 | Narcan 0.4-2.0 mg IV Push or IM, SC or ET. Additional Narcan (0.4-2.0 mg) may be administered as necessary. |
3.3. ALTERED MENTAL STATUS
An alteration in mental status is the hallmark of central nervous system (CNS) injury or illness. Any alteration in mental status is abnormal and warrants further examination. Altered mental status may be due to many factors. A common grouping of causes for altered mental status is the following: AEIOU-TIPS; Alcoholism, Epilepsy, Insulin, Overdose, Underdose, Trauma, Infection, Psychiatric and Stroke. Altered mental status may present as mild confusion or complete unconsciousness (coma). The level of consciousness is evaluated based upon the Glasgow Coma Scale (see Appendix G) and/or the following:
A- alert
V- responds to verbal stimuli
P- responds to painful stimuli
U- unresponsive
NOTE: See also Protocols for Toxicology/ Poisoning; Seizures; Shock; Syncope; and/or Head Trauma/Injury.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain appropriate body substance isolation precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer high concentration of oxygen.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
5. Obtain appropriate S-A-M-P-L-E history related to event.
6. Monitor and record vital signs and ECG.
TREATMENT
BASIC PROCEDURES
1. Maintain appropriate body substance isolation precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen.
4. In cases of suspected head/neck injury, assure cervical spine immobilization.
5. BLS STANDING ORDERS
a. If patient is a known diabetic who is conscious and can speak and swallow, administer oral glucose or other sugar source as tolerated. One dose equals one tube. A second dose may be necessary.
CAUTION: Do NOT administer anything orally if the patient does not have a reasonable Level of Consciousness and normal gag reflex.
BASIC PROCEDURES (continued)
6. Activate ALS intercept, if deemed necessary and if available.
7. If patient is unconscious or seizing, transport on left side (coma position
8. If patient’s BLOOD PRESSURE drops below 100 systolic: treat for shock.
9. Initiate transport as soon as possible with or without ALS.
10. Monitor and record vital signs every 5 minutes at a minimum if unstable, or every 15 minutes if stable.
11. Notify receiving hospital.
INTERMEDIATE PROCEDURES
(oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.1. Maintain appropriate body substance isolation precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts
3. Administer high concentration of oxygen by non-rebreather mask.
4. In cases of suspected head/neck injury, assure cervical spine immobilization.
5. If patient is a known diabetic who is conscious and can speak and swallow, administer oral glucose or other sugar source as tolerated. One dose equals one tube. A second dose may be necessary.
CAUTION: Do NOT administer anything orally if the patient does not have a reasonable Level of Consciousness and normal gag reflex.
6. Activate Paramedic intercept, if deemed necessary and if available.
7. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Draw red top blood sample and initiate IV Normal Saline or D5W while in transport.
c. If patient’s BLOOD PRESSURE drops below 100 systolic: treat for shock. Administer a 250 cc bolus of IV Normal Saline, or titrate IV to patient’s hemodynamic status.
8. Initiate transport as soon as possible with or without Paramedics.
9. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain appropriate body substance isolation precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts
(oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.3. Administer high concentration of oxygen by non-rebreather mask.
4. ALS STANDING ORDERS
(if indicated).a. Provide advanced airway management
b. Initiate IV Normal Saline
(KVO). If suspect hypovolemic etiology, titrate IV to patient’s hemodynamic status.c. Cardiac Monitor: manage dysrhythmias per protocol.
PARAMEDIC PROCEDURES (continued)
d. If obvious narcotic overdose:
| Narcan 0.4-2.0 mg IV Push or IM, SC or ET. Additional Narcan (0.4-2.0 mg) may be administered as necessary. |
unless patient is clearly suffering from hypoglycemia due to insulin shock)e. Thiamine 100 mg IV or IM (
f. Determine Blood Glucose level:
| If glucose is greater than 100 mg/dL, Glucose administration unnecessary. |
| If glucose is less than 100 mg/dL, administer Dextrose 50%, 25 grams IV Push. Additional Dextrose 50% may be administered as necessary. |
| CAUTION: If cerebrovascular accident is suspected, contact Medical Control prior to administration. |
g. If no IV access, administer Glucagon 1-2 mg IM for suspected hypoglycemia.
5. Initiate transport as soon as possible.
6. MEDICAL CONTROL may order:
a. Dextrose 50%, 25 gm IV Push
b. Narcan 0.4-2.0 mg IV Push or IM
c. Further Normal Saline bolus.
d. Dependent upon conditions for suspected substance abuse, overdose, toxic exposure: refer to specific protocols.
7. Notify receiving hospital.