A 17-year-old man presents after being found unresponsive in his apartment. He was given naloxone intranasally
A 17-year-old man presents after being found unresponsive in his apartment. He was given naloxone intranasally in the field with no change in his respiratory or mental status. Vital signs are temperature 37° C (98.6° F), blood pressure 95/60 mm Hg, heart rate 102 bpm, respiratory rate 12 breaths/min, and SpO2 88% on room air. Physical examination demonstrates no signs of trauma. Neurological examination shows a sedated appearance, pinpoint pupils, and bradypnea. Shortly after arrival, the patient’s respiratory status worsens and ventilation and oxygenation are supported with a bag-mask-valve. He receives 4 mg naloxone IV and within a minute his respiratory status improves but he remains sedated. A repeat intravenous dose of naloxone is administered and the patient wakes up. After 10 minutes, the patient’s oxygen saturation is 89% and he develops tachypnea with pulmonary rales diffusely throughout both lung fields. What is the reason for this patient’s decompensated respiratory status? A. Undiagnosed trauma B. Sympathomimetic overdrive C. CNS depression D. Fentanyl-induced pulmonary edema
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