Medical

Opioid overdose / aspiration risk

Before / During / After / Pitfalls

Before

• Treat reversible hypoventilation first when safe: oxygen, BVM, naloxone per protocol, suction ready.
• Assess aspiration/emesis risk and airway protective reflexes.
• Prepare intubation if ventilation, oxygenation, or protection remain inadequate.

During

• Suction and preoxygenate; expect vomit/secretions.
• Use standard confirmation and avoid anchoring on overdose alone.
• Assign post-tube sedation/analgesia even if patient was initially obtunded.

After

• Treat aspiration pneumonitis/pneumonia risk as clinically indicated.
• Reassess ventilation, EtCO2, and acid-base status.
• Continue tox workup and recurrent opioid toxicity monitoring.

Pitfalls

• Delaying BVM because naloxone is coming.
• No suction plan.
• No sedation after paralysis as mental status improves.