T40.2 + (X42.99/X62.99/Y12.99)
DESCRIPTION
Patients present with the triad of CNS depression, respiratory depression and constricted pupils. Non-cardiogenic pulmonary oedema can occur.
GENERAL MEASURES
Supportive management aimed at maintaining cardiorespiratory function.
Body packers/stuffers:
- Patients may ingest packages of heroin, and are at great risk of life-threatening toxicity in the event of rupture.
- Abdominal X-rays or CT scan may show packages.
- Conservative management is recommended, as any attempt at removal risks package rupture.
- Activated charcoal and whole bowel irrigation may aid in expelling packets.
- Surgery is reserved for those who develop obstruction or perforation.
MEDICINE TREATMENT
- Naloxone, IV, 0.4 mg immediately, in patients with significant respiratory depression.
- Effectiveness is limited by a half-life (± 1 hour) that is shorter than most opioids; therefore repeated incremental doses may be needed at 2 to 3 minute intervals, followed by a naloxone infusion.
- If there is no response after a maximum of 10 mg of naloxone is administered, the diagnosis of opioid-induced or partial opioid-induced toxicity should be questioned.
- Consider intramuscular or subcutaneous administration, if the intravenous route is not available.
- Note: Clinical response is measured by reversal of respiratory depression, as the level of CNS depression improves. Continuous monitoring is required for all patients who received naloxone.