Adult Medical Emergency Handbook - Scottish Intensive Care Society

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FURTHER TREATMENT TO CONSIDER
If you suspect an OPIATE OVERDOSE (drug paraphernalia at scene,
track marks, pinpoint pupils, reduced respiratory rate) give NALOXONE
as per Toxicology chapter.
If you suspect a BENZODIAZEPINE OVERDOSE (previous prescriptions
of benzodiazepines, empty drug boxes, reduced respiratory rate).
manage as per Toxicology chapter.
If you suspect MENINGITIS (neck stiffness, rash or fever) give
INTRAVENOUS ANTIBIOTICS: Ceftriaxone 2g IV. See meningitis
section.
FURTHER INVESTIGATIONS TO CONSIDER
If the cause of the coma is not immediately evident, further investigation
is usually required. Consider;
• CT brain: once circulation is stable and the airway is secure
• Drug levels: toxicology screen
• Lumbar puncture: cell count, protein, glucose, culture.
Early advice from a neurologist and/or neurosurgeon and/or
intensive care physician may be crucial.
ONGOING CARE OF THE UNCONSCIOUS PATIENT
• Monitoring of conscious level, blood pressure, pulse, ECG and
oxygen saturations
• DVT prophylaxis: heparin may be contraindicated
• Pressure sore prevention
• Nutrition
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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