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Neurologic · Adult / adolescent · ALS

Altered mental status

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.