An opioid overdose happens when opioids such as fentanyl, heroin or prescription pain pills suppress the brain's drive to breathe. A patient can stop breathing anywhere, even in a waiting room, so staff must recognize it fast and act.
Key symptoms
- Unresponsive or very hard to wake
- Slow, shallow or snoring breathing, or no breathing
- Blue or gray lips and fingertips
- Pinpoint pupils
What you find on exam
- Check response and breathing, call for help and get naloxone
- Breathing rate and oxygen saturation; check for a pulse
- Pupils, skin color, needle marks or skin patches
- Blood glucose to exclude low blood sugar
Tests
- Treatment comes first; tests never delay naloxone or ventilation
- Capnography to monitor ventilation
- Glucose, ECG; drug screen and acetaminophen level if the intent is unclear
Treatment basics
- Open the airway and ventilate with a bag-valve mask and oxygen
- Naloxone 4 mg intranasal or 0.4 mg IV or IM; repeat every 2 to 3 minutes as needed
- The goal is adequate breathing, not full wakefulness
- No pulse: start CPR and use the AED
- Monitor for hours, since naloxone wears off before many opioids; offer opioid use disorder treatment and a naloxone kit
Red flags
- No breathing or no pulse
- Sedation returns as naloxone wears off
- Vomiting with risk of aspiration
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCSBN 2026 NCLEX-RN Test Plan; NASEMSO National Model EMS Clinical Guidelines; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.