Ch. 19: Diabetic Emergencies and Altered Mental Status

Question 1

Reticular activating system (RAS)

Answer 1

series of neurologic circuits in the brain that controls the functions of staying awake, paying attention, and sleeping

Question 2

Requirements of Oxygen

Answer 2

oxygen, glucose, and nutrients

Question 3

Action when signs of respiratory failure

Answer 3

positive pressure ventilation

Question 4

Signs of hypoperfusion associated with shock

Answer 4

Rapid heart rate, absent radial pulses, pale skin, & delayed capillary refill

Question 5

determine a baseline mental status

Answer 5

APVU
□ Alert: responds to voice
□ Verbal: open eyes to the sound of your voice
□ Painful: opens eyes upon uncomfortable sensation
□ Unresponsive: the patient does not respond at all

Question 6

action if hypoglycemia is detected

Answer 6

administer glucose

Question 7

Action if the stroke is detected

Answer 7

rapid transport to appropriate facility

Question 8

Average Blood glucose

Answer 8

90 mg/dL

Question 9

type 1 diabetes

Answer 9

Don’t produce insulin or enough insulin

Question 10

type 2 diabetes

Answer 10

The body has become resistant to insulin

Question 11

Where is insulin produced?

Answer 11

the islet of Langerhans in the pancreas (or beta cells)

Question 12

how many people in the country suffer from diabetes mellitus?

Answer 12

16 million Americans or 1 in 17 people `

Question 13

The most common causes of hypoglycemia

Answer 13

• Takes too much insulin (or, less commonly, takes too much of an oral medication used to treat diabetes), thereby transferring glucose into the cells too quickly and causing a rapid depletion of available sugar
• Reduces sugar intake by not eating
• Overexercises or overexerts himself, thus using sugars faster than normal
• Vomits a meal, emptying the stomach of sugar as well as other food
• Increases the metabolic rate in conditions such as fever or shivering

Question 14

Role of Sympathetic nervous symptoms and signs

Answer 14

sympathetic nervous system signals the liver to release glycogen (a form of stored sugar) in an attempt to raise blood glucose levels
-Signs: pale, sweaty skin, tachycardia, rapid breathing

Question 15

Treatment of hypoglycemia

Answer 15

• Oral glucose if the patient can manage

- ALS can inject dextrose

Question 16

causes of hyperglycemia

Answer 16

□ Caused by a decrease in insulin
□ insulin deficiency may be due to the body’s inability to produce insulin or may exist because insulin injections were forgotten or not given in sufficient quantity
□ infection, stress, or increasing dietary intake can also be a factor in hyperglycemia
□ Develops over days and even weeks

Question 17

Symptoms of hypoglycemia

Answer 17

chronic thirst and hunger; increase urination, nausea
Extremely high levels of sugar in the blood begin to draw water away from the body’s cells, potentially resulting in profound dehydration. Starving body cells begin to burn fats and proteins in a manner that results in excessive waste products being released into the system

Question 18

causes and symptoms of diabetic ketoacidosis

Answer 18

waste products build up and combine with dehydration to cause a condition called diabetic ketoacidosis (DKA)

• Profoundly altered mental status
• Signs and symptoms of severe shock (caused by ketoacidosis)
• rapid breathing
• Fruity acetone odor of breath

Question 19

Patient Assessment of Diabetic Emergencies

Answer 19

1. Ensure safety
2. Primary Assessment; identify altered mental status
3. Secondary Assessment
   § History of present episode
   □ how the episode occurred, time of onset, duration, associated symptoms, any mechanism of injury or other evidence of trauma, whether there have been any interruptions to the episode, seizures, or a fever.
   § SAMPLE history
   □ Does patient have diabetes
   ® Look for a medical identification bracelet, wallet card, or other identification of a diabetic condition such as a home-use blood glucose meter. Look in the refrigerator or elsewhere at the scene for medications such as insulin, a medication with a trade name for insulin (such as Humulin), or an oral medication used to treat diabetes (such as metformin, Glucotrol, Glucophage, Micronase)
   ® Look for implanted pumps
   ® Ask about last mean, medication dose and related illness
   □ Perform blood glucose monitoring
4. Determine whether patient is able to swallow
5. Baseline Vitals
   § Depending on jurisdiction may be before baseline vitals

