What is a common pediatric poisoning scenario that can cause arrest, and how is it treated?

• A. Batteries ingestion; monitor and observe
• B. Acetaminophen overdose; administer N-acetylcysteine
• C. Opioid overdose; administer naloxone 0.1 mg/kg IV/IO, repeat as needed up to maximum total dose; ensure supportive ventilation
• D. Insulin overdose; administer glucagon

Answer: (C)

Opioid overdose is a common pediatric poisoning scenario that can precipitate arrest because opioids depress the brainstem’s drive to breathe, leading to severe hypoxia that can progress to cardiac arrest if not quickly reversed. The treatment is naloxone, a competitive antagonist at opioid receptors. In a child with suspected opioid-induced respiratory depression or arrest, administer naloxone 0.1 mg/kg IV or IO and repeat as needed, up to the maximum total dose per protocol, while simultaneously providing supportive ventilation with bag-mask ventilation and oxygen (and progress to advanced airway as needed). Because naloxone’s effect can wear off before longer-acting opioids have cleared, monitor closely for re-sedation and be prepared to give additional doses or an infusion if necessary. Other listed scenarios involve different antidotes or management strategies—batteries require urgent assessment for injury, acetaminophen overdose is treated with N-acetylcysteine, and insulin overdose is treated with glucagon—so reversing opioid-induced respiratory depression remains the most direct and commonly encountered approach to arrest in this context.