An unconscious young man is brought with respiratory rate of 6 per minute, pin-point pupils, and circumoral cyanosis. Needle marks are seen over both forearms. Which single intervention addresses the immediate threat to life?
- A Intravenous flumazenil
- B Intravenous physostigmine
- C Intravenous naloxone ✓
- D Gastric lavage with activated charcoal
Correct answer: C. Intravenous naloxone
Explanation
The opioid triad is coma, miosis, and respiratory depression, and respiratory depression is what kills. Naloxone, a pure mu-receptor antagonist, reverses it within minutes. Because naloxone is shorter acting than most opioids, repeated doses or infusion may be needed. Flumazenil treats benzodiazepine overdose, physostigmine treats anticholinergic poisoning, and charcoal is adjunctive and hazardous in a patient with depressed airway reflexes.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
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Written and medically reviewed by the StethoPrep medical team.