3. MEDICAL EMERGENCIES
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, P sychiatric 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) and/or the following:
A- alert
V- responds to verbal stimuli
P- responds to painful stimuli
U- unresponsive
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed. Assume spinal injury when appropriate and treat accordingly.
3. Administer high concentration oxygen via non-rebreather mask.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs.
5. Obtain appropriate history related to event, including Past Medical History, Medications, Drug Allergies, Substance abuse or Trauma.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid 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. 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, give oral glucose or other sugar source as tolerated. CAUTION: Do NOT administer anything orally if the patient does not have a reasonable Level of Consciousness and normal gag reflex.
6. Activate ALS intercept, if deemed necessary and if available.
7. Initiate transport as soon as possible with or without ALS.
8. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid 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. In cases of suspected head/neck injury, assure cervical spine immobilization.
5. If patient is a known diabetic that is conscious and can speak and swallow, give oral glucose or other sugar source as tolerated. 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.
8. Initiate transport as soon as possible with or without Paramedics.
9. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid 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
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline (KVO). If suspect hypovolemic etiology, titrate IV to patient’s hemodynamic status.
c. Cardiac Monitor: manage dysrhythmias per protocol.
d. If obvious narcotic overdose:
- Narcan 0.4-2.0 mg IV Push or IM, SQ or ET. Additional Narcan (0.4-2.0 mg) may be administered as necessary.
e. Thiamine 100 mg IV or IM (unless patient is clearly suffering from hypoglycemia due to insulin shock)
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.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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