Paramedics bring a 24-year-old female university student to the acute care clinic after her roommates found her unresponsive on the couch. Her temperature is 36.5°C (97.7°F), blood pressure is 105/62 mm Hg, pulse is 55/min, and respiratory rate is 6/min. Pulse oximetry shows an oxygen saturation of 86% on room air. On physical examination, the patient is somnolent and minimally responsive to sternal rub. Cardiopulmonary auscultation reveals shallow but clear breath sounds bilaterally and a bradycardic but regular heart rhythm. Pupillary examination demonstrates 1.5-mm pupils bilaterally that are sluggishly reactive to light. Bowel sounds are diminished. Which of the following is the most appropriate next step in management?
- Administer intravenous naloxoneCevap
- BTransport the patient for a noncontrast CT scan of the head
- CAdminister intravenous furosemide and initiate noninvasive positive-pressure ventilation
- DAdminister broad-spectrum antibiotics and perform a lumbar puncture
- EDelay intervention to obtain collateral history regarding advance directives from the roommates
Cevap
Administer intravenous naloxone
The correct answer is administering intravenous naloxone. The patient's clinical presentation—characterized by profound respiratory depression (respiratory rate of 6/min), altered mental status, and pinpoint pupils (miosis)—is the hallmark triad of acute opioid intoxication. In this scenario, the immediate life-threatening issue is respiratory failure. Naloxone is a competitive mu-opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression and should be given immediately in the acute care setting.
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Anahtar Kavram
The classic presentation of opioid intoxication includes depressed mental status, respiratory depression, and miosis. The definitive acute management is the administration of the opioid antagonist naloxone.
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