Acute onset, Respiratory Arrest and Pinpoint Pupils


• Airway – BVM
• Airway – Nasopharyngeal
• Naloxone – 1mg Intranasal
• Airway – Capnography
• Naloxone – 1mg Intranasal
• Airway – Nasopharyngeal
• Blood Glucose Analysis 176
• IV
• Naloxone – 2mg IV
• 12 Lead EKG – Sinus Rhythm, No ST Elevation


Dennis Russell, M.Ed, ATC, CSCS, NRP, CP Paramedic United Ambulance, Lewiston, Maine
John Whittier, EMT-P, I/C United Training Center


Merlin Curry, MD Paramedic University of Arizona


• Heroin overdose
• Narcotic overdose
• Respiratory arrest

Differential Diagnosis

• Narcotic overdose
• Head trauma
• Myocardial infarction
• Stroke/CVA

Key Points

• Airway manager needs to upgrade his PPE
• Do a brief airway exam and head-to-toe survey, even if other providers are on-scene before you
• Always check blood sugar
• This case is a review of good BVM technique

Editor’s Notes

• Teaching Points:
• Great use of BVM
• Use of EtCO2 even with face-mask ventilations, great idea. Nasal cannula EtCO2 would work as well.
• LMA or King may be considered for prolonged (>5 min) of PPV.
• Consider reasons why we do not intubate this type of patient (quickly reversible cause).
• Consider giving naloxone IM as soon as narcotics are suspected.
• Good use of mucosal atomizers.
• Demonstrates why relying on IV medication administration is frustrating, some times getting an IV is just difficult.


• Gender: Male
• Age: 30 years
|• Height: N/A
• Weight: 160 lb/72.6 kg


• Temperature: N/A
• Blood Pressure: 127/65
• Heart Rate: 87
• Respiratory Rate: N/A
• Pulse Oximetry: 99%

Signs and Symptoms

Adult male found unconscious at scene with agonal respirations; no needle marks.


• None available upon arrival

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