Case #5: When Naloxone Doesn’t Help
Author: Michael Gottlieb, MD
Peer Reviewer: Michele Zell Kanter, PharmD, DABAT
A 23-year-old male is brought to the ED by paramedics after being found unresponsive on a park bench. Upon presentation, he is lethargic with brief periods of apnea that resolve without treatment. There is no additional history from the paramedics. His fingerstick glucose was normal and he was given 2 rounds of naloxone 2mg IV en route without changes in his respiratory status. On exam, he has no signs of head trauma, his pupils are 3 mm bilaterally and reactive to light, and he is noted to have scattered bullae on his posterior lower legs. The remainder of the exam is non-focal.
Initial VS: Temp: 95.0 HR: 70 BP: 92/60 RR: 6 O2: 94% on RA
His family has been notified and will arrive in 15 minutes.
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