Code 3 Workshop

Paramedic Education
Home/All lessons/Cardiac & ECG/Opioid-Associated Cardiac Arrest
Lesson

Opioid-Associated Cardiac Arrest

10 min Cardiac & ECG Skip to quiz

Objective: Do not let naloxone delay CPR in pulseless opioid arrest — bag and compress first, antagonist second if it does not steal the pause.

Why This Is Hard

Everyone wants to spray naloxone and watch. AHA 2025: if they are in cardiac arrest, CPR comes first. An opioid antagonist may be reasonable if it does not interrupt high-quality CPR. Respiratory arrest with a pulse is bag-then-naloxone.

On this truck
  • If no pulse and no breathing: CPR and defibrillation as indicated. Someone can prepare naloxone without stopping the compressor.
  • If there is a pulse: that is the respiratory-arrest lesson — bag at 10/min adult.
  • Polysubstance is common. Naloxone will not fix a benzo/alcohol apnea by itself.

Field Rules (Education)

  • AHA 2025 Part 10: opioid antagonist for suspected opioid respiratory arrest. In cardiac arrest, antagonist may be reasonable if CPR is not interrupted.
  • After ROSC they may need more naloxone. Watch the airway. Withdrawal agitation is a new problem — plan it.
  • Scene safety per service policy. Do not skip gloves for folklore powder panic, and do not skip CPR for decon theater.
  • Refusal after reversal is a capacity/protocol problem. See naloxone lesson.

Field Pitfalls

  • Spraying naloxone instead of starting CPR on a pulseless patient.
  • Calling every OD “arrest” when there is a pulse.
  • No BVM because “naloxone will wake them.”

Practice

60-second drill

Partner: RR 0, no pulse, track marks. 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

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

1. Pulseless suspected opioid OD:
2. Pulse present, not breathing, opioid picture:
3. Naloxone in cardiac arrest is:
4. After they gasp and fight:
← Cardiac Arrest in Pregnancy Cardiogenic Shock in the Field →