Question 20

Signs and Symptoms of a Diabetic Emergency

Answer 20

○ Rapid onset of altered mental status:
§ After missing a meal on a day the patient took prescribed insulin
§ After vomiting a meal on a day the patient took prescribed insulin
§ After an unusual amount of physical exercise or work
§ May occur with no identifiable predisposing factor
○ Intoxicated appearance, staggering, slurred speech, to unconsciousness
○ Cold, clammy skin
○ Elevated heart rate
○ Hunger
○ Uncharacteristic behavior
○ Anxiety
○ Combativeness
Seizures

Question 21

Children are at a greater risk of which diabetic emergency

Answer 21

hypoglycemia

Question 22

BG: less than 60 mg/dL (milligrams per deciliter) in asymptomatic diabetic (i.e., a patient with a mild alteration in mental status or who is diaphoretic [sweaty])

Answer 22

typical of hypoglycemia and indicates the need for prompt administration of glucose

Question 23

BG: Less than 50 mg/dL will typically have significant alterations in mental status that may include complete unresponsiveness

Answer 23

Patients with a blood glucose level that is this low will often be unable to safely receive oral glucose

Question 24

BG: Greater than 140 mg/dL

Answer 24

indicated hyperglycemia

Question 25

BG: Mid to high 100s are often without acute symptoms

Answer 25

may lead to hypoglycemia

Question 26

BG: Greater than 300 especially for a prolonged time

Answer 26

may experience dehydration and other more serious symptoms and should receive medical care

Question 27

BG: reading ‘HIGH’

Answer 27

usually above 500 mg/dL

Question 28

BG: reading ‘LOW’

Answer 28

extremely low blood glucose (15 mg/dL)

Question 29

Patient Care: Diabetic Emergency

Answer 29

1. Occasionally a person with only mild hypoglycemia and minor altered mental status can be treated by simply giving him something to eat. In a person who is only slightly confused, it may be more appropriate to ask him to ingest a glass of milk or a piece of toast than a tube of oral glucose. You must understand that this course of treatment will take longer to resolve the hypoglycemia and is certainly not appropriate for a patient who has severe hyperglycemia. Always use good clinical judgment to determine if your patient needs more aggressive care.
   2. Determine if all of the following criteria for administration of oral glucose are present: The patient has a history of diabetes, has an altered mental status, and is awake enough to swallow safely.
   3. If the patient meets the criteria for administration of oral glucose and if he is able, let the patient squeeze the glucose from the tube directly into his mouth.
   4. Reassess the patient. If the patient’s condition does not improve after administration of oral glucose, consult medical direction about whether to administer more. If at any time the patient loses consciousness, do not administer further oral glucose, and take steps to ensure an open airway.
   ○ Patient not awake enough to swallow:
   § Secure airway, provide
   § artificial ventilation if necessary
   § CPR if needed
   § Position the patient appropriately. If the patient does not need to be ventilated, place him in the recovery position (on his side) so he is less likely to choke on or to aspirate fluids or vomitus into his lungs.
   Call for ALS

Question 30

Can I give oral glucose?

Answer 30

§ We only administer oral glucose to those patients we feel can swallow it and protect their airway from aspiration.
§ Some EMS systems allow administration of intranasal glucagon to patients who are unable to safely swallow oral glucose. Glucagon is a naturally occurring hormone that signals the liver to convert stored glycogen into glucose and release it into the bloodstream.
□ Not in mass
□ To use an intranasal medication, the appropriate dose of glucagon is drawn into a syringe, which is then attached to an atomizer device. The atomizer is then inserted into the patient’s nostril, and the medication is administered rapidly. The mist that is ejected from the atomizer clings to the highly vascular mucous membrane of the nose, and the medication is absorbed into the bloodstream.

Question 31

Differentiating between hypoglycemia and hyperglycemia

Answer 31

○ Three typical differences
§ Onset
□ Hyperglycemia slower; hypoglycemia is faster & seizures may occur
§ Skin
□ Hyperglycemia: warm, red, dry skin
□ Hypoglycemia: cold, pale, moist or clammy skin
§ Breath
□ Hyperglycemia: acetone breath (not always present)
○ Hyperglycemia
§ rapid and deep breathes (like they just ran a race)
§ Dry mouth, thirst, abdominal pain and vomiting
§ Treatment: given under close medical supervision in hospital
○ Giving glucose will help the hypoglycemic patient by getting needed sugar into his bloodstream and to the brain. Although the hyperglycemic patient already has too much sugar in his blood, the extra dose of glucose will not have time to cause damage in the short time before he reaches the hospital and can be diagnosed and treated. This is why “sugar (glucose) for everyone” is the rule of thumb for diabetic emergencies

