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Cant stay awake fentanyl8/27/2023 ![]() ![]() (In a supervised consumption setting where there are limited resources and the client has responded to the intervention, further details and toxicology are not usually obtained and hence were not available for this case report.)įentanyl-induced muscle rigidity was diagnosed. The analyzed sample was found to contain fentanyl (N-(1-phenethyl-4-piperidyl) propionanilide), but cocaine, methamphetamine, other opioids or fentanyl analogues were not detected. The cooker the patient had used to prepare his drugs was transported to Health Canada’s Drug Analysis Service by a member of the Vancouver Police Department. He reported that he had injected a mixture of heroin and methadone from a new supplier. The patient fully recovered without any apparent sequelae. Within six minutes, his rigidity had fully subsided, with relaxed arms and neck, he opened his eyes when spoken to and he was breathing spontaneously at a rate of eight breaths/min. His saturation had improved to 100%, and he began to take respirations with stimulation. Two minutes following naloxone administration, it became easier to ventilate the patient and to position his airway. His oxygen saturation was 84%, and his heart rate was 92 beats/min with a strong carotid pulse. Artificial respirations were initiated with a bag valve mask on 25 L/min of oxygen, providing partial ventilation, and 0.4 mg of naloxone was administered subcutaneously. He was cyanotic, had a rigid chest and was not spontaneously breathing. ![]() Shortly after injection, he was found by nursing staff seated with elbows flexed, fists clenched, and neck flexed and stiff his eyes were open, but he was unresponsive to verbal stimuli or sternal rub. In the community, naloxone 0.4 mg intramuscularly should be administered immediately if no response occurs, additional doses of intramuscular naloxone should be given at two-minute intervals.Ī 52-year-old man injected a mixture of opioids intravenously at Insite, a supervised consumption facility in Vancouver. ![]()
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