Acute & emergency · UKMLA & AKT
Opioid overdose
A free high-yield preview for the UKMLA Applied Knowledge Test, covering how to recognise this condition. The full SA Note notes add investigations, management and complications, with practice questions on this topic.
Key high-yield points
- The opioid toxidrome is one of the most recognisable patterns in emergency medicine - rapid recognition is life-saving.
- Classic triad: pinpoint pupils (miosis), reduced/absent consciousness, respiratory depression
- Miosis - 1-2 mm, symmetrical; near-pathognomonic; enhanced parasympathetic tone via mu receptor activation
- Respiratory depression - reduced rate (<12 breaths/min) and/or tidal volume; can progress to apnoea; the life-threatening feature
- Reduced consciousness - drowsiness to coma
- Bradycardia, hypotension, hypothermia, decreased bowel sounds - additional features
- Cyanosis/desaturation - late sign of significant hypoventilation
If pupils are dilated - consider co-ingestion of a sympathomimetic. If pupils are asymmetrical - consider a structural intracranial cause (not opioid toxicity).
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