About
Section 1: General Patient Care
Section 2: Medical Protocols
2.01 - Adrenal Insufficiency / Crisis (Adult & Pediatric)2.02A - Allergic Reaction / Anaphylaxis2.02P - Allergic Reaction / Anaphylaxis2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult2.03P - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Pediatric2.04 - Behaviorial Emergencies (Adult & Pediatric)2.05 - Behaviorial Emergencies - Restraints (Adult & Pediatric)2.06A - Bronchospasm / Respiratory Distress (Adult)2.06P - Bronchospasm / Respiratory Distress (Pediatric)2.07 - Hyperthermia (Environmental - Adult & Pediatric)2.08 - Hypothermia (Environmental - Adult & Pediatric)2.09 - Nerve Agent / Organophosphate Poisoning2.10 - Obstetrical Emergencies2.11 - Newly Born Care2.12 - Resuscitation of the Newly born2.13 - Pain and Nausea Management2.14 - Poisoning / Substance Abuse / Overdose2.15A - Seizures2.15P - Seizures2.16A - Shock2.16P - Shock2.17A - Sepsis2.17P - Sepsis2.18 - Stroke2.19 - Hyperkalemia2.20 - Home Hemodialysis Emergency Disconnect
Section 3: Cardiac Emergencies
Section 4: Trauma Protocols
Section 5: Airway Protocols & Procedures
Section 6: Medical Director Options
Section 7: Medical Policies & Procedures
Section 8: Special Operations Principles
Appendices
2.03A - Altered Mental / Neurological Status / Diabetic Emergencies / Coma - Adult
EMT-Basic (Standing Orders)
- 1.0 Routine Patient Care
- If patient is unconscious or seizing, transport on left side (recovery position).
- Glucose or glucagon are indicated only for documented hypoglycemia. If authorized and trained to do so, obtain a blood sugar reading.
- If glucose is known to be less than 70 mg/dL and the patient is conscious and can speak and swallow, administer oral glucose or other sugar source as tolerated.
- Oral glucose. One dose is one tube.
- Other sugar sources are acceptable
- A second dose may be necessary after 10 minutes if patient remains symptomatic.
- Glucagon 1mg IM
- Recheck glucose 15 minutes after administration of glucagon.
- May repeat glucagon 1mg IM if glucose level is <70mg/dL with continued altered mental status.
EMT-Advanced (Standing Orders)
- For HYPOglycemic emergency:
- Dextrose 12.5 g IV/IO. Recheck glucose 5 minutes after administration of dextrose.
- May repeat dextrose up to 25 g IV/IO if glucose level is <70mg/dL with continued altered mental status.
- Glucagon 1mg IV/IO/IM/IN if unable to establish IV access
- Recheck glucose 15 minutes after administration of glucagon.
- May repeat glucagon 1mg IV/IO/IM/IN if glucose level is <70mg/dL with continued altered mental status.
- For HYPERglycemic emergency:
- Administer 500mL fluid bolus, then 250ml/hr.
EMT-Advanced (Medical Control)
- Additional doses of above medication
EMT-Paramedic (Standing Orders)
- See Above protocols
Caution:
If cerebrovascular accident is suspected, follow2.18 Stroke Protocoland notify Medical Control.
Note:
- Hypoglycemic Emergency:
- Glucose < 70mg/dL with associated altered mental status.
- Causes of hypoglycemia include medication misuse or overdose, missed meal, fection, cardiovascular insults (e.g., myocardial infarction, arrhythmia), or changes in tivity (e.g., exercise).
- Sulfonylureas (e.g., glyburide, glipizide) have long half-lives ranging from 12-60 hours. Patients th corrected hypoglycemia who are taking these agents are at particular risk for recurrent mptoms and frequently require hospital admission. Hyperglycemic Emergency:
- Glucose > 300 mg/dL with associated altered mental status
Note:
Dextrose may be administered in any concentration (D10, D25, D50), as long as the correct dose is given.