General Approach to All Patients

Measures to Manage All Patients

The following measures will apply to the management of all patients:

Basic Life Support

  • Establish patent airway
  • Supplemental oxygen if any respiratory signs or symptoms present
  • Record and monitor vital signs
  • Record blood glucose level if any weakness, altered mental status or history of diabetes
  • Nothing by mouth, unless patient is a known diabetic with hypoglycemia and is able to self- administer oral glucose paste, or a glucose containing beverage

Advanced Life Support

  • When condition warrants (specified as “Full ALS Assessment and Treatment” in individual protocols):
    • Advanced airway/ventilatory management as needed
    • Perform cardiac monitoring
    • Evaluate 12-lead ECG if chest pain, dyspnea, abdominal pain above the umbilicus or ischemic equivalent symptoms
      • If STEMI criteria present on 12 lead ECG, transmit ECG to PCI capable hospital and expedite transport (see Chest Pain protocol)
    • Record & monitor continuous 02 saturation and microstream capnography
    • IV 0.9% NaCl KVO or IV lock
      • If evidence of dehydration (tachycardia, dry mucous membranes, poor skin turgor) administer boluses of 0.9% NaCl at 250 ml (hold at 500 ml total if no hypotension)
      • If BP < 90 mm Hg systolic, administer boluses of 0.9% NaCl at 250 ml until systolic BP > 90 mm Hg
        • Contraindicated if evidence of congestive heart failure (e.g. rales)
  • 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
  • For patients with severe nausea or vomiting:
    • Ondansetron (Zofran), 4 mg slow IV or 4 mg Oral Disintegrating Tablet (ODT) by mouth
  • Transport patient to nearest appropriate Emergency Department
  • Minimize on scene time when possible