General Approach to All Patients

Altered Mental Status

Advanced Life Support

  • Full ALS Assessment and Treatment
  • If hypoglycemic (Blood glucose < 70 mg/dL [<50mg/dL if stroke]):
    • Dextrose 50% 25 gm slow IV
    • If the patient appears malnourished administer Thiamine 100 mg IV
    • If no IV available:
      • Glucose paste or other oral glucose containing agent (e.g. orange juice) if patient alert enough to self administer oral agent
      • If unable to take oral glucose administer Glucagon 1 mg IM
  • If hypoglycemia persists:
    • Repeat blood glucose check with a different glucometer
    • Repeat Dextrose 50% 25 gm once if blood glucose < 70 mg/dl after 10 minutes
  • If Opioid overdose suspected (significantly altered mental status or respiratory depression):
    • Naloxone (Narcan) 2 mg IV (start at 0.4 mg for patients over 65 years old)
      • Naloxone (Narcan) can be given in 0.4 mg increments, titrated to mental status and respiratory drive (monitor respiratory status with continuous capnography)
      • If respiratory depression persists, repeat every 3 minutes to a maximum of 8 mg
      • If IV access has not been established, Naloxone (Narcan) can be given IM or via Mucosal Atomizer Device
  • If Stroke suspected see Stroke Protocol
  • If Sepsis suspected (advanced age, high risk for infection, febrile), see Sepsis Protocol
  • If Head Injury suspected see Trauma/Head Injury Protocol
  • If severely agitated and/or violent see Behavioral Emergencies Protocol
  • If cardiac arrhythmia present see appropriate Cardiac Arrhythmia Protocol

Note: Patients presenting with altered mental status, who respond to Narcan are not candidates for informed refusal. Due to the relatively short half-life of Narcan, these patients are medically incapacitated, and should be transported, regardless of the presence of an apparently normal mental status.