Adult Opioid Toxicity Flashcards
What are 2 Cautions/considerations when dealing with an opioid toxicity patient
- Consider other causes of altered conscious state (AEIOUTIPS)
- Patients can become aggressive following naloxone administration
Signs of Opioid toxicity
- respiratory depression (O2Sa <92% in Ra) /apnea
- unable to maintain airway
- CNS depression from drowsiness to coma
- Miosis (pinpoint pupils) - amphetamines often dilate and other non opioid substances can also cause miosis
- Prolonged QT interval (methadone oxycodone, loperamide)
Complications of opioid toxicity
- Aspiration pneumonitis
- Pressure injury / rhabdomyolisis
- cardiac arrest due to prolonged hypoxia
Notes for isolated heroin toxicity
- Rebound toxicity and other complications are less likely.
-risk of toxicity increased if H taken with sedative - if reversed can be left with family, friends or carer -advise to monitor 4 hours and call 000 if re-sedation occurs
Notes for other opioid toxicity
- Consider medication onset mechanisms (delayed, immediate)
-Toxicity more likely if patient Elderly, naive and or frail, Additional sedatives co taken, high-potency synthetic opioids are taken
Considerations for Synthetic opioids
- May require higher doses of naloxone
-Greater risk of rebound toxicity dependent on duration of action - Fentanyl analogues may be particularly potent
List 3 examples of when opioid toxicity might occur in the paediatric population
- Accidental overdose (carer inadvertently gives a 2nd dose after partner already dosed or multiple medications)
- Paediatric patients accessing parents medications inappropriately stored
- A tablet or liquid from a parents preperation (ie methadone)
Simple opioid toxicity definition
Single modal opioid
-unable to maintain airway or
-Sp02 < 92% on RA
Simple opioid toxicity treatment pathway
- Airway / ventilation
- Naloxone 800 mcg IM
- Repeat once at 10 min
- Adequate response
- consider referral
- Inadequate response
- Transport
- consider SGA
Simple opioid toxicity notes
-Rebound toxicity rare
- if there is complete reversal of opioid effects patients may be left at home with family / friends with advice to
- watch friend for 4 hours
- administer take home naloxone and call 000 if re sedation occurs
- There are a group of patients who are resistant to transport even if indicated as per CPG these patients should be provided information on local and social and drug supports available and the appropriate information sheet
- Risk of toxicity is increased where heroin is co administered with a benzo or other sedative
Complex opioid toxicity definition
- Prescription opioids
- Polydrug toxicity
- Iatrogenic (secondary to opioid analgesia)
- Unknown cause
Complex opioid toxicity pathway
- Airway / ventilation
- Naloxone 100mcg IV
- repeat at 2 minute intervals (MAX of 200mcg)
- Target return of ventilation ( SAT of -1 acceptable in AV care)
- IF NO IV access Naloxone 400 IM (single dose)
- Consider SGA
Complex opioid toxicity notes
- Complex opioid toxicity also encompasses all forms of opioid toxicity that is not a isolated IV opioid
- Rebound toxicity and other complications are rare but possible due to the relatively short half life of Naloxone compared to many opioids
- Smaller titrated doses of naloxone are recommended in this group to manage respiratory depression and avoid acute opioid withdrawal.
Scane safety considerations when dispatched to a suspected opioid toxicity
- uncapped sharps at scene or on patient
- Complete DRA
- Apply appropriate PPE
- Assess potential for multi patient event.
Care objectives when considering opioid toxicity
- Airway patency and adequate ventilation
- Reverse opioid action sufficiently enough to permit adequate spontaneous respiration with4out causing opioid withdrawal
