ValleyProtocolBook

The Valley Hospital Mobile ICU

26

Standing Orders / Communications Failure Orders

8.41-7.18 Standing orders for altered mental status

(a) The following standing orders are authorized in the event that an adult patient is unconscious or presents with altered mental status. The treatment of an unconscious person/altered mental status patient shall be directed by the suspected etiology of the event. Specific orders may be omitted by an ALS crewmember if the order does not pertain to the suspected etiology of the medical emergency:

1. Asses and secure airway;

2. Evaluate blood glucose. If etiology suggests possible stroke follow the New Jersey Department of Health and Senior Services’ Stroke Triage Guidelines.

3. Establish vascular access;

4. Assess blood glucose, if blood glucose is less than 60mg/dL;

i. Administer 25 g Dextrose in water intravenously;

ii. If unable to establish vascular access, administer 1 mg Glucagon intramuscularly; and

iii. If there is no response to (a) 4 i and ii above, or if the blood glucose is greater than 60mg/dL, administer up to 2mg Naloxone through an approved route of administration. Start with 0.4mg and titrate the dose to reversal of any respiratory depression; and

5. Contact Medical Command

Communications Failure Orders for altered mental status

(a) If the patient has a blood glucose level > 300mg/dL and is presenting with signs and symptoms of Diabetic Ketoacidosis, administer Normal Saline 1 liter IV/IO drip.

(b) If the patient is presenting with the signs or symptoms of a stroke and the onset of symptoms is less than 4.5 hours of the ALS crew’s arrival, establish secondary vascular access.

(c) If the patient is combative and requires sedation, Lorazepam 2 mg IV/IM.

(d) If patient presents with signs of dystonic reaction or extrapyramidal symptoms, administer Diphenhydramine 50 mg IV/IM.