Question 32

Other causes of Altered Mental Status (than diabetic emergencies)

Answer 32

Hypoxia, sepsis, drug and alcohol use, brain injuries, metabolic abnormalities, infectious disease such as meningitis

Question 33

Sepsis

Answer 33

Simply an infection; refers to a more severe collection of problems associated with the body’s response to an infection

Question 34

severe sepsis

Answer 34

§ vasodilation that once helped move white blood cells now causes a severe drop in pressure within the cardiovascular system –> distributive shock
§ capillary permeability that helped dilute toxins now results in a massive fluid shift out of the cardiovascular system –> hypovolemic shock
§ Together leas to massive hypoperfusion of body tissue

Question 35

Three most common types of infection associated with severe sepsis

Answer 35

respiratory infections and pneumonia, urinary tract infections (UTIs), and skin/wound infections

Question 36

recognize pneumonia

Answer 36

history of coughing and fever

Question 37

recognize UTI

Answer 37

history of frequent or painful urination, foul-smelling urine, and/or fever
commonly associated with patients who have indwelling devices such as urinary catheters or vascular access devices as these devices provide an easy access route into the body for bacteria and other microbes.

Question 38

Signs and symptoms of severe sepsis

Answer 38

Altered mental status 
Increased heart rate 
Increased respiratory rate 
 Low blood pressure 
 High blood glucose levels 
Decreased capillary refill time

Question 39

patient care: severe sepsis

Answer 39

• severe sepsis frequently results in profound shock
• Consider high-concentration oxygen, particularly if hypoxia is present. Contact Advanced Life Support and intercept with them if possible.

Question 40

partial seizure

Answer 40

• affect only one part or side of the brain

- Seizure often only affects one part of body

Question 41

generalized seizures

Answer 41

affect entire brain

Result in loss of consciousness

Question 42

tonic-clonic seizure

Answer 42

a type of generalized seizure characterized by unconsciousness and major motor activity; without warning patient may cry

Question 43

Three distinct phases of convulsions

Answer 43

tonic, clonic, and postictal phase

Question 44

tonic phase

Answer 44

body becomes rigid, stiffening for no more than 30 seconds. Breathing may stop, the patient may bite his tongue (rare), and bowel and bladder control could be lost.

Question 45

clonic phase

Answer 45

body jerks about violently, usually for no more than 1 or 2 minutes (some can last 5 minutes). The patient may foam at the mouth and drool. His face and lips often become cyanotic.

Question 46

postictal phase

Answer 46

begins when convulsions stop. The patient may regain consciousness immediately and enter a state of drowsiness and confusion, or he may remain unconscious for several hours. Headache is common
□ Length may vary
□ some patients may become combative and even violent toward rescuers during this phase

Question 47

What precedes seizures

Answer 47

aura

Question 48

aura phase

Answer 48

§ sensation the patient has when a seizure is about to happen
§ a smell, a sound, or even just a general feeling right before the seizure begins. It can be important to document this finding when it exists

Question 49

Causes of seizures in infants and children 6 month- 3 years

Answer 49

febrile seizures; high fever

Question 50

causes of seizures

Answer 50

hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, brain tumor, congenital brain defects, infections, metabolic, idiopathic, epilepsy, measles, mumps (& other childhood diseases), eclampsia, heat stroke

Question 51

hypoxia

Answer 51

A lack of oxygen frequently causes seizures. These seizures often immediately precede respiratory and/or cardiac arrest

Question 52

stroke

Answer 52

Clots and bleeding in the brain are frequent causes of seizures. We will discuss this topic in greater detail later in this chapter

Question 53

traumatic brain injury

Answer 53

Brain injuries can cause seizures. So can scars formed at the site of previous brain trauma

Question 54

toxins

Answer 54

Drug or alcohol use, abuse, or withdrawal can cause seizures. Other poisons can also alter brain function to cause a seizure

Question 55

hypoglycemia

Answer 55

(low blood sugar) is a frequent cause of seizures.

