Episode Notes

Respiratory rescue is the moment when a patient who was stable minutes ago suddenly isn’t breathing. The key isn’t panic—it’s pattern recognition. This episode teaches you how to identify the cause of respiratory depression so you can treat the physiology, not just the symptom.

Key clues

Bradypnea (low respiratory rate)

Sedation

Pinpoint pupils

Mechanism
Opioids suppress the brainstem’s carbon dioxide drive by binding to mu receptors.

Antidote

Naloxone

Nursing trap

Naloxone wears off before many opioids

Risk of resedation

Risk of acute pain, withdrawal, agitation, and flash pulmonary edema

Clinical pearl

Wake them up enough to breathe—not enough to fight.

Key clues

Loss of deep tendon reflexes (first sign)

Normal pupils

Later: respiratory depression

Decreasing urine output

Why reflexes matter
Loss of patellar reflexes signals rising neuromuscular blockade before breathing fails.

Antidote

Calcium gluconate (given slowly)

Critical safety point
Calcium gluconate does not remove magnesium—it buys time while the kidneys clear it.

The problem
Patients can appear awake but still be paralyzed after anesthesia.

Old reversal

Neostigmine

Slow onset

Causes bradycardia, bronchospasm, and secretions

Requires atropine or glycopyrrolate

Modern reversal

Sugammadex

Encapsulates rocuronium directly

Rapid reversal

Fewer cardiopulmonary side effects

Nursing takeaway
Know which reversal agent was used—your monitoring priorities change.

An antidote doesn’t fix the problem—it buys time.

Naloxone wears off

Magnesium is still in the body

Paralytics can re-emerge

You didn’t save the day—you saved the minute. Now save the hour.

Bedside nurses

ICU, OB, PACU, and med-surg nurses

New grads building clinical judgment

Nursing students preparing for boards

Anyone who wants to think like a nurse, not just follow orders

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