View source for 2-14 ALTERED MENTAL STATUS

Considerations: cardio-respiratory arrest, airway obstruction, shock, stroke, seizure, trauma, overdose, diabetic complications, hypo/hyperthermia.  Evaluate for suspected child abuse in infants with altered mental status or new seizures. 
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|'''EMR - Emergency Medical Responder'''
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# Perform an initial assessment, confirm ABCs 
## If apneic, pulseless or in shock/hypotension, refer to appropriate protocol. 
## Cervical spine precautions are to be taken if circumstances surrounding the event are not known or indicate a possible spine or head injury.
# Begin initial medical care with emphasis on maintaining a functional airway
## Refer to the airway protocol
## Apply high-flow oxygen, if not already done
## Anticipate need for suction
## If no spinal injury, may place in recovery position
## Provide appropriate airway management based on patient condition.
# Evaluate temperature exposure.  Treat as indicated.
# Obtain history from witnesses
# If reason for altered consciousness becomes evident, treat per appropriate protocol.

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|'''EMT - Emergency Medical Technician'''  ''Perform/Confirm All Above Interventions''
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# Perform Glucometry and follow hypoglycemia protocol if indicated.
# Perform a rapid neurological exam.
## Report level of consciousness via GCS or AVPU scoring system
## Check pupils, response to pain, any unequal movements, slurred speech, etc.
## Any observed or reported seizure activity
# If respiratory effort inadequate, ventilate patient with BVM or attempt appropriate airway based on level of training and verify placement.
# If signs and symptoms consistent with CVA Stroke) follow CVA protocol.
# If altered mental status persists, '''Consult Medical Control''' regarding need for ALS intercept

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|'''AEMT – Advanced Emergency Medicine Tech  ''' ''Perform/Confirm All Above Interventions''
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# Initiate Transport and establish IV en route
# Apply cardiac monitor, print rhythm strip for reference
# '''Consult Medical Control''' for further orders
# Evaluate for narcotic overdose based on medications, history and pupillary exam. Treat as indicated with '''naloxone (Narcan)''' 0.4mg IV or IN per dose.  Repeat as needed up to 2 mg.  Titrate primarily to ensure adequate ventilation, airway control and to maintain a systolic BP >90.

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|'''Intermediate -''' ''Perform/Confirm All Above Interventions''
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# Assess and treat any symptomatic dysrhythmia.  Consider Overdose if evidence of dysrhythmias or wide-complex QRS
# Treat seizure if present, per Seizure guideline

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|'''Paramedic -''' ''Perform/Confirm All Above Interventions''
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# Administer antidotes as indicated
# Administer antidysrhythmics as indicated