In a cyanotic infant with pinpoint pupils who has just begun ventilation, what is the most appropriate immediate action?

• A. Administer naloxone
• B. Begin chest compressions
• C. Check blood pressure
• D. Call for advanced life support

Answer: (A)

Opioid overdose is suggested by the combination of cyanosis and pinpoint pupils in a patient with respiratory depression who has just started ventilation. Naloxone is an opioid receptor antagonist that rapidly displaces the opioid from mu receptors, reversing respiratory depression and restoring ventilatory drive. Because the infant’s ventilation is already underway, giving naloxone now directly tackles the reversible cause and often improves oxygenation within minutes.

administer naloxone with weight-based dosing (for example, 0.1 mg/kg IV/IO/IM, repeat every 2–3 minutes if needed, up to a safe total). If IV access isn’t available, IM or intranasal routes are acceptable alternatives. Monitor for re-sedation or recurrence of respiratory depression, since some opioids may outlast a single dose of naloxone and additional doses could be required.

Chest compressions would be indicated only if there is no pulse, and calling for advanced life support is important but does not address the immediate reversible cause in this scenario.