A 24-year-old man is brought to the emergency department by his friends for altered mental status, vomiting, severely slowed breathing, and cold clammy hands. On physical examination, he has a bluish tone to his lips and pinpoint pupils. When his family arrives in the emergency department, they mention that the patient has been abusing fentanyl for the past 6 months.
Which of the following is the most appropriate treatment for this patient?
The correct answer is:
D) Naloxone
Naloxone is a short-acting opioid antagonist generally administered intravenously in cases of opioid overdose. If there is a delay in securing intravenous access, it may be administered nasally, subcutaneously, or intramuscularly. This patient is demonstrating evidence of an opioid overdose given his history of fentanyl abuse, pinpoint pupils, and signs of cardiopulmonary depression. Since this patient has respiratory depression, pulse oximetry should be monitored, and the patient should be ventilated by bag-valve mask attached to supplemental oxygen before and during naloxone administration to reduce the chance of acute respiratory depression.
Answer choice A: Dextromethorphan, is incorrect. Dextromethorphan is a Mu opioid agonist added to cough syrups in order to help suppress cough. It would not make the patient's symptoms better. In fact, it may exacerbate his cardiopulmonary depression.
Answer choice B: Flumazenil, is incorrect. Flumazenil is a GABAA antagonist used in the treatment of benzodiazepine overdose.
Answer choice C: Methadone disorder, is incorrect. Methadone is used in opioid detoxification and/or maintenance therapy.
Answer choice E: Naltrexone, is incorrect. Naltrexone is a long-acting opioid antagonist used to prevent relapse in patients once they have been detoxified from opioids. It would not be appropriate to use this agent in the acute setting of an opioid overdose.
Brief psychotic disorder is characterized by schizophrenic symptoms that last less than 1 month. Brief psychotic disorder can commonly be brought on by stress.
Key Learning Point
Naloxone is a short-acting opioid antagonist usually administered intravenously in cases of opioid overdose.
