Altered Mental Status/Diabetic Emergency Pearls: Meds: History: Signs/Symptoms: Differential: Known diabetic, medic alert tag Decreased mental status Head Drugs, drug paraphernalia Change in baseline mental status Trauma Report of illicit drug use or toxic ingestion Bizarre behavior CNS Past Medical history Hypoglycemia (cool, diaphoretic skin) (stroke, Medications Hyperglycemia (warm dry skin; fruity tumor, History of Trauma breath, Kussmal resps: signs of seizure, GI History dehydration) infection Syncope Diabetic Cardiac Syncope (MI, CHF) Thyroid (hyper/hypo) Shock Diabetes · of shock include SBP <90 Epinephrine 0.1=0.3 cc IM; 0.1-0.3mg SQ, SL Legend · The shorter the onset from contact to symptoms, the more severe the Repeat Epinephrine PRN EMT reaction. Diphenhydramine 25-50 mg PO/IM/IV A EMT-A A · A single dose of Epinephrine may not reverse the effects of Albuterol 2.5.mg Pt.’s MDI per P EMT-P P Anaphylaxis. prescription SVN Administer additional doses as needed. Albuterol 2.5 mg M MC Order M & · Obtain ECG tracing during pharmacological Atrovent 0.5 mg (Hyper/hypoglycemia) administrations. SVN Blood Glucose check Toxicologic · EMT may assist with patients own MDI Methylprednisolone 125 mg IV A Obtain IV access A Acidosis / Alkalosis Environmental exposure Pulmonary (Hypoxia) Electrolyte abnormality Psychiatric disorder Syncope Administer Oral Glucose A Normal Saline A A Normal Saline A Yes P Thiamine P A Dextrose A A Naloxone prn A P Glucagon prn P No
Pearls: · of shock include SBP <90 · The shorter the onset from contact to symptoms, the more severe the reaction. · A single dose of Epinephrine may not reverse the effects of Anaphylaxis. Administer additional doses as needed. · Obtain ECG tracing during pharmacological administrations. · EMT may assist with patients own MDI Meds: Epinephrine 0.1=0.3 cc IM; 0.1-0.3mg SQ, SL Repeat Epinephrine PRN Diphenhydramine 25-50 mg PO/IM/IV Albuterol 2.5.mg Pt.’s MDI per prescription SVN Albuterol 2.5 mg & Atrovent 0.5 mg SVN Methylprednisolone 125 mg IV History: Known diabetic, medic alert tag Drugs, drug paraphernalia Report of illicit drug use or toxic ingestion Past Medical history Medications History of Trauma GI History Syncope Signs/Symptoms: Decreased mental status Change in baseline mental status Bizarre behavior Hypoglycemia (cool, diaphoretic skin) Hyperglycemia (warm dry skin; fruity breath, Kussmal resps: signs of dehydration) Diabetic Syncope Differential: Head Trauma CNS (stroke, tumor, seizure, infection Cardiac (MI, CHF) Thyroid (hyper/hypo) Shock Diabetes (Hyper/hypoglycemia) Toxicologic Acidosis / Alkalosis Environmental exposure Pulmonary (Hypoxia) Electrolyte abnormality Psychiatric disorder Syncope Altered Mental Status/Diabetic Emergency Legend EMT A EMT-A A P EMT-P P M MC Order M A Obtain IV access A Blood Glucose check A Normal Saline A Administer Oral Glucose A Normal Saline A Yes No P Thiamine P A Dextrose A A Naloxone prn A P Glucagon prn P
2012_lc_ems_protocols.docx