Opioid Overdose case Flashcards

1
Q

What is the key diagnostic factor in a history of opioid overdose

What other signs may point to opioid overdose

A

Low RR
Pinpoint pupils
Signs of respiratory depression

Central cyanosis, low SO2

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2
Q

What may the ABG show

What may the Aa gradient be

A
pH
-low => acidotic
PO2
-low due to low resp rate
PCO2
-high due to low resp rate
HCO3
-unlikely to be chronic CO2 retainer, may be normal

Aa gradient likely to be normal assuming this patient has no other underlying conditions => no issues with the alveolar capillary exchange surface

Type 2 resp failure

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3
Q

What may a CXR show

A

NAD

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4
Q

What are the possible other differentials for type 2 respiratory failure
Issue with the pump function
-VITAMIN CDEF

A

Iatrogenic/idiopathic
-Opioids, sedatives

Trauma

  • head trauma
  • surgery
  • spinal cord, nerve injury

Autoimmune
-Myasthenia gravis

Metabolic
-Pompes

Inflammatory/infective
-Late stage COPD exacerbation

Neoplastic
-Malignant compression of the phrenic

Congenital
-DMD

Degenerative

  • Disc prolapse
  • MND
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5
Q

How would you manage opioid overdose

Why does opioid overdose result in pinpoint pupils

A

Naloxone

Opiates block the inhibition of the oculomotor pupillary reflex at the Edinger Westphal nucleus

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