Altered/Neuro/Overdose Administrative Guideline

Question 1

History to check

Answer 1

• Diabetes
• Medical Alert Tag/Bracelet
• Report of toxic ingestion or overdose
• History of trauma
• Past medical history
• ETOH/Drug usage
• Seizure

Question 2

Signs and symptoms

Answer 2

• Decreased level of consciousness
• Change in behavior reported
• Signs of hypoglycemia(cool/clammy)
• Hyperglycemia, signs of DKA
  (dehydration, Kussmal respiration)
• Irritability

Question 3

Differential

Answer 3

• Shock or sepsis
• Cardiac arrhythmia
• `Hyperglycemia/hypoglycemia/other
  metabolic abnormality
• Ingestion/intoxication
• Seizures or postictal state

Question 4

If altered level of consciousness or possible overdose…

Answer 4

Perform Prehospital Stroke screen

also check FSBS

Question 5

If hypoventilation and/or pinpoint pupils

Answer 5

Suspect opioid overdose
Give naloxone 0.4mg-2mg IM/IV/IO/IN
Repeat every 3-5 as needed

Question 6

What else should you consider if the patient is unconscious/unresponsive?

Answer 6

• Stroke AG
• Shock AG
• Trauma AG
• Behavioral Violent/Combative AG
• AG for age-appropriate dysrhythmia

Question 7

What’s one last thing to do for altered people while you are reassessing them?

Answer 7

Consider consultation with AZ Poison Center (1-800-222-1222)