Altered Mental Status
Stroke
- Obtain glucose reading via glucometer
- Assess patient for Stroke symptoms, using the Cincinnati Pre-hospital Stroke Scale for facial droop, pronator drift, and speech
- Determine as accurately as possible the time of symptom onset
- Transport to the closest appropriate hospital
Hypothermia
- Handle carefully and prevent further heat loss
- If patient is alert enough to swallow, give food and drinks high in calories
- Oxygen, heated and humidified if possible
- IV fluids to maintain SBP >90 or minimum for age and signs of adequate perfusion
- For patients with altered level of consciousness, consider Narcan or D50W when appropriate
- No medications if core temperature is <86F or <30C
Head Trauma
- Monitor and maintain SpO2 >90%
- If breathing is adequate, high flow O2 by NRB mask
- Do not hyperventilate, EXCEPT for a) Fixed or asymmetric pupils; b) abnormal extension; c) GCS <9 with a further decrease of 2 or more points
- Advanced airway management when needed
Altered Mental Status
- Immobilize if evidence of trauma
- High flow oxygen via mask
- Determine blood glucose level; if < 80 mg/dl, administer D50W 25 g IV or if no IV glucagon 1 mg IM or SQ
- If object not visible, intubate the airway; push object down to obstruct right lung and allow air to left lung
- Administer naloxone 2 mg IVP
