Protect ventilation, assess perfusion, check glucose, and treat the identified cause.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Do not give oral glucose to a child who cannot protect the airway.
Use the glucose threshold in this condition order; the seizure order has different threshold wording.
Initial assessment
Protect the airway and assist ventilation with BVM when needed. Monitor rhythm and document a strip.
Check SpO₂; below 95% on room air, provide high-flow mask oxygen or nasal cannula/direct blow-by as tolerated. Obtain history, medication access, onset, and a measured or appropriately estimated weight.
Poor perfusion
For poor perfusion or systolic BP below 80, establish IV/IO and give normal saline 20 mL/kg, maximum 250 mL, with base contact.
May repeat twice for three total boluses. Reassess BP, lung sounds, skin signs, and mental status rather than giving repeats automatically.
Hypoglycemia
Measure and document glucose. Below 60 mg/dL, use oral glucose only if tolerated with intact airway reflexes, or D10 5 mL/kg IV, maximum 250 mL.
If IV cannot be established, glucagon is 0.5 mg IM. IO dextrose under this order requires unconsciousness, glucose below 60, inability to obtain IV, and no response to IM glucagon.
Suspected opioid toxicity & transport
For suspected narcotic toxicity with respiratory rate at or below 12/min, support ventilation and give naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg, every 3 minutes as needed. The source separately lists the preloaded 4 mg/0.1 mL nasal spray.
Reassess and document response to every treatment. Provide ALS escort to an appropriate ERC; contact base as needed, with a pediatric-capable base preferred.