Opioid Overdose — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Opioid overdose?
   Opioid overdose (respiratory-depression triad)? (Opioid toxidrome triad: respiratory depression (RR <8–10/min or apnea), coma/drowsiness, pinpoint pupils (± hypotension). First open the airway, ventilate and oxygenate, monitor.)
   • Respiratory depression / suspected overdose → Naloxone
   • No respiratory depression → No respiratory depression
2. [End] No respiratory depression
   Alert, no respiratory depression: monitor, look for other causes; if there is opioid exposure, continue observation (long-acting opioids can depress later).
3. [End] Naloxone
   Naloxone (titrate to restore spontaneous breathing, not full arousal, to avoid precipitating withdrawal): no dependence / critical (apnea, cyanosis) 0.4–2 mg IV (or 2 mg IM/intranasal), repeat q2–3 min; question the diagnosis if 10 mg total has no effect. In known opioid dependence start low at 0.04–0.1 mg and titrate up. Short half-life (~30–90 min) — long-acting opioids (methadone, extended-release) need repeat dosing or a continuous infusion (~2/3 of the effective bolus per hour); watch for re-depression — observe for several hours. Bag-mask ventilation and oxygen throughout.

Source guidelines & references

• Naloxone prescribing information (FDA/CHEMM); StatPearls opioid toxicity
• AHA ACLS opioid-associated emergencies

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways