Altered Neurologic Function (Non-traumatic)

BLS

• Ensure patent airway

• O2 saturation, O2 and/or ventilate PRN

• Spinal motion restriction PRN

• Position on affected side if difficulty managing secretions

• Do not allow patient to walk

• Restrain PRN

• Monitor blood glucose

BLS - Symptomatic suspected opioid OD with RR <12

Use with caution in opioid-dependent, pain-management patients

• Naloxone 4 mg via nasal spray preloaded single-dose device. Administer full dose in one nostril

  OR

• Naloxone 2 mg via atomizer and syringe. Administer 1 mg into each nostril

EMTs may assist family or friend to medicate with patient’s prescribed naloxone in symptomatic suspected opioid OD

BLS - Suspected hypoglycemia or patient’s blood sugar is <60 mg/dL

• If patient is awake and able to manage oral secretions, give 3 oral glucose tabs or paste (15 gm total)

• Patient may eat or drink, if able

• If patient is unconscious, NPO

BLS - Stroke/TIA

• Treat per Stroke and Transient Ischemic Attack

• Pediatric patients presenting with stroke symptoms should be transported to Rady Children’s Hospital

BLS - Seizures

• Protect airway and protect from injury

• Treat associated injuries

ALS

• Monitor/ECG

• Capnography

• IV/IO

ALS - Symptomatic suspected opioid OD with respiratory depression

Respiratory depression: RR<12, Spo2<96%, or EtCO2 greater than or equal to 40 mmHg

Titrate slowly in opioid-dependent patients

• Naloxone 2 mg IN/IM/IV, MR. Titrate IV dose to effect, to drive the respiratory effect

  OR

• Naloxone 4 mg via nasal spray preloaded single-dose device. Administer full dose in one nostril, MR

If patient refuses transport:

• Give additional naloxone 2 mg IM

  OR

• Naloxone 4 mg via nasal spray preloaded single-dose device. Administer full dose in one nostril, MR

ALS - Symptomatic hypoglycemia with altered LOC or unresponsive to oral glucose agents

• Dextrose 25 gm IV if bS <60 mg/dL

• If patient remains symptomatic and BS remains <60 mg/dL, MR

• If no IV, glucagon 1 mL IM if BS <60 mg/dL

ALS - Symptomatic hyperglycemia

500 mL fluid bolus IV/IO if BS greater than or equal to 350 mg/dL or reads “high”, if no rales MR x1

ALS - Status epilepticus*

*Generalized, ongoing, and recurrent seizures without lucid interval

• Patients greater than or equal to 40kg: midazolam 10 mg IM

• Patients less than or equal to 40kg: midazolam 0.2 mg/kg IM

If vascular access present

• Midazolam 0.2 mg/kg IV/IO to max dose of 5 mg, MR x1 in 10 min. Max 10mg total, d/c if seizure stops

ALS - Partial seizure lasting greater than or equal to 5 min*

*Includes seizure time prior to arrival of prehospital provider

• Midazolam 0.2 mg/kg IN/IM/IV/IO to max dose of 5 mg, MR x1 in 10 min. Max 10 mg total, d/c if seizure stops

ALS - Eclamptic seizure of any duration

Treat per Obstetrical Emergencies / Newborn Deliveries