Case 2

You are a first year SHO on a night shift in the ED. You hear a CNM taking a pre-alert from the ambulance team. They are advising that a man in his 40s year is in respiratory arrest after being found unconscious on the quays with drug paraphernalia in his vicinity. The ambulance is 2 minutes away. With your nurses and registrar, you prepare for their arrival in resus.

On arrival you notice the patient is being ‘bagged’ by a paramedic. He is making little respiratory effort and he is centrally cyanosed. His respiration is only 6 breaths per minute, and he has a weak pulse of around 50 beats per minute. You note that he has fresh needle marks on his arms and the paramedic informs you that the needle was still in his hand when he was found.  His GCS is 3 - E1, V1, M1.

Your registrar asks the resus nurse to administer naloxone while he continues to assess the patient. Within a few minutes the respiration rate increases to 10, his O2 sats are 92 and climbing, his HR is 90 and BP 100/60, and patients GCS improved to 9, E2, V3, M4

Question 1

What is a likely drug that this patient overdosed on?

Questions 2

How long should you observe a patient after administering naloxone?

Question 3

What bedside test can help conform your diagnosis?

Question 4

What radiological investigations should you consider?