Overview
The Immediate Danger Is Inadequate Breathing
An opioid overdose is a ventilation emergency before it is a diagnostic puzzle.
An opioid overdose is a ventilation emergency before it is a diagnostic puzzle. A person who is difficult to rouse and has slow, shallow, absent, or abnormal breathing needs treatment before the cause is proven. Small pupils support the pattern, but they are not required; cyanosis and gurgling indicate that oxygenation or airway protection is already failing. The first objective is to restore gas exchange: activate 9-1-1, give naloxone as soon as it is available, provide rescue ventilation or CPR as indicated, and remain with the person. Naloxone can reverse the opioid effect without removing the opioid from the body, so improvement may be temporary. The patient’s breathing—not a negative history, a toxicology result, or full wakefulness—determines the immediate priority.