Browse categories and answer follow-up questions to refine your symptom profile.
Immediate priorities
Stabilization priorities
If apnea
Bag valve mask ventilation
Advanced airway for persistent apnea or refractory hypoventilation
If hypoxemia
Supplemental oxygen
Positive pressure ventilation as needed
If hypotension
Isotonic crystalloid bolus
Vasopressor infusion if fluid refractory
If bradycardia with instability
Atropine per ACLS
Transcutaneous pacing if refractory
If hypoglycemia
Dextrose bolus
Continuous infusion if recurrent
If seizure activity
Benzodiazepines for active seizures
Second line antiseizure therapy if refractory
Temperature
Active warming for hypothermia
Passive cooling for hyperthermia from coingestants
Toxidrome recognition
Sedative hypnotic toxidrome
CNS depression
Somnolence to coma
Slurred speech
Ataxia
Respiratory depression
Hypoventilation
Hypercapnia
Hemodynamics
Usually stable in isolated benzodiazepine exposure
Hypotension suggests coingestion or alternate diagnosis
Pupils
Normal to mildly miotic
Marked miosis suggests opioid coingestion
Skin
Usually normal
Diaphoresis suggests alternate toxidrome
Key decision points
High risk triggers
Mixed ingestion concern
Alcohol
Opioids
Tricyclic antidepressants
Barbiturates
Z drugs
Gamma hydroxybutyrate
Long acting agent concern
Diazepam
Chlordiazepoxide
Clonazepam
Sustained release coingestant concern
Extended release sedatives or other agents
Vulnerable physiology
COPD
OSA
Frailty
Pregnancy
Trauma risk from fall
Head strike
Anticoagulation
Monitoring and targets
Monitoring
Continuous pulse oximetry
Oxygen saturation target per local practice
Escalation if persistent desaturation
Cardiac monitor
Dysrhythmia detection
QT prolongation screening if coingestants
Capnography
Early hypoventilation detection
Ventilation target
End tidal CO2 trend normalization
Frequent mental status reassessment
Airway protective reflexes
Trend toward awakening
Temperature monitoring
Hypothermia detection
Aspiration pneumonia risk with hypothermia
Antidote posture
Flumazenil posture
Avoid routine use in undifferentiated overdose
Seizure risk in chronic benzodiazepine use
Seizure risk in mixed ingestion with proconvulsants
Consider only in select scenarios
Iatrogenic sedation reversal with airway risk
Known isolated benzodiazepine ingestion
No seizure history
No proconvulsant coingestion concern
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.