Aims and Objectives Benzodiazepine overdose causes significant morbidity and mortality amongst the UK population. Flumazenil is an effective antidote but concerns regarding side effects have limited its use in the UK. This project aims to review flumazenil use within NHS Lothian.

Method and Design A search was conducted on the electronic note system for ‘flumazenil’ over the last 2 years. These notes were reviewed by two toxicologists who stated yes/no/insufficient information as to whether flumazenil was indicated. Additionally, the two toxicologists reviewed intubations within the ED caused by toxins/overdose. Each case was given a yes/no/unsure for whether flumazenil was indicated.

Results and Conclusion With duplicates removed there were 39 mentions of ‘flumazenil’. It was considered but not given in 14 cases and it was given in the remaining 25. Of the cases where flumazenil was given both reviewers agreed with its administration in 9 cases and both disagreed with its administration in 3 cases. The two reviewers directly disagreed on 3 occasions with the remaining 10 at least one reviewer ‘unsure/insufficient information’.

Of the 14 where it was considered but not given the reviewers agreed that it was not indicated in 10 of the cases. They both agreed in two of the cases that it was indicated and the remaining two at least one reviewer was ‘unsure/insufficient information’.

Of the 15 intubations, in 4 cases both reviewers thought flumazenil was indicated, 4 cases at least one reviewer thought it was indicated and the other was ‘unsure/insufficient information’.

From reviewing flumazenil use it is obvious that there is significant variation in its use as well as disagreement amongst expert reviewers as to when it is indicated/contraindicated. We have also identified at least 4 occasions where flumazenil could have potentially avoided an ICU admission. This project demonstrates a need for a comprehensive guideline for flumazenil use in the ED.