Basic Life Support (BLS) protocols are the standard sequence of actions taken in an emergency, typically designed to address cardiac arrest. In a suspected opioid overdose, the mechanism of injury is fundamentally different, requiring modification of the standard response. Opioids are central nervous system depressants that cause death primarily through severe respiratory depression, meaning the person stops breathing before the heart stops beating. While the core principles of BLS—maintaining circulation and oxygenation—remain the foundation, the immediate priorities must shift to reflect this primary respiratory failure. The approach must integrate manual breathing support with the use of a specific medication to counteract the drug’s effects.
Recognizing the Opioid Emergency
Identifying an opioid overdose directs the rescuer toward specialized BLS modifications. The most telling sign is a person who is unresponsive and exhibits severely depressed or absent breathing. Unlike a sudden cardiac event, the victim’s breathing becomes extremely slow, shallow, or stops entirely, often accompanied by soft, gurgling sounds or snoring.
Another observable physical sign is miosis, or pinpoint pupils. The lack of oxygen often causes the skin, especially the lips and fingernails, to take on a bluish or grayish tint, known as cyanosis. Recognizing these signs—unresponsiveness, respiratory failure, and pinpoint pupils—suggests the immediate need is to restore oxygen.
Prioritizing Airway and Breathing
The primary goal in an opioid emergency is to overcome respiratory depression by prioritizing A (Airway) and B (Breathing) over the standard C-A-B sequence. Since opioid toxicity causes the brain to stop sending signals to breathe, manual ventilation, or rescue breathing, is the most immediate life-saving intervention. This is crucial if the person has a pulse but is not breathing adequately, as the heart may still be functioning.
The recommended frequency for rescue breathing is one breath every five to six seconds, equating to 10 to 12 breaths per minute. Each breath should be delivered slowly over one second, just enough to make the chest rise visibly. This controlled delivery ensures the lungs receive oxygenated air without forcing too much air into the stomach.
If the rescuer is unsure whether a pulse is present or if the victim is not breathing at all, the standard approach of starting chest compressions (CPR) should be initiated. However, for a suspected opioid overdose where a pulse is felt, the focus must remain on ventilations. This manual respiratory support delivers oxygen and buys time while waiting for a counter-agent to take effect. If no pulse is detected, the full cycle of 30 compressions followed by two breaths (CPR) is required until emergency medical services arrive.
Integrating Naloxone Use
Naloxone is an opioid antagonist medication designed to rapidly reverse the effects of an overdose. It works by competing with opioid molecules for receptor sites in the central nervous system, displacing the opioid and restoring normal respiratory function. This medication is a time-sensitive adjunct to BLS, not a replacement for manual breathing support.
Naloxone should be administered as soon as it is available, typically while rescue breathing is being performed or immediately following the call to 911. It is available in two primary formats for non-medical personnel: an intranasal spray or an intramuscular injection. The intranasal spray is preferred for lay rescuers due to its ease of use, with a common dose being 2 milligrams delivered into one or both nostrils.
If the person does not show signs of improvement, such as increased responsiveness or restored breathing, within two to four minutes, a second dose of naloxone should be administered. Naloxone has a relatively short half-life, lasting only 30 to 90 minutes, which is often shorter than the duration of the opioids in the person’s system. Therefore, continuous monitoring and continued breathing support are necessary even after administration.
Post-Intervention Steps and Monitoring
Once naloxone has been administered, or if rescue breathing has restored spontaneous respiration, the person requires continuous monitoring. If the person begins breathing normally but remains unconscious, they should be carefully placed in the recovery position. This position, typically lying on the side with the top leg bent, helps keep the airway open and reduces the risk of aspiration.
It is necessary to stay with the person until emergency medical services (EMS) arrive, even if they appear to have fully recovered and are awake. The short duration of naloxone’s effect means the person can relapse into respiratory depression once the medication wears off. Providing a thorough report to EMS, including the number of naloxone doses and the exact time of administration, is necessary for continued treatment.
Professional medical evaluation is required after an overdose reversal to ensure the person is stable and to address any underlying issues. Continued observation in a medical setting, often for several hours, is a standard precaution to monitor for the return of respiratory depression.