Objective: To inform doctors of potential hazards if opioids are administered in excessive doses to patients with acute pulmonary oedema.
Clinical features: Three elderly patients were unresponsive and hypotensive on arrival in the emergency department. All had received morphine parenterally as a component of prehospital treatment for acute pulmonary oedema.
Interventions and outcome: All were given naloxone intravenously, regained consciousness and had a rise in blood pressure.
Conclusion: Parenteral administration of opioids should be used with caution in acute pulmonary oedema. The authors present a protocol for prehospital drug therapy.