Protect the airway & preserve the history

No oral food or fluid; the source specifically permits dissolving ondansetron.
Avoid IO/external-jugular access in a potential stroke-neurology destination patient because thrombolysis may create difficult-to-control bleeding. The source’s narrow IO dextrose exception is stated below.

Check the ischemic-stroke pathway

All three: usual neurologic baseline within the past 24 hours; appropriate response to voice/visual cues or spontaneous eye opening; and new one-sided arm drift/paralysis, facial droop, or unequal grip.

Sudden, severe headache within 24 hours plus repeated vomiting, neurologic deficit, altered mental status, or diastolic BP above 100.
If altered mental status prevents obtaining a history: unexplained repeated vomiting, neurologic deficit, diastolic BP above 100, or paramedic judgment of acute bleeding may meet criteria.

Record last known well. Obtain a witness phone number when possible.
Contact base for patients meeting stroke-triage criteria and prepare for stroke-team activation.
Monitor rhythm and document a strip. If room-air SpO₂ is below 95%, give high-flow oxygen by mask or nasal cannula at 6 L/min as tolerated.
Avoid oral food or fluids; the source permits dissolving ondansetron.
If criteria are not met, provide ALS transport to the nearest emergency receiving center.

Check blood glucose. SO-M-025 uses a value below 60 mg/dL: D10 250 mL IV, or glucagon 1 mg IM if IV access cannot be obtained.
The IO dextrose exception is limited to an unconscious patient with glucose below 60, no IV access, and no response to IM glucagon.
For nausea/vomiting when pregnancy is neither known nor suspected: ondansetron 8 mg ODT or 4 mg IV. The IV dose may be repeated after about 3 minutes if symptoms persist.

Document when the patient was last at their usual neurologic baseline, not just when the deficit was discovered. Obtain a witness callback number when possible.
Report the observed deficit, glucose and response to treatment, level of consciousness, headache/vomiting findings, and BP. Coordinate the stroke destination through base.