All patients where unresponsiveness or altered mental status from non-traumatic causes are suspected including diabetes, overdose, and seizures. Dextrose is harmful to persons with ischemic brain injury when hypoglycemia is not present.

1. Perform patient assessment and ABC's (consider c-spine injury).
2. Administer high-flow oxygen via NRM. Apply pulse oximetry device and record.
3. Monitor vital signs in accordance with S.O.P. protocol.
4. Measure blood glucose level using glucometer.
5. If information available, determing:
   1. Present history; last intake, onset and progression of present symptoms.
   2. Associated symptoms; headaches, seizures, confusion, etc.
   3. Trauma clues
   4. Past history; previous medical or psychiatric problems
   5. Medications; use or abuse

6. Note surroundings; Check for pill bottles, syringes, etc. and bring with patient to the hospital. Note any unusual odor in the immediate area.
7. Transport in lateral recumbent position, or supine with full spinal immobilization if trauma suspected.
8. Secure airway with Combi-Tube if BGL is within Normal Limits, and patient does not have an intact gag reflex.

INTERMEDIATE LIFE SUPPORT

1. Establish IV access using isotonic solution, set rate appropriate to patient vitals.
2. If blood glucose level is less than 80 mg/dcl, administer 1 amp (25 gm) Dextrose 50% (D50), slow IV push. Repeat in 10 minutes if no response is noted or the patient remains lethargic. (If patient history & current presentation suggest possibility of TIA/CVA/Seizure or Drug toxicity with a history of Diabetes, and BGL is "borderline" hypoglycemic, it is acceptable to administer 12.5 gms of D50 and assess response before continuing with full 25 gms).
3. If no response to Dextrose: consider Naloxone Narcan 0.4 mg slow IV, SQ, or IM route. May repeat q 3-5 minutes, titrate for normal respiratory effort and/or adequate patient airway control. Higher doses of Naloxone are required in certain narcotic overdoses, (Darvon, Darvocet, Talwin, Talacen, etc.).
4. If patient has glucose level less than 80 mg/dcl, with associated signs and symptoms and you are unable to establish IV access (3 attempts). Administer Glucagon 1mg IM.

ADVANCED LIFE SUPPORT

1. If patient condition fails to improve or if vitas are unstable, attach and monitor ECG.
2. If the cause of the comatose patient cannot be diagnosed and reversed, Secure the airway with an ETT as soon as practical.