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.

EMR - Emergency Medical Responder

1. Perform an initial assessment, confirm ABCs
   1. If apneic, pulseless or in shock/hypotension, refer to appropriate protocol.
   2. Cervical spine precautions are to be taken if circumstances surrounding the event are not known or indicate a possible spine or head injury.
2. Begin initial medical care with emphasis on maintaining a functional airway
   1. Refer to the airway protocol
   2. Apply high-flow oxygen, if not already done
   3. Anticipate need for suction
   4. If no spinal injury, may place in recovery position
   5. Provide appropriate airway management based on patient condition.
3. Evaluate temperature exposure.  Treat as indicated.
4. Obtain history from witnesses
5. If reason for altered consciousness becomes evident, treat per appropriate protocol.

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

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

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Initiate Transport and establish IV en route
2. Apply cardiac monitor, print rhythm strip for reference
3. Consult Medical Control for further orders
4. 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.

Intermediate - Perform/Confirm All Above Interventions

1. Assess and treat any symptomatic dysrhythmia.  Consider Overdose if evidence of dysrhythmias or wide-complex QRS
2. Treat seizure if present, per Seizure guideline

Paramedic - Perform/Confirm All Above Interventions

1. Administer antidotes as indicated
2. Administer antidysrhythmics as indicated