After administering Narcan for an opioid overdose, the patient begins gasping with very slow breaths. What is the next step?

• A. Assist her ventilation
• B. Administer another dose of naloxone
• C. Place her in the recovery position
• D. Administer oxygen by non-rebreather mask

Answer: (A)

The patient’s breathing is severely inadequate after naloxone, so the immediate priority is ensuring ventilation and oxygen delivery. Naloxone reverses opioid-induced respiratory depression, but it doesn’t automatically restore adequate ventilation if the patient is still hypoventilating. Gasping with very slow breaths means insufficient air exchange and risk of hypoxemia, so you must support breathing right away.

If you’re trained, use a bag-valve-mask to provide assisted ventilation with supplemental oxygen. Deliver about 10–12 breaths per minute (one breath every 5–6 seconds for an adult), ensuring a good seal and visible chest rise. Reassess frequently; continue monitoring oxygen saturation and breathing effort. After stabilizing ventilation, you can consider additional naloxone dosing if respiration remains inadequate or shows signs of re-narcotization.

Why not the other steps alone? Giving another dose of naloxone right away won’t fix the current hypoventilation and could risk re-narcotization later if the opioid effect returns. Placing the patient in the recovery position helps only when the patient is breathing adequately and protecting the airway; it won’t correct slow, inadequate breaths. Providing oxygen by a non-rebreather mask helps with oxygenation, but without sufficient ventilation, oxygen alone won’t correct the underlying hypoventilation.