breathing in a patient that cannot be awakened. • Fingernails or lips turning blue/purple. • Extremely small pupils – "pinpoint pupils." • Slow heartbeat and/or low blood pressure. • Verify that the airway is clear. • With one hand on the patient's chin, tilt the head back and pinch the nose closed. • Place your mouth over the patient's mouth to make a seal and give 2 slow breaths (the patient's chest should rise, but not the stomach). • Follow up with one breath every 5 seconds. • The most rapid onset of action is achieved by intravenous administration, which is recommended in emergency situations. • The product Evzio ® is specifically designed for intramuscular use but may also be administered subcutaneously. • The intramuscular or subcutaneous route of administration may be more suitable for patients with a history of opioid dependence because it provides a slower onset of action and a prolonged duration of effect, which may minimize rapid onset of withdrawal symptoms. • There is not yet an FDA-approved intranasal formulation – there are only kits made available to deliver the injectable formulation intranasally. Despite the intranasal formulation's current lack of FDA approval, it is being used off-label by first responders. • Most patients respond to naloxone by returning to spontaneous breathing, with mild withdrawal symptoms. The response generally occurs within 3–5 minutes of naloxone administration. (Rescue breathing should continue while waiting for the naloxone to take effect.) • The duration of effect of naloxone is 30–90 minutes depending on dose and route of administration. Patients should be observed after that time for re-emergence of overdose symptoms. More than one dose of naloxone may be required to revive the patient. • The goal of naloxone therapy should be restoration of adequate spontaneous breathing, but not necessarily complete arousal. Step 2: Recognize Overdose Step 3: Support Respiration Step 4: Administer Naloxone Step 5: Monitor the Patient's Response Adapted from Substance Abuse and Mental Health Services Administration. SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) 14-4742. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. AN OPIOID OVERDOSE NEEDS IMMEDIATE MEDICAL ATTENTION. Step 1: Call for Help (Dial 911)