Question 56

congenital brain defects

Answer 56

Seizures due to congenital defects of the brain (defects

one is born with) are most often seen in infants and young children

Question 57

infection

Answer 57

Swelling or inflammation of the brain caused by an infection can cause seizures

Question 58

metabolic

Answer 58

Seizures can be caused by irregularities in the patient’s body chemistry (metabolism)

Question 59

idiopathic

Answer 59

This means occurring spontaneously with an unknown cause. This is often the case with seizures that start in childhood.

Question 60

eclampsia

Answer 60

a severe complication of pregnancy

Question 61

epilepsy

Answer 61

□ an umbrella term used when a person has multiple seizures from an unknown cause
□ Born or result of head injury or surgery
□ treatment: Medication

Question 62

Patient Assessment: Seizures

Answer 62

§ important to be able to describe the seizure to emergency department personnel
§ What was the person doing before the seizure started? Was there an aura?
§ Exactly what did the person do during the seizure—movement by movement—especially at the beginning? Was there loss of bladder and/or bowel control?
§ How long did the seizure last?
§ What did the person do after the seizure? Was he asleep (and for how long)? Was he awake? Was he able to answer questions? (If you are present during the seizure, use the AVPU scale to assess mental status.)
-Multiple patients seizing at the same time is a major scene safety red flag. If this occurs, consider the possibility of a chemical weapon or similar weapon of mass destruction and take appropriate precautions

Question 63

Patient Care: If you are present when a convulsive seizure occurs

Answer 63

• Place the patient on the floor or ground. If there is no possibility of spine injury, position the patient on his side for drainage from the mouth.
• Loosen restrictive clothing.
• Remove objects that may harm the patient.
-Protect the patient from injury, but do not try to hold the patient still during convulsions

Question 64

Patient Care: After Convulsions have ended

Answer 64

○ Protect the airway. A patient who has just had a generalized seizure will sometimes drool and will usually be very drowsy for a little while, so you may need to suction the airway. If there is no possibility of spine injury, position the patient on his side for drainage from the mouth.
○ If the patient is cyanotic (blue), ensure an open airway and provide artificial ventilation with supplemental oxygen. Patients who are breathing adequately may be given oxygen by nasal cannula or nonrebreather based on pulse oximetry readings. Hypoxia is common after long periods of seizure activity.
○ Treat any injuries the patient may have sustained during the convulsions, or rule out trauma. Head injury can cause seizures, or the patient may have injured himself during the seizure. Immobilize the neck and spine if the trauma is suspected.
-Transport to a medical facility, monitoring vital signs and respirations closely.

Question 65

status epilepticus

Answer 65

When the patient has two or more convulsive seizures in a row without regaining full consciousness or a single seizure lasting more than 10 minutes (Some systems may consider a patient who is still seizing when EMS arrives) This is a high-priority emergency requiring immediate transport to the hospital and possible ALS intercept (having an Advanced Life Support team meet your ambulance en route). The Paramedics must open and suction the airway and administer a high concentration of oxygen at the scene and while en route

Question 66

complex partial seizure (symptoms and treatment)

Answer 66

often preceded by an aura.
® abnormal behavior varies widely
® Ie. Confusion, glossy stare, aimless moving about, lip-smacking, chewing, or fidgeting with clothing, may appear to be drunk or on drugs
® not violent but may struggle or fight if restrained
® Very rarely such extreme behavior as screaming, running, disrobing, or showing great fear
Treatment: For a simple or complex partial seizure, do not restrain the person; simply remove objects from his path and gently guide him away from danger.

Question 67

absence seizure (Symptoms and treatment)

Answer 67

® Less than 10 seconds
® no dramatic motor activity and the person usually does not slump or fall
® temporary loss of concentration or awareness
® may go unnoticed by everyone except the person and knowledgeable members of his family
® child may suffer several hundred absence seizures a day, severely interfering with his ability to pay attention and do well in school
® often stop before adulthood but sometimes worsen and become tonic-clonic seizures
Treatment: if you are aware that it has occurred, simply provide the patient with any information he may have missed

Question 68

Post seizure protocol

Answer 68

can not be left alone and must go drive

Question 69

Stroke or cerebral vascular accident

Answer 69

death or injury of brain tissue that is deprived of oxygen

Question 70

ischemic stroke

Answer 70

occur when a clot or embolism occludes an artery

Responsible for most strokes

Question 71

hemorrhagic stroke

Answer 71

caused by bleeding into the brain
§ Can be a result of long-standing high blood pressure/hypertension
Can be a result of weak area of an artery (an aneurysm ) bulges out and eventually ruptures forcing the brain into a smaller than usual space within the skull.

