A 22-year-old man is brought to the emergency department after a heroin overdose. He is given intravenous naloxone and regains consciousness. After 40 minutes, he becomes obtunded again with a respiratory rate of 6/min. What is the most appropriate next step?
- A Start a naloxone infusion ✓
- B Administer flumazenil
- C Give activated charcoal
- D Perform rapid sequence intubation
Correct answer: A. Start a naloxone infusion
Explanation
Naloxone has a shorter half-life (30-80 minutes) than most opioids, so rebound respiratory depression can occur after initial reversal. The appropriate management is a continuous naloxone infusion titrated to respiratory rate. Flumazenil is for benzodiazepine overdose, charcoal is not useful for IV overdose, and intubation is unnecessary if naloxone can be continued.
Reference: Harrison's Principles of Internal Medicine, 20th ed.
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Written and medically reviewed by the StethoPrep medical team.