You decide to immediately intubate for airway protection. ![]() She has minimal bowel sounds and is hypo-reflexive. On arrival, you examine the patient and find her to be unresponsive to noxious stimuli, with pupils fixed at 4 mm bilaterally. Prior to Emergency Department (ED) arrival, she’s received 2 mg of naloxone with no effect. Emergency Medical Services (EMS) reports she was found in a parking garage unresponsive with an empty bottle of co-formulated acetaminophen/diphenhydramine (Tylenol PM). A 54 year old female presents to your emergency department via ambulance with chalky white residue around her mouth, hypotensive with a systolic blood pressure in the 80’s, and with a GCS of 4.
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