Rosh Emergency Medicine Practice Test

What is the most appropriate clinical intervention for a patient presenting with signs of benzodiazepine overdose?

1. Administer flumazenil

2. Administer naloxone

3. Perform gastric lavage followed by activated charcoal

4. Provide supportive care with continuous monitoring

The correct answer is: Provide supportive care with continuous monitoring

In cases of benzodiazepine overdose, supportive care with continuous monitoring is the most appropriate clinical intervention. Benzodiazepines can cause significant central nervous system depression, potentially leading to respiratory compromise, decreased level of consciousness, or even coma. The primary management involves ensuring the patient’s safety; this includes maintaining an open airway, providing supplemental oxygen if necessary, and continuously monitoring vital signs to observe for any respiratory or hemodynamic stability issues. Supportive care allows for the management of symptoms as they arise, without unnecessary interventions that could complicate the clinical picture. For example, while flumazenil is an antidote for benzodiazepine overdose, its use is often discouraged due to the risk of seizures, especially in patients with poly-drug overdoses or those who are dependent on benzodiazepines. Naloxone, which is used in opioid overdoses, would not be effective in this case, as it specifically targets opioid receptors. Gastric lavage followed by activated charcoal is typically reserved for specific circumstances and may not be advisable if the patient is drowsy or at risk for airway compromise. By focusing on supportive care, healthcare providers can effectively monitor and treat the patient while avoiding unnecessary risks associated with other intervention methods.