EMT Standing Orders

• Routine Patient Care.
• Administer oxygen as appropriate with a target of achieving 94 – 98% saturation.
• Assist inadequate ventilations with BVM (bag-valve-mask ventilation). If respiratory arrest occurs, manage airway with OPA/NPA and maintain oxygenation and ventilations with BVM (bag-valve-mask ventilation). Anticipate and avoid aspiration.
• Obtain glucose readings via glucometer.
• If blood glucose < 3.0 mmol \ L or 60 mg/dL with associated altered mental status, refer to Diabetic Emergencies (Hypoglycemia) Protocol – Adult.
• If the patient’s mental status and respiratory effort are severely depressed, (eg narcotic overdose) consider restraint and administer naloxone
• A single dose of NARCAN (4mg) IV/IM. May repeat every 3 – 5 minutes if there is no response or if the patient relapses to a maximum of 12 mg OR
• Patients given naloxone should be transported to the emergency department for further evaluation.
• Consider acquiring 12-lead ECG.
• If trauma can be excluded, transport a patient in the coma/recovery position. If trauma is suspected, see the Advanced Spinal Assessment Procedure.
• Perform stroke assessment. Refer to Stroke Protocol – Adult. as indicated.
• See Poisoning/Substance Abuse/Overdose – Adult.
• Minimize scene time.
• Call for AEMT/Paramedic intercept, if available & assist them in patient care.

AEMT/Paramedic Standing Order:

• Establish IV/IO access.
• For severe respiratory depression, administer naloxone 0.4 – 2 mg IV/IM/IO/SQ/
• For hyperglycemic, give 500 mL bolus 0.9% NaCl IV/IO. See Diabetic Emergencies (Hyperglycemia) Protocol – Adult.
• Advanced airway as indicated.
• If hypotensive (SBP < 90), administer fluid bolus 500 mL 0.9% NaCl IV/IO. Contact Medical Direction for additional fluid or medication orders.
• Assess and monitor cardiac rhythm. Treat as indicated per appropriate protocol.
• If hypotension persists after a 2-litre fluid bolus, consider vasopressors. See Shock Protocol – Adult.
• If the patient is violent or agitated, consider restraint. See Behavioral Emergencies Including Suicide Attempts & Threats Protocol.

PEARLS:

• Altered mental status may be caused by many factors including the following: stroke, drug overdose, infection, hypoglycemia, hyperglycemia or trauma.
• AEMT/Paramedic may titrate use of naloxone in patients with respiratory depression (e.g.: narcotic overdose) to avoid transition to combative behavior by patient
• Use appropriate discretion regarding immediate intubation of patients who may quickly regain consciousness, such as hypoglycemic patients after administration of dextrose, or opiate overdose cases after administration of naloxone.