Red flags
- RR <8, GCS <8
- Long-acting opioid (methadone/OxyContin) — recurrent depression
- Body packer / stuffer
First steps
- ABCDE, jaw thrust, bag-mask ventilation
- Naloxone 0.4-2 mg IV/IM/IN — titrate to respirations
- Continuous monitoring
Key investigations
- ECG (methadone QT)
- Glucose, ABG
- Urine tox screen
Differentials
- Sedative overdose
- Post-ictal
- CO poisoning
Initial management
- Repeat naloxone q2-3 min
- Consider infusion: 2/3 of effective bolus per hour
- Observe ≥6 h; long-acting opioids ≥12 h
- Refer to detox/rehab, harm reduction, naloxone kit on discharge
Referral
- Toxicology, addiction services
AI clinical assessment
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