NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesHard
A 24-year-old female is found unresponsive. Her friends state she ingested an unknown quantity of pills. On arrival, she has pinpoint pupils, respiratory rate of 6 breaths/minute, and shallow breathing. Her pulse is 50 bpm and skin is cool and clammy. What is the MOST immediate intervention for this patient?
- AInitiate positive pressure ventilation.
- BObtain a blood glucose level.
- CAdminister activated charcoal.
- DApply a non-rebreather mask at 15 L/min.
Show answer & explanationAnswer & explanation
Correct answer: A. Initiate positive pressure ventilation.
The patient's severely depressed respiratory rate (6 breaths/minute) and shallow breathing indicate profound respiratory depression, likely due to opioid overdose given the pinpoint pupils. This is an immediate life threat, and positive pressure ventilation is required to support her breathing and prevent hypoxia and respiratory arrest.
Why the other options are wrong
- B. While obtaining a blood glucose is important in altered mental status, it is secondary to addressing the immediate life-threatening respiratory compromise. Hypoglycemia would not typically cause pinpoint pupils.
- C. Activated charcoal may be indicated for certain ingestions, but it is secondary to addressing the life-threatening respiratory depression. Administering it to an unresponsive patient with a compromised airway is also dangerous due to aspiration risk.
- D. A non-rebreather mask provides supplemental oxygen but does not assist with the patient's severely depressed breathing effort. It will not adequately ventilate the patient or correct the hypoventilation.
Opioid Overdose Respiratory Depression
Opioid overdose can cause severe respiratory depression, leading to hypoxemia and hypercapnia, requiring immediate ventilatory support and naloxone.
- Pinpoint pupils are a classic sign.
- Respiratory rate can drop dangerously low.
- Ventilatory support is the priority, even before naloxone, if breathing is inadequate.
Memory trick: Breathing First, Then Specifics