Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYN Neurologic Emergencies: Altered Level of Consciousness (ALOC) - 7000 ALTERED LEVEL OF CONSCIOUSNESS (ALOC) HISTORY Known diabetic, medic alert tag Drugs, drug paraphernalia Report of illicit drug use or toxic ingestion Past medical history Medications History of trauma Change in responsiveness/condition Changes in feeding or sleep habits Disorientation SIGNS AND SYMPTOMS Decreased mental status or lethargy Change in baseline mental status Bizarre behavior Hypoglycemia (cool, diaphoretic skin) Hyperglycemia (warm, dry skin; fruity breath; Kussmaul respiration; signs of dehydration) Irritability Lowered gross motor or deep tendon reflexes Glasgow Coma Scale <14 ASSESSMENT CNS (stroke, tumor, seizure, infection, trauma) Cardiac (MI, CHF) Hypothermia Infection (CNS and other) Thyroid (hyper / hypo) Shock: septic, metabolic, trauma Diabetes (hyper/ hypoglycemia) Toxicologic or ingestion Acidosis / Alkalosis Pulmonary (Hypoxia) Electrolyte abnormality Psychiatric disorder TREATMENT GUIDELINES R-EMR E – EMT A-AEMT P-PARAMEDIC **M-Medical Control ** ***Higher level of providers are responsible for lower level treatments*** Initial Patient Contact (2000). Administer Oxygen 10-15 L via non rebreather (9000). Consider Spinal Immobilization (9062). Stroke Scale (A5). Glasgow Coma Scale (A2). R Assist ALS with Cardiac Monitor and 12-lead EKG if indicated. Transport to receiving facility. E Establish IV with NS, draw labs; do not delay transport for IV access. 2 Blood Glucose Analysis (9040); for glucose <60 and awake with patent airway, administer 1 tube Oral Glucose PO/SL. Reevaluate blood glucose in 5 minutes; may repeat Oral Glucose if ALOC and or glucose remains <60. 2 If Paramedic is not on scene or expected within 10 minutes and lungs are clear, consider D5W, 5 cc/kg IV Bolus, and check for breath A ________________________________________________________________________________________________________________ _______________________ BCEMS Medical Director Effective: 04/01/14 final 7/6/2022 page 1 of 2