A young man is found drowsy in the hospital corridor with respiratory rate 5 per minute, pinpoint pupils, and a palpable strong radial pulse. The MOST appropriate immediate intervention is:

• A Start chest compressions immediately
• B Flumazenil 0.2 mg IV push
• C Immediate endotracheal intubation before any drug
• D Naloxone intramuscularly or intranasally with bag-mask ventilation ✓

Explanation

The presence of a pulse means this is respiratory failure from opioid toxicity, not cardiac arrest, so compressions are not indicated. Naloxone by intramuscular or intranasal route with supported ventilation is the definitive early treatment and can be repeated or infused. Flumazenil is the benzodiazepine antagonist and risks precipitating seizures in chronic users. Intubation may be needed later, but naloxone often obviates it and should not delay reversal of the cause.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.