====== Table of Contents ======
[[#Opioids|Opioids]][[#Opioids-Problem 1|Problem 1]][[#Opioids-Problem 2|Problem 2]][[#Opioids-Problem 3|Problem 3]][[#Opioids-Problem 4|Problem 4]]
====== Opioids ======
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===== Problem 1 =====
\\  A 25-year-old man is found by the ambulance cyanosed but with a detectable pulse. A needle and syringe are on the ground beside him; he has numerous track marks.\\  He is given assisted ventilation with a bag and mask and given 2 mgs of naloxone he becomes aggressive, spits at the ambulance personnel, and runs away.\\ 

  - What are the possible causes for his behaviour?
  - What route should naloxone be administered?
  - What are the risks in allowing him to leave?
  - If he is caught and brought to hospital how long would he need to be observed and what clinical assessment is required to clear him for discharge?
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===== Problem 2 =====
\\  A 25-year-old man is found by the ambulance cyanosed but with a detectable pulse. A needle and syringe are on the ground beside him; he has numerous track marks.\\  He is given assisted ventilation with a bag and mask and given 2 mgs of naloxone. His respiratory rate appears to improve but he does not wake.\\ 

  - What is your differential for his lack of response?
  - Should he receive more naloxone and if so what dose?
He is noted to have a swollen buttock and a foot drop. His urine is dark. His CPK is 80 000.\\ 

  - What’s going on and what are you going to do?
  - What does this imply about his initial presentation?
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===== Problem 3 =====
\\  A 31-year-old man is found by the ambulance cyanosed but with a detectable pulse. A needle and syringe are on the ground beside him; he has numerous track marks.\\  He is given assisted ventilation with a bag and mask and given 2 mgs of naloxone. He becomes aggressive, begins sweating profusely and refuses to lie down on the ambulance stretcher.\\  On arrival at hospital he is confused, tachypnoeic and is cyanosed.\\ 

  - What are the possible causes for his behaviour?
  - What treatments options are there to resolve his cyanosis?
  - What complications are possible?
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===== **Problem 4** =====
\\ \\  A drowsy 2 year old boy is brought into an Emergency Department. His father is on suboxone (buprenorphine/naloxone) maintenance therapy. The child grabbed some tablets when his father wasn't looking and 3 tablets are unaccounted for.\\ \\ \\ 

  - Describe the pharmacokinetics of buprenorphine?
  - What is the purpose of naloxone in this combination drug?
  - What is the risk assessment for this child?
  - How would you manage this child?