NREMT Emergency Medical Technician (EMT) Cognitive ExamAirway, Respiration & VentilationHard
A 50-year-old male is found unconscious after an unknown overdose. His respirations are slow and shallow, and you note pinpoint pupils. He is breathing at 6 breaths per minute. You have administered naloxone, and his respiratory effort has not improved. What is your most appropriate next intervention?
- APlace the patient in the recovery position and monitor.
- BAdminister a second dose of naloxone.
- CApply a non-rebreather mask at 15 L/min and continue monitoring.
- DInsert a nasopharyngeal airway (NPA) and begin positive pressure ventilation.
Show answer & explanationAnswer & explanation
Correct answer: D. Insert a nasopharyngeal airway (NPA) and begin positive pressure ventilation.
The patient's respiratory rate of 6 breaths per minute indicates severe respiratory depression and inadequate breathing, which is a life-threatening condition. Even after naloxone, if respiratory effort has not improved, positive pressure ventilation (assisted breathing) is immediately required. An NPA can help maintain an open airway during ventilation.
Why the other options are wrong
- A. The recovery position is for unconscious patients who are breathing adequately and can protect their airway. This patient is not breathing adequately.
- B. While a second dose of naloxone might be considered, the immediate priority for a patient with a respiratory rate of 6 is to support ventilation, not to wait for medication to take effect.
- C. A non-rebreather mask provides supplemental oxygen but does not assist with ventilation. This patient's breathing is too slow and shallow to benefit sufficiently from just oxygen; he needs help breathing.
Opioid Overdose Respiratory Management
Opioid overdose primarily causes respiratory depression. While naloxone is the antidote, immediate airway and ventilatory support are paramount if breathing is inadequate.
- Signs include pinpoint pupils, respiratory depression (slow, shallow, or absent breathing), and altered mental status.
- Naloxone reverses opioid effects, but may take time or require multiple doses.
- If breathing is inadequate, positive pressure ventilation (BVM) is immediately necessary, regardless of naloxone administration.
Memory trick: Naloxone's great, but if they still can't ventilate, don't hesitate, manually inflate!