Emergency Cases Northwest Group

030 Naloxgroan

Situation

Comatose patient responded to naloxone. But he had a SAH.

Background

51 year old man collapsed at work. Arrived to ED with iGel, GCS 8 and pre-hospital consultant. Suspected opiate OD, some improvement in GCS after naloxone en route. Family baffled when asked about any drug use. Intubated, CT head showed massive sub-arachnoid haemorrhage.

Assessment

His collapse had nothing to do with opiates. It was a SAH. The naloxone simply agitated the patient giving the false impression of improving his GCS after administration.

Recommendation

If you suspect opioid OD, give naloxone and if the GCS jumps to 15/15; the diagnosis is probably correct!

However if the patient simply groans or moves a bit more be aware that naloxone can cause agitation in non-opioid patients. In this situation yes it may still be from an OD but exclude other causes as well.

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group