4-2 PEDIATRIC ALTERED MENTAL STATUS-HYPOGLYCEMIA

EMR - Emergency Medical Responder

1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
2. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
3. Open the airway via chin lift or modified jaw thrust.
4. Suction as necessary
5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
6. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
7. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
8. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
9. Assess circulation and perfusion.
10. Call for ALS intercept

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Check blood glucose and if less than 60 mg/dL, administer Glucagon 0.1 mg/kg IM (Max dose 1 mg if weight >20kg and 0.5 mg if weight < 20 kg).
3. Initiate transport and Contact MEDICAL CONTROL to request ALS intercept.

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

1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
2. Consider need for vascular access and administer NS at a TKO rate if indicated. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 do not attempt further IV placement.
3. If vascular access obtained, recheck blood glucose and if less than 60, administer Dextrose according to the following:
   1. Administer 5mL/kg of D10 up to 125mL
      1. This dose is for all ages (newborn - adult size)
      2. If blood glucose remains <60, a repeat does may be administered.
   2. If vascular access unavailable, consider glucagon administration as above.
4. Contact MEDICAL CONTROL to request ALS intercept and for orders regarding rate of fluid administration or further medication order, including consideration for administration of naloxone (Narcan), 0.1 mg/kg (max dose 2 mg total).

Intermediate - Perform/Confirm All Above Interventions

1. Consider alternate causes of altered mental status, including dehydration, head trauma, seizures and drug intoxication and treat appropriately.
2. Evaluate for need for endotracheal intubation.
3. Initiate transport.
4. Contact MEDICAL CONTROL for further orders.

Paramedic - Perform/Confirm All Above Interventions