opioid

This case was written by Dr. Martin Kuuskne from McGill University. Dr. Kuuskne is a PGY4 Emergency Medicine resident and one of the editors-in-chief at EMSimCases.

Why it Matters

Opioid toxicity is a clinical diagnosis that should be rapidly recognized and managed. This case highlights four important aspects of a patient presenting after an opioid overdose:

Maintaining and addressing a wide differential diagnosis for the comatose patient.
Indications for and dosing of naloxone in the treatment of opioid toxicity.
Preoxygenation and intubation of a patient in the setting of significant hypoxemia.
Recognition of heroin associated acute respiratory distress syndrome (ARDS), a rare complication of opioid toxicity.

Clinical Vignette

You are working in a community centre emergency department. A 34-year-old male is being brought into the resuscitation bay by EMS after being found unconscious in an alley-way by bystanders who called 911. The patient was given O₂ by facemask and no other therapies en-route.

Case Summary

A 34-year-old male was found unconscious in an alleyway by bystanders who called EMS. The patient presents with a clinical opioid intoxication requiring naloxone administration. The patient also presents with acute respiratory distress syndrome (ARDS) secondary to heroin use requiring airway support, intubation and mechanical ventilation.