Opioid Overdose

Scenario:
Opioid Overdose
Contributed by ALIM NAGJI on August 24, 2020, last updated on May 13, 2021.
Language:
English
Author(s):
  • First Name: 
    Stephanie
    Last Name: 
    Mokrycke
    Credentials/degrees: 
    MD
    Organization: 
    McMaster University
  • First Name: 
    Alim
    Last Name: 
    Nagji
    Credentials/degrees: 
    MD CCFP-EM DRCPSC
    Organization: 
    McMaster University

Goals & Objectives

Brief Summary of Case:

The team is called to manage an unresponsive man with respiratory depression. The initial assessment involves rapidly evaluating potential causes for altered mental status, including hypoglycemia, hypoxia, and intoxication. Initial management of hypoglycemia and airway support does not improve the patient’s mental status. The team must recognize opioid toxidrome and administer naloxone. The patient will require multiple doses of naloxone to achieve adequate response. He will emerge in precipitated withdrawal, and try to leave AMA. The team will discuss disposition for this patient.

Learning Objectives:

CRM Objectives:

  1. Work with the team to correctly identify and carry out priorities of airway support and prompt administration of naloxone in opioid overdose,
  2. Demonstrate high-quality communication when there are findings (hypoglycemia, fentanyl patch) and changes in patient status occur in response to treatment provided (glucose, naloxone response).

Medical Objectives:

  1. Develop an organized initial approach to the unresponsive patient, including obtaining blood glucose early in the assessment,
  2. Recognize the key features of opioid toxicity, namely respiratory depression, altered level of consciousness, and miosis,
  3. Demonstrate initial airway management in the apneic patient,
  4. Understand the role of naloxone in opioid overdose, dose appropriately,
  5. Manage hypoglycemia in opioid overdose,
  6. Discuss precipitated opioid withdrawal and disposition (at debrief).  
Targeted competencies:

Details

Setting:
Critical care unit, Emergency room, Hospital ward, Outpatient clinic / family care practice
Simulation modality:
Manikin (high sophistication), Manikin (mid/low sophistication), Standardized/simulated patients or real patients
Evaluation/validation:

Have run this several times at Joseph Brant Hospital. This simulation works really well for non-traditional critical care areas - for example having the patient deteroirate in an outpatient clinic, mental health area or diagnostic imaging. This will help uncover potential latent safety threats in the environment. 

Peer Review Status:
None

Sharing

CITATION

Mokrycke 
S
 Opioid Overdose. Simulation resource published by Simulation Canada; 2021. Available from http://www.sim-one.ca/scenario/opioid-overdose.
Nagji 
A
 Opioid Overdose. Simulation resource published by Simulation Canada; 2021. Available from http://www.sim-one.ca/scenario/opioid-overdose.
License: Download and use of this resource is subject to these terms.
Authors interested in research collaboration?
Yes
What type of resource do you want to submit?: 
Scenario
How would you like to submit your resource?: 
I will upload files
Your Title: 
Director, Simulation Learning Joseph Brant Hospital
Language: 
English
Author(s): 
First Name: 
Stephanie
Last Name: 
Mokrycke
Credentials/degrees: 
MD
Organization: 
McMaster University
First Name: 
Alim
Last Name: 
Nagji
Credentials/degrees: 
MD CCFP-EM DRCPSC
Organization: 
McMaster University
Authored Date: 
Saturday, December 1, 2018
Interprofessional: 
No
Target learners: Profession(s): 
  • Medicine
Target learners: Level(s): 
Undergraduate / post-secondary
Graduate / postgraduate / residency
Continuing professional development
Healthcare field(s): 
Emergency / trauma
Brief Summary: 

The team is called to manage an unresponsive man with respiratory depression. The initial assessment involves rapidly evaluating potential causes for altered mental status, including hypoglycemia, hypoxia, and intoxication. Initial management of hypoglycemia and airway support does not improve the patient’s mental status. The team must recognize opioid toxidrome and administer naloxone. The patient will require multiple doses of naloxone to achieve adequate response. He will emerge in precipitated withdrawal, and try to leave AMA. The team will discuss disposition for this patient.

Simulation modality(ies): 
  • Manikin (high sophistication)
  • Manikin (mid/low sophistication)
  • Standardized/simulated patients or real patients
Minimum: 
1
Maximum: 
3
Pilot Testing / Revisions: 

Have run this several times at Joseph Brant Hospital. This simulation works really well for non-traditional critical care areas - for example having the patient deteroirate in an outpatient clinic, mental health area or diagnostic imaging. This will help uncover potential latent safety threats in the environment. 

Development time: 
10
Research Collaboration: 
Yes
Documents: 
Peer Review: 
No
Targeted competencies: 
Setting: 
Critical care unit
Emergency room
Hospital ward
Outpatient clinic / family care practice
Learning Objectives: 

CRM Objectives:

  1. Work with the team to correctly identify and carry out priorities of airway support and prompt administration of naloxone in opioid overdose,
  2. Demonstrate high-quality communication when there are findings (hypoglycemia, fentanyl patch) and changes in patient status occur in response to treatment provided (glucose, naloxone response).

Medical Objectives:

  1. Develop an organized initial approach to the unresponsive patient, including obtaining blood glucose early in the assessment,
  2. Recognize the key features of opioid toxicity, namely respiratory depression, altered level of consciousness, and miosis,
  3. Demonstrate initial airway management in the apneic patient,
  4. Understand the role of naloxone in opioid overdose, dose appropriately,
  5. Manage hypoglycemia in opioid overdose,
  6. Discuss precipitated opioid withdrawal and disposition (at debrief).