SIM Scenario Exchange

Opioid Overdose

Contributed on May 13, 2021, last updated July 14, 2022.



Stephanie Mokrycke, MD , McMaster University
Alim Nagji, MD CCFP-EM DRCPSC, McMaster University

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The team is called to manage an unresponsive man with respiratory depression. The initial assessment involves rapidly evaluating potential causes for altered mental status, including hypoglycemia, hypoxia, and intoxication. Initial management of hypoglycemia and airway support does not improve the patient’s mental status. The team must recognize opioid toxidrome and administer naloxone. The patient will require multiple doses of naloxone to achieve adequate response. He will emerge in precipitated withdrawal, and try to leave AMA. The team will discuss disposition for this patient.

Learning Objectives:

CRM Objectives:

Work with the team to correctly identify and carry out priorities of airway support and prompt administration of naloxone in opioid overdose,
Demonstrate high-quality communication when there are findings (hypoglycemia, fentanyl patch) and changes in patient status occur in response to treatment provided (glucose, naloxone response).

Medical Objectives:

Develop an organized initial approach to the unresponsive patient, including obtaining blood glucose early in the assessment,
Recognize the key features of opioid toxicity, namely respiratory depression, altered level of consciousness, and miosis,
Demonstrate initial airway management in the apneic patient,
Understand the role of naloxone in opioid overdose, dose appropriately,
Manage hypoglycemia in opioid overdose,
Discuss precipitated opioid withdrawal and disposition (at debrief).

Simulation Modality:

Manikin-based, Standardized/simulated patients or real patients


Have run this several times at Joseph Brant Hospital. This simulation works really well for non-traditional critical care areas – for example having the patient deteroirate in an outpatient clinic, mental health area or diagnostic imaging. This will help uncover potential latent safety threats in the environment.


Mokrycke S, Nagji A. Opioid Overdose. Simulation resource published by Simulation Canada; 2021. Available from

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Target Learners






Continuing professional development
Graduate / postgraduate / residency
Undergraduate / post-secondary

Fields / Disciplines:

Emergency / trauma

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