An 76-year-old male with a history of back problems responds only to painful stimuli. His skin is pale and diaphoretic. Vital signs are P 56, R 6 and shallow, pupils are constricted. What should you administer ?

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Opioid overdose with respiratory depression is being addressed. The presentation—lethargy responding only to painful stimuli, shallow respirations, bradycardia, constricted pupils, and diaphoretic skin in a patient likely using opioid analgesics—fits opioid toxicity. The best treatment is naloxone, an antagonist that competes for mu-receptor sites and rapidly reverses CNS and respiratory depression caused by opioids. Administering naloxone will quickly improve breathing and responsiveness. It can be given by intramuscular or intranasal routes in the field, with repeated dosing if needed due to longer-acting opioids. After reversal, monitor closely for re-narcotization and maintain oxygenation; oxygen helps, but it doesn’t fix the underlying cause. Epinephrine and glucose aren’t indicated here given the opioid overdose presentation.