Management of Acute Alcohol Poisoning in Patients with GCS 3

Airway Management

• Endotracheal intubation is mandatory for patients with a Glasgow Coma Scale of 3 from acute alcohol intoxication to protect the airway and prevent aspiration. 1
• Standard airway management should begin with establishing an open airway, proceed to bag‑mask ventilation as needed, and then perform endotracheal intubation. 1

Aggressive Supportive Care

• Prompt initiation of comprehensive supportive treatment—including intravenous fluid resuscitation, glucose assessment and correction, temperature regulation, electrolyte monitoring, and administration of thiamine and other B‑complex vitamins—is recommended for severe alcohol intoxication. 1

Assessment for Co‑Ingestion

• Clinicians should actively evaluate for co‑ingestion of opioids, benzodiazepines, or other central nervous system depressants in patients presenting with severe alcohol intoxication. 1

Pharmacologic Considerations in Co‑Ingestion

• Naloxone should be administered without delay when opioid co‑ingestion is suspected, even if alcohol intoxication is confirmed. 1
• Flumazenil should be avoided in cases of suspected benzodiazepine co‑ingestion because of the risk of seizures and cardiac dysrhythmias. 1