Question 72

Signs and Symptoms of Stroke

Answer 72

hemiparesis (one-sided weakness), difficulty or inability to speak, headache, aphasia
				○ Confusion 
				○ Dizziness 
				○ Numbness, weakness, or paralysis (usually on one side of the body) 
○ Loss of bowel and/or bladder control 
○ Impaired vision 
○ High blood pressure 
○ Difficult respiration or snoring 
○ Nausea or vomiting 
○ Seizures 
○ Unequal pupils 
○ Headache 
○ Loss of vision in one eye 
Unconsciousness (uncommon)

Question 73

expressive aphasia

Answer 73

difficulty in using words

Question 74

receptive aphasia

Answer 74

case the patient can speak clearly but cannot understand what you are saying, so he will clearly say things that do not make much sense or are inappropriate for the situation.

Question 75

Transient Ischemic Attack

Answer 75

ministroke
§ a patient looks as though he is having a stroke because he has the typical signs and symptoms of the condition. However, unlike stroke, a patient with a TIA has complete resolution of his symptoms without treatment within 24 hours (usually much sooner).
§ small clots may be temporarily blocking circulation to part of the brain
§ the patient’s symptoms resolve because the affected brain tissue had only a short period of hypoxia and did not sustain permanent damage
§ Patient at significant risk for full stroke
○ Need to be evaluated to avoid subsequent stroke
§ Always remember that if symptoms are present, it is impossible to distinguish between a stroke and a TIA in the field. Always assume the worst and treat as if it is a stroke

Question 76

Cincinnati Prehospital Stroke Scale

Answer 76

• Ask the patient to grimace or smile.
• Ask the patient to close his eyes and extend his arms straight out in front of him with his palms facing upward
• Ask the patient to say, “You can’t teach an old dog new tricks.”

Question 77

Patient Care: stroke

Answer 77

§ most important treatment step in caring for a stroke patient is recognition of the stroke
§ it may be difficult to determine that a stroke has taken place. There are many problems that can mimic strokes, including tumor or infection in the brain, head injury, seizures, hypoglycemia, and bacterial or viral infections that cause weakness or paralysis of facial nerves
§ you should also not fear being incorrect. It is far better to overtreat a suspected stroke patient than to ignore an actual stroke
§ Time-sensitive disorder
§ commonly the most important treatment priority will be rapid transport to an appropriate destination
○ For a conscious patient who can maintain his airway, calm and reassure him, monitor the airway, and administer oxygen if the oxygen saturation is below 94 percent or if signs of hypoxia or respiratory distress are present.
○ For an unconscious patient or a patient who cannot maintain his airway, maintain an open airway, provide high-concentration oxygen, and transport.
○ Transport to a hospital with the capabilities to manage a stroke patient (CT scan at a minimum). Your destination choice may be guided by a local stroke care protocol, so follow local guidelines.
§ Most wide-spread Advances in treatment
○ Definite onset of stroke symptoms less than 3 hours prior to the administration of the thrombolytic drug
○ An emergency CT scan of the brain confirming that there is no evidence of a hemorrhagic stroke
○ Blood pressure that is not excessively hypertensive at the time the drug is administered
○ potential candidates for thrombolytics is to determine and document the exact time of onset of symptoms
® Note down person who provides time and contact information

Question 78

syncope

Answer 78

§ many cases you will not be able to diagnose the true cause of the syncope
§ brief loss of consciousness with spontaneous recovery (few seconds to few minutes)
§ Some warning: light-headedness, dizziness, nausea, weakness, vision changes, sudden pallor (loss of normal skin color), or sweating
○ include fluttering in the chest (palpitations), a sensation of a racing heart (tachycardia), a slow heart rate (bradycardia), or headache
○ Occasionally incontinence of bladder and/or bowels

Question 79

dizziness

Answer 79

§ Determine patients meaning
○ A sensation of loss of strength
○ Vertigo (surrounding spinning around you)
○ Light-headedness

Question 80

Causes of Dizziness and syncope

Answer 80

§ Generally related to brain
§ hypoxia, hypoglycemia, and hypovolemia
§ events may happen rapidly, such as blood flow to the brain being reduced by a cardiac dysrhythmia; or they may happen slowly, such as slow gastrointestinal bleeding that finally reaches the point where the patient is unable to stand without losing consciousness
- Cardiovascular Causes
-stimulation of the carotid sinus
-vasovagal synscope (simply fainting; most common)

