Opioids

Problem 1

A 25-year-old man is found by the ambulance cyanosed but with a detectable pulse. A needle and syringe are on the ground beside him; he has numerous track marks.
He is given assisted ventilation with a bag and mask and given 2 mgs of naloxone he becomes aggressive, spits at the ambulance personnel, and runs away.

What are the possible causes for his behaviour?
What route should naloxone be administered?
What are the risks in allowing him to leave?
If he is caught and brought to hospital how long would he need to be observed and what clinical assessment is required to clear him for discharge?

Problem 2

A 25-year-old man is found by the ambulance cyanosed but with a detectable pulse. A needle and syringe are on the ground beside him; he has numerous track marks.
He is given assisted ventilation with a bag and mask and given 2 mgs of naloxone. His respiratory rate appears to improve but he does not wake.

What is your differential for his lack of response?
Should he receive more naloxone and if so what dose?

He is noted to have a swollen buttock and a foot drop. His urine is dark. His CPK is 80 000.

What’s going on and what are you going to do?
What does this imply about his initial presentation?

Problem 3

A 31-year-old man is found by the ambulance cyanosed but with a detectable pulse. A needle and syringe are on the ground beside him; he has numerous track marks.
He is given assisted ventilation with a bag and mask and given 2 mgs of naloxone. He becomes aggressive, begins sweating profusely and refuses to lie down on the ambulance stretcher.
On arrival at hospital he is confused, tachypnoeic and is cyanosed.