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Lesson

Opioid-Associated Cardiac Arrest

10 min Cardiac & ECG Skip to quiz

Objective: If they have no pulse, start CPR first. Give naloxone only if it does not stop compressions. A pulse with no breathing is a ventilation problem: bag first, then give naloxone.

Why this matters

Do not give naloxone and then stand and watch. If there is no pulse, start CPR first. Naloxone must not stop compressions. If there is a pulse and no breathing, that is a ventilation problem. Bag first, then give naloxone.

Clinical sequence

  1. If there is no pulse and no breathing, start CPR and defibrillate if the rhythm is shockable. Someone can prepare naloxone without stopping the compressor.
  2. If there is a pulse, this is respiratory arrest, not cardiac arrest. Bag an adult at about 10 breaths a minute, then give naloxone per protocol.
  3. More than one drug is common. Naloxone will not fix benzodiazepine or alcohol apnea by itself. Keep bagging if they do not breathe.
  4. After ROSC, they may need more naloxone. ROSC means pulses are back. Watch the airway. Agitation from withdrawal is a new problem. Plan for it.

Teaching points

  • Naloxone is for suspected opioid respiratory arrest. In cardiac arrest, give it only if CPR is not interrupted.
  • Scene safety follows your service policy. Wear gloves. Do not skip CPR for a long decontamination delay.
  • Refusal after reversal is a capacity and protocol problem. See the naloxone lesson.

Common errors

  • Giving naloxone instead of starting CPR on a pulseless patient.
  • Calling every overdose an arrest when there is a pulse.
  • Skipping the bag because “naloxone will wake them.”

Practice

One-minute check

Partner: respiratory rate 0, no pulse, and track marks. Say the first 15 seconds, including when naloxone happens.

Related: Naloxone, Respiratory arrest.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. A pulseless patient with a suspected opioid overdose should get:
2. Pulse present, not breathing, opioid picture — what is first?
3. Naloxone in cardiac arrest is:
4. After they gasp and fight, you should:
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