A woman overdoses on Xanax and is unresponsive. What is the next management step?

In the scenario of a woman who has overdosed on Xanax, which is a benzodiazepine, the immediate management priority is to ensure her airway is protected due to her unresponsiveness. Intubation is a critical step in this situation because it secures the airway and prevents aspiration, which could lead to further respiratory complications. Benzodiazepine overdoses often lead to respiratory depression or failure, and given the woman's unresponsiveness, she cannot maintain her own airway.

While flumazenil is a benzodiazepine antagonist that might reverse sedation, it carries risks, especially in unknown overdoses, as it can precipitate seizures in patients who may have polysubstance use or certain underlying conditions. Administering Narcan, which is an opioid antagonist, would not be appropriate in this case since Xanax is not an opioid. Close observation may be necessary but is insufficient as a primary intervention for an unresponsive patient experiencing a potential life-threatening condition. Thus, ensuring that the airway is managed through intubation is the decisive next management step.