Step 2: Check for Signs

Signs of OVERDOSE, which often results in death if not treated, include:


  • Extreme sleepiness inability to awaken verbally or upon sternal rub

  • Breathing problems can range from slow to shallow breathing in a patient that cannot be awakened

  • Fingernails or lips turning blue/purple

  • Extremely small “pinpoint” pupils

  • Slow heartbeat and/or low blood pressure



Signs of OVERMEDICATION, which may progress to overdose, include:


  • Unusual sleepiness, drowsiness, or difficulty staying awake despite loud verbal stimulus or vigorous sternal rub

  • Mental confusion, slurred speech, intoxicated behavior

  • Slow or shallow breathing

  • Extremely small “pinpoint” pupils; although normal size pupils do not exclude opioid overdose

  • Slow heartbeat, low blood pressure

  • Difficulty waking the person from sleep 


Because opioids depress respiratory function and breathing, one telltale sign of a person in a critical medical state is the “death rattle.” If a person emits a “death rattle” — an exhaled breath with a very distinct, labored sound coming from the throat — emergency resuscitation will be necessary immediately, as it almost always is a sign that the individual is near death.

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