# Altered mental status

Support the airway, check glucose, assess stroke criteria, and treat poor perfusion or suspected opioid toxicity.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See linked source for document revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/altered-mental-status/
Official source: [SO-M-020 — Altered Mental Status](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- No oral glucose without intact airway reflexes.
- Persistent respiratory depression requires ventilation support while naloxone is being administered.

## Source documents

- [SO-M-020 — Altered Mental Status](https://www.ochealthinfo.com/sites/hca/files/import/data/files/12033.pdf)

## Initial priorities

- Protect the airway and support ventilation as needed. Determine whether stroke-neurology criteria are met.
- Monitor cardiac rhythm and document a strip. If SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula at 6 L/min as tolerated.

## Check glucose & treat the patient

- SO-M-020 treats glucose at or below 60 mg/dL and permits treatment in the 60–80 range when hypoglycemia is suspected.
- Options: oral glucose if airway reflexes are intact; D10 up to 250 mL IV, titrated to improved consciousness; or glucagon 1 mg IM if IV cannot be established.
- IO dextrose is a narrow exception for an unconscious patient with glucose below 60, no IV, and no response to IM glucagon.

## Perfusion & breathing

- For hypotension or poor perfusion with clear lungs/no CHF, establish IV and give 250 mL saline boluses up to 1 L. Reassess lungs and clinical response.
- For respiratory depression at about 12/min or fewer, the order lists naloxone: 0.8, 1, or 2 mg IN/IM, or 0.4–1 mg IV, repeating every 3 minutes as needed; a preloaded 4 mg nasal product is also listed. Continue ventilatory support.

## Repeat assessment & handoff

- Document response after each intervention, including consciousness, breathing, BP, and glucose-related findings. A single reversible cause should not end the assessment.
- Provide ALS escort to the nearest ERC or contact base as needed. Use the stroke pathway when its criteria apply. Pediatric patients have a separate SO-P-065 pathway and different doses.