Support the airway, check glucose, assess stroke criteria, and treat poor perfusion or suspected opioid toxicity.
OCEMS source summary · Updated 2026-09-16
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.