Safe and Ethical Opioid Reversal in the Emergency Department

In this session, the indications for Naloxone administration in the setting of an acute opioid overdose will be discussed. Specific mention will be placed on ethical considerations, specifically in relationship to dosing. Naloxone should only be administered in the setting of inadequate ventilation in order to save a person's life. Once administered, end-tidal CO2 monitoring is the modality that should be placed, as it detects hypercarbia, as opposed to pulse oximetry which is more commonplace. Dosing will be reviewed, as often standard dosing leads to a precipitated withdrawal state, with distress for the patient and provider. Dilution of the 0.2mg naloxone to 0.02mg allows titration of the antidote to increasing ventilation, without complete CNS arousal and without the risk of precipitated withdrawal.