FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- No oral glucose without intact airway reflexes.
- Persistent respiratory depression requires ventilation support while naloxone is being administered.
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.
UNDERSTAND THE CARE
Why altered mental status needs parallel assessment
Altered mental status describes a finding rather than a final diagnosis. Airway protection, ventilation, perfusion, glucose and the neurologic assessment can reveal different urgent problems. Establish the patient’s usual function and last normal state through witnesses when possible. A response to one treatment helps describe the case but does not remove the need to examine the remaining causes.
Applying the guidance
The route of glucose treatment depends on airway safety and the order’s access requirements. Similarly, naloxone is paired with continuing ventilatory support when breathing is inadequate. Repeat the same observations after treatment so the receiving team can distinguish improvement in breathing from improvement in consciousness. Persistent focal deficits still need the stroke assessment even if the glucose or responsiveness improves.
Putting it together
Teaching example: a patient becomes more responsive after treatment but still has an asymmetric examination. Document the change in consciousness and the persistent deficit separately and continue the applicable neurologic pathway.
Diagram text & teaching checkpoints
- Airway and breathing
- Support immediate physiologic needs.
- Glucose
- Use this order’s threshold and a safe route.
- Neurologic findings
- Assess stroke criteria and baseline.
- Repeat examination
- Look for residual or additional problems.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.