Opioid Overdose case Flashcards
What is the key diagnostic factor in a history of opioid overdose
What other signs may point to opioid overdose
Low RR
Pinpoint pupils
Signs of respiratory depression
Central cyanosis, low SO2
What may the ABG show
What may the Aa gradient be
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
What may a CXR show
NAD
What are the possible other differentials for type 2 respiratory failure
Issue with the pump function
-VITAMIN CDEF
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
How would you manage opioid overdose
Why does opioid overdose result in pinpoint pupils
Naloxone
Opiates block the inhibition of the oculomotor pupillary reflex at the Edinger Westphal nucleus