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Some have proposed that the concept be abandoned completely because modern EMS providers should be able to determine the likely etiology of the change in mental status. At a minimum, the clinical presentation of the patient should rule in or out some portions of the coma cocktail. For example, with
260:
has well-documented effectiveness; as a matter of fact, 575/609 patients (mainly with heroin overdose) showed improved consciousness and respiration within five minutes of treatment. The major downsides to naloxone are the hypersensitivity from the patient and its reaction with substances
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If the blood glucose concentration of the patient is alternating consciousness or at least contributing to the alteration, said patient likely needs hypertonic dextrose. Another indicator is seizures. Hypertonic dextrose is effective in treating
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The coma cocktail is thought to have been created in United States as a first line treatment for an unconscious patient in an era where intensive care was new and difficult to maintain. Original coma cocktails included
221:, and one in twelve patients administered for altered mental status suffer from it. This statistic may be sufficient evidence for doctors to support the routine of administering the drug.
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In terms of hypersensitivity, the patient may subsequently suffer from restlessness, headache, and vomiting. Opiates/opioids, such as heroin, can be contaminated with
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individuals when the cause of the coma has not yet been determined. The intention is to work against various causes of a coma seen in an emergency setting including
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Overall, thiamine does not cause as notable issues in the cocktail, but patients can be sensitive to it nonetheless. If a physician administers both
208:. As medicine and assessment techniques have advanced, the preceding drugs have been mostly replaced by the modern coma cocktail as described above.
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can actually mediate the effects of other lethal drugs in the system, so flumazenil's action to reverse its effects can actually be harmful.
155:(100 mg IV). It has been suggested that the use of naloxone and flumazenil be administered more selectively than glucose and thiamine.
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For this reason, flumazenil is recommended in scenarios with only benzodiazepine ingestion so as to avoid the other negative effects.
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Bartlett D (December 2004). "The coma cocktail: indications, contraindications, adverse effects, proper dose, and proper route".
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Patients that are specifically at risk of being impacted this way are those with alcoholic tendencies or malnourishment.
609:
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Doyon S, Roberts JR (May 1994). "Reappraisal of the "coma cocktail". Dextrose, flumazenil, naloxone, and thiamine".
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Bledsoe BE (November 2002). "No more coma cocktails. Using science to dispel myths & improve patient care".
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It allows adequate ventilation for impacted patients, and health professionals administer it intravenously.
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ingestion. For ethylene glycol, thiamine helps by preventing synthesis of the glycol's metabolites.
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574:“The Poisoned Patient with Altered Consciousness. Controversies in the Use of a 'Coma Cocktail'.”
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120:. The coma cocktail is sometimes colloquially referred to as a “party pack” by
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Buylaert WA (December 2000). "Coma induced by intoxication".
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and respiratory depression caused by opiate/opioid overdose.
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contributes to the controversy of coma cocktails by inducing
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can be more narrowly defined and its use more regimented.
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and agitation. When a patient overdoses intentionally,
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104:is a combination of substances administered in an
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527:Sivilotti, Marco L.A. (7 August 2015).
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487:Journal of Emergency Medical Services
341:, as is common in comatose patients,
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163:, the indications for administering
410:"Making Light: Sweetness and Light"
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229:in patients that are deficient in
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139:A standard combination included
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261:contaminating opioids/opiates.
345:should be administered first.
322:is effective for treatment of
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437:10.1016/S0733-8627(20)30429-6
324:Wernicke–Korsakoff syndrome
287:as well as intensive care.
227:Wernicke–Korsakoff syndrome
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425:Emerg. Med. Clin. North Am
126:emergency medical services
388:10.1016/j.jen.2004.09.002
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615:Intensive care medicine
300:, and symptoms include
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283:. It can be used in
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124:in the pre-hospital
247:effectively treats
610:Emergency medicine
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219:hypoglycemia
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326:as well as
285:anaesthesia
266:scopolamine
202:nikethamide
161:glucometers
605:Toxicology
594:Categories
349:References
298:withdrawal
291:Flumazenil
277:Flumazenil
272:Flumazenil
198:picrotoxin
194:strychnine
145:flumazenil
122:paramedics
50:; try the
37:link to it
106:emergency
79:Specialty
59:June 2022
40:. Please
563:26469689
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472:11233676
396:15565045
343:thiamine
339:thiamine
335:dextrose
320:Thiamine
315:Thiamine
302:seizures
258:Naloxone
245:Naloxone
240:Naloxone
231:thiamine
223:Dextrose
212:Dextrose
153:thiamine
149:naloxone
141:dextrose
110:comatose
585:7629986
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206:camphor
171:History
165:glucose
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