NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationEasy
A 45-year-old male is found unresponsive after a suspected opioid overdose. His respirations are slow and shallow at 6 breaths per minute, and his SpO2 is 82% on room air. Pupils are pinpoint. What is the MOST immediate and critical intervention?
- AApply high-flow oxygen via non-rebreather mask.
- BInitiate positive pressure ventilation with a bag-valve-mask.
- CAdminister naloxone intravenously.
- DEstablish an IV line and administer a fluid bolus.
Show answer & explanationAnswer & explanation
Correct answer: B. Initiate positive pressure ventilation with a bag-valve-mask.
The patient is experiencing severe respiratory depression, leading to hypoxemia (SpO2 82%). While naloxone is indicated, the immediate priority is to support ventilation to improve oxygenation and prevent further hypoxia and hypercapnia. Positive pressure ventilation with a BVM will provide immediate respiratory support.
Why the other options are wrong
- A. High-flow oxygen alone will not overcome severe hypoventilation; positive pressure is needed to move air.
- C. Naloxone is critical but takes time to take effect; ventilation is needed immediately.
- D. Fluid bolus is not indicated for respiratory depression and could worsen pulmonary edema if not careful.
Opioid Overdose Respiratory Support
In severe opioid overdose, respiratory depression is the primary life threat. Immediate positive pressure ventilation is crucial to reverse hypoxemia and hypercapnia, even before naloxone takes full effect.
- Opioids depress the respiratory drive, leading to slow, shallow breathing.
- Hypoxemia and hypercapnia can rapidly lead to cardiac arrest.
- BVM ventilation provides immediate support while awaiting naloxone's effects.
Memory trick: Breathe for them first, then reverse the drug's curse.