Podcast 998: Delayed Intubation After an Overdose

Podcast 998: Delayed Intubation After an Overdose

From Emergency Medical Minute by Emergency Medical Minute

March 16, 2026 · 3 min

About this episode

This episode discusses the findings of a study on delayed intubation after opioid overdose treatment with naloxone.

Contributor: Aaron Lessen, MD Educational Pearls: How long do we need to watch patients with a presumed overdose who were treated with naloxone in the field? A 2025 study in the Annals of Emergency Medicine took a look at this question Methods Prospective, multi-institutional cohort study Included ED patients with suspected acute opioid overdose with biologic testing to confirm substances. This paper performed a secondary analysis evaluating the risk of "delayed intubation," defined as intubation occurring >4 hours after ED arrival. Results 1,591 patients with presumed opioid overdose were included. Delayed intubation occurred in only 9 patients (0.6%). 8 of the 9 cases had non-respiratory causes contributing to intubation. Only 1 patient had respiratory-related deterioration, presenting with respiratory acidosis after receiving 6.4 mg naloxone prior to intubation. Key Takeaway Delayed respiratory deterioration requiring intubation after 4 hours of ED monitoring is extremely rare, suggesting prolonged monitoring may not be necessary for most stabilized overdose patients. How else can we mitigate risk? Give patients take-home naloxone at discharge and educate them on how to use it…

People in this episode

Guest: Aaron Lessen, MD

Topics covered

  • overdose
  • intubation
  • naloxone
  • emergency medicine
  • patient monitoring

Keywords

  • overdose
  • naloxone
  • intubation
  • emergency department
  • respiratory acidosis
  • opioid

Mentioned in this episode

Organizations: Annals of Emergency Medicine

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