Question 81

Cardiovascular causes of dizziness and syncope

Answer 81

○ syncope can be a sign of acute myocardial infarction and can be caused by an alteration in the heart’s ability to pump
○ Frequently these symptoms are caused by electrical changes in the heart that result in abnormal heart rates. A cardiac dysrhythmia in which the heart beats extremely fast (a tachycardia) can lead to either dizziness or syncope
○ A very slow heart rate (a bradycardia) may also lead to dizziness or syncope through reduced cardiac output
○ May not be noticeable when patient in lying flat
® When the patient tries to sit or stand, though, dizziness and syncope can occur when blood goes to the legs and the brain does not get enough blood

Question 82

carotid sinus

Answer 82

® area is located in the carotid artery under the mandible. When stimulated, it sends signals to the heart to slow down. Some people have a very sensitive carotid sinus. All that may be needed to stimulate it in some sensitive individuals is turning the head while wearing a shirt with a tight collar

Question 83

vasovagal syncope

Answer 83

® thought to be the result of stimulation of the vagus nerve, which in turn signals the heart to slow down.
® Suddenly frightened and under significant emotional stress

Question 84

hypovolemia

Answer 84

low fluid/blood volume

Question 85

hypovolemic cause of a stroke

Answer 85

○ Causes: dehydration, internal bleeding, and trauma
® Most serious: bleeding
® Dehydration: common in heat or diarrhea
○ Women of childbearing age: ruptured ectopic pregnancy that results in significant blood loss.
® Usually accompanied by abdominal pain
○ A slowly bleeding (“leaking”) abdominal aortic aneurysm can also lead to life-threatening blood loss. Such an aneurysm often causes the patient to experience abdominal pain radiating to the back
○ Gastrointestinal bleeding with or without abdominal pain
® Fairly common in the elderly

Question 86

Metabolic and Structural Causes of Stoke

Answer 86

○ metabolic, something is wrong with the brain or the structures near it
® the inner and middle ears must be properly functioning for a person to maintain a sense of balance
® Inflammation in these areas can cause dizziness
○ Hypoglycemia –> both dizziness and syncope
○ Occasionally a stroke or seizure

Question 87

Environmental/Toxicological Causes

Answer 87

○ Alcohol is the most commonly used drug, and when a patient drinks too much, it can lead to an altered level of consciousness.
® Fluctuating levels of consciousness
○ Panic and anxiety attack
patient hyperventilates by breathing faster and deeper. When a patient breathes this hard, it can change the blood chemistry in a way that constricts the blood vessels supplying the brain with oxygen. Fortunately when the patient loses consciousness, the hyperventilation ceases and things return at least partly to normal

Question 88

Patient Assessment: Stoke

Answer 88

§ Questions to ask:
○ Describe what you mean by “dizziness.” Let the patient use his own words.
○ Did you have any warning? If so, what was it like?
○ When did it start?
○ How long did it last?
○ What position were you in when the episode occurred?
○ Have you had any similar episodes in the past? If so, what cause was found?
○ Are you on medication for this kind of problem?
○ Did you have any other signs or symptoms? Nausea? Vomiting (is there blood or material resembling coffee grounds)? Black, tarry stools (digested blood)?
○ Did you witness any unpleasant sight or experience a strong emotion?
○ Did you hurt yourself?
○ Did anyone witness involuntary movements of the extremities (like seizures)?
§ Most cases should be evaluated by ALS
○ initiate cardiac monitoring and rule out certain dysrhythmias as a cause
underestimate shock and sepsis as a potential underlying problem associated with these findings.

Question 89

Patient Care: Stroke

Answer 89

§ After attending to any threats of life
1. Administer oxygen based on oxygen saturation levels (goal is 94 percent) and patient’s level of distress. Some patients will not receive oxygen.
2. Call for ALS if the patient has signs of instability and it is available in your area.
3. Loosen any tight clothing around the neck.
4. Lay the patient flat.
5. Treat any associated injuries the patient may have incurred from the fall.
§ Decision Point: Is My Patient Stable? Is My Patient Likely to Remain Stable?
The urgency of your treatment and transport will depend on these decisions.