A 45-year-old man is admitted to the intensive care unit after a suspected intentional overdose of an unknown substance. He is obtunded with a Glasgow Coma Scale score of 6, and his respiratory rate is 8 breaths per minute with shallow respirations. He is hypoxemic with an SpO₂ of 89% on a non-rebreather mask and hypotensive at 88/52 mmHg on a norepinephrine infusion (0.05 mcg/kg/min). Physical examination reveals a diminished gag reflex. The time of ingestion is unknown. What is the most appropriate initial intervention?

A 45-year-old man is admitted to the intensive care unit following an intentional overdose of an unknown substance. He was found unresponsive at home approximately 45 minutes prior to arrival. He is receiving oxygen via a non-rebreather mask and norepinephrine infusion for hypotension. On assessment, his Glasgow Coma Scale (GCS) score is 6, and he has a diminished gag reflex. His vital signs are: HR 110 bpm, BP 85/50 mmHg (on norepinephrine 0.1 mcg/kg/min), RR 8 breaths/min (shallow), and SpO₂ 90% on FiO₂ 1.0. Administration of activated charcoal via a nasogastric tube is being considered. Which of the following interventions is most critical to perform prior to considering gastrointestinal decontamination?

A 65-year-old man with severe gastroesophageal reflux disease and a history of recurrent aspiration pneumonia is admitted to the ICU after ingesting an unknown quantity of benzodiazepines. He is somnolent, responds only to painful stimuli (GCS 7), and is breathing 8 shallow breaths per minute on 100% oxygen via non-rebreather mask. Preparations are under way for endotracheal intubation and central venous access. Which of the following is the MOST critical safety consideration when deciding whether to administer single-dose activated charcoal?

A 45-year-old man is brought to the intensive care unit after an intentional overdose. He is unresponsive with a Glasgow Coma Scale score of 6, respiratory rate of 8 breaths/min, oxygen saturation of 88% on room air, and a diminished gag reflex. Before administering activated charcoal for gastrointestinal decontamination, which of the following is the highest priority?

A 45-year-old man is admitted to the critical care unit after an intentional overdose of a sustained-release opioid. He is intubated and on assist-control ventilation, with a norepinephrine infusion via a central venous catheter to maintain mean arterial pressure. His Glasgow Coma Scale is 3T. He ingested approximately 100 tablets of a 30 mg sustained-release opioid about 2 hours before arrival. Which gastrointestinal decontamination strategy is most appropriate at this time?

A 45-year-old man is admitted to the intensive care unit after an intentional overdose. He was found unresponsive at home and was intubated in the field. He is on assist-control ventilation with a Glasgow Coma Scale of 3, pinpoint pupils, and shallow respirations despite ventilatory support. A rapid bedside glucose is 95 mg/dL. EMS reports finding multiple empty pill bottles, including opioids and benzodiazepines, at the scene. It has been approximately 30 minutes since ingestion. Given this presentation, which of the following is the most appropriate next step regarding gastrointestinal decontamination?

A 45-year-old man is admitted to the intensive care unit after a suspected large acetaminophen overdose. He is on continuous cardiac and pulse oximetry monitoring with peripheral IV access. His Glasgow Coma Scale score is 7. Vital signs are: BP 105/60 mm Hg, HR 92 bpm, RR 8 breaths/min, and SpO₂ 90% on a non-rebreather mask. The clinical team plans gastrointestinal decontamination with activated charcoal. Which intervention should be prioritized before administering activated charcoal?

A 34-year-old man is admitted to the intensive care unit (ICU) following an intentional overdose of an unknown substance. He is intubated, receiving mechanical ventilation on assist-control mode, and has a central venous catheter for fluid resuscitation. His Glasgow Coma Scale (GCS) score is 3, and he is unresponsive. Initial vital signs are: BP 90/55 mmHg, HR 110 bpm, RR 12 breaths/min (ventilator-controlled), and SpO₂ 92% on an FiO₂ of 0.6. Administration of activated charcoal for gastrointestinal decontamination is being considered. Prior to administering activated charcoal, which of the following is the most critical action to prevent a procedural complication?

A 45-year-old man is admitted to the intensive care unit after being found unresponsive with empty pill bottles nearby. A central line is being placed for hemodynamic monitoring and vasopressor support. The patient’s Glasgow Coma Scale (GCS) score is 6 (E1, V1, M4). He is receiving 15 L/min of oxygen via a non-rebreather mask, but his respiratory rate is 8 breaths/min with an SpO₂ of 88%. His blood pressure is 85/40 mmHg and heart rate is 125 bpm. Which of the following is the most critical priority before considering gastrointestinal decontamination?

A 45-year-old man is admitted to the ICU after intentional overdose. He has a Glasgow Coma Scale of 7, respiratory rate of 8 breaths/min with shallow, irregular effort, and oxygen saturation of 88% on room air. He remains hypotensive despite vasopressor support. Gastrointestinal decontamination with activated charcoal is being considered. Before proceeding with any GI decontamination, which of the following is the MOST critical initial step?