All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.
Overdose: Opioid Analgesics
  1. Altered consciousness
  2. Respiratory depression
  3. Constricted pupils - miosis


Management of opioid overdose:

  1. Terminate dental treatment.
  2. Position the patient.
  3. A-B-C Airway, Breathing, Circulation - Basic life support.
  4. Definitive Care:
    1. Get medical assistance, if needed.
    2. Administer oxygen
    3. Monitor vital signs
    4. Establish IV line, if possible
    5. Administer Naloxone
      • IV - Adult - Dilute 1 ml ampule (0.4 mg) with 3 ml any IV fluid, administer 1 ml/min until ventilation rate and alertness increase acts within 1-2 minutes
      • IM - Adult - Inject 1 ml intra-muscular or sub-lingual, acts within 10 minutes
  5. Permit recovery. Dental treatment may resume, or must remain under constant supervision for 1 hour.
  6. Discharge: May require transport to hospital for observation, but in most cases hospitalization is not necessary.

Source: Sedation, A Guide to Patient Management by Stanley F. Malamed