Case: 32-year-old male brought in by EMS for altered mental status, breathing six breaths per minute. You suspect opioid overdose, what clues you in to the culprit?
1) ECG shows prolonged QTC –>
2) ECG shows widened QRS –>
3) Patient has a seizure while in the department –>
1) ECG shows prolonged QTc –> methadone
2) ECG shows widened QRS –> propoxyphene (Darvocet): Na-channel effect similar to Type IA antiarrhythmics
3) Patient has a seizure while in the department –> meperidine, tramadol
Inspired by toxicologist Dr. Ruben Olmedo
Stolbach A, Hoffman RS. “Acute opioid intoxication in adults.” Uptodate. Apr 2014.