Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNNeurologic Emergencies: Altered Level of Consciousness (ALOC) - 7000

ALTERED LEVEL OF CONSCIOUSNESS (ALOC)HISTORY

Known diabetic, medic alert tag Drugs, drug paraphernalia Report of illicit drug use or toxic

ingestion Past medical history Medications History of trauma Change in

responsiveness/condition Changes in feeding or sleep habits Disorientation

SIGNS AND SYMPTOMS Decreased mental status or lethargy Change in baseline mental status Bizarre behavior Hypoglycemia (cool, diaphoretic

skin) Hyperglycemia (warm, dry skin;

fruity breath; Kussmaul respiration; signs of dehydration)

Irritability Lowered gross motor or deep tendon

reflexes Glasgow Coma Scale <14

ASSESSMENT CNS (stroke, tumor, seizure,

infection, trauma) Cardiac (MI, CHF) Hypothermia Infection (CNS and other) Thyroid (hyper / hypo) Shock: septic, metabolic,

trauma Diabetes (hyper/

hypoglycemia) Toxicologic or ingestion Acidosis / Alkalosis Pulmonary (Hypoxia) Electrolyte abnormality Psychiatric disorder

TREATMENT GUIDELINESR-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level of providers are responsible for lower level treatments***

Initial Patient Contact (2000). Administer Oxygen 10-15 L via non rebreather (9000). Consider Spinal Immobilization (9062). Stroke Scale (A5). Glasgow Coma Scale

(A2).R

Assist ALS with Cardiac Monitor and 12-lead EKG if indicated. Transport to receiving facility. E Establish IV with NS, draw labs; do not delay transport for IV access.2

Blood Glucose Analysis (9040); for glucose <60 and awake with patent airway, administer 1 tube Oral Glucose PO/SL. Reevaluate blood glucose in 5 minutes; may repeat Oral Glucose if ALOC and or glucose remains <60.2

If Paramedic is not on scene or expected within 10 minutes and lungs are clear, consider D5W, 5 cc/kg IV Bolus, and check for breath sounds after giving bolus.2

For glucose <60 and no IV, administer 1unit (1 mg) Glucagon IM.2

For glucose <60 and patent IV, administer 12.5-25 gm of 50% Dextrose IV. Reevaluate blood glucose and repeat as indicated for glucose <60 and ALOC. Consider Naloxone for decreased respirations and glucose >60. IV NS 10-20 cc/kg bolus for signs of dehydration and/or blood glucose >250.2

A

ALS required for continued ALOC, long transport, oral diabetic medication.

Consider other causes of ALOC if patient not responding to above measures. 12 lead EKG; transmit when possible to Medical control if abnormal.

P ** Call Medical Control for Stroke, worsening LOC or need for Intubation**. M2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/14/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNNeurologic Emergencies: Altered Level of Consciousness (ALOC) - 7000

Be especially cautious if the patient is on oral diabetic medication. Beware of Hypoglycemia in alcoholics.

_______________________________________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 04/01/14 final 5/14/2023 page 2 of 2