An unresponsive 17-year-old female is gasping and cyanotic. What is the likely cause?

In the case of an unresponsive 17-year-old female who is gasping and cyanotic, the presence of gasping respiration (often described as agonal breathing) and cyanosis strongly suggests inadequate ventilation and oxygenation. This scenario is commonly associated with opioid agonist use.

Opioids can depress the central nervous system, leading to respiratory depression and inadequate breathing. In this instance, the patient may be unable to maintain an adequate airway or breathing pattern due to the effects of the opioids, which results in the observed gasping and cyanosis from decreased oxygen levels in the blood.

While respiratory failure and respiratory distress could certainly present similar symptoms, the context of opioid use is especially critical since it points to a specific cause of the respiratory depression. Pulmonary embolism could also cause respiratory distress and cyanosis, but it typically manifests with additional signs such as sudden onset of shortness of breath and chest pain. The profile of this case — notably the unresponsiveness and gasping — aligns most consistently with opioid agonist use.