Immediate management

Give flumazenil iv ^a   400 microgram ^d

Why?

• It improves the GCS (by around 2 points) ^b and patients are more likely to become fully conscious ^a  
• Watch out for adverse reactions: shivering, agitation, fall in blood pressure, nausea and vomiting -they are relatively common ^a

Flumazenil wakes patients up following an overdose but can causes side-effects

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
coma and suspected overdose a	flumazenil	placebo	recovered enough to provide useful information at 15 minutes	2%	2000% (190% to 15000%)	3 (2 to 4)
			adverse reaction at	3%	-342% (-1700% to 0%)	-8 (-57 to -4)