Here's an interesting one...

[Eydawn]

Maintain IV access, monitor airway, get him to definitive care or hand off to an ALS unit. If he seizes there's nothing I can do as a Basic to intervene... and I am not seeing anything I can further treat.

Wendy

CO EMT-B

[akflightmedic]

3 man engine with a Capt riding....???

Sorry got distracted

[firedoc5]

Was he having a BM and vageled? I'd do a 12 lead, is his skin tenting?

Beat me to it.

O2 Sat? Any improvement with LOC with O2? Any voluntary or involuntary movement? Any Rx of Digitalis, PO Insulin?

Also possible CVA. Good mention of meningitis, reaching but something to keep in mind. Also, with the snoring resp. consider aneurism. Lost my Fire Capt. to an aneurism.

Outstanding scenenario.

[mark]

So following our ALOC unknown cause protocol, we push .4mg Narcan IV. We still have no have no med list but we figured we'll give it a shot and see what happens. Sure enough, he starts coming around. He begins opening his eyes to painful stimuli and starts moving arms and legs trying to get out of c-spine, becomes verbal to yes/no questions, shows signs of short term memory loss. He is an obviously post ictal state. At this point, you begin preparing pt for transport and move him to the stretcher and then to the truck. What's next? This will be my last post before I fill you in on the answer.

[firedoc5]

If coming around with Narcan, accidental doubling up on home Rx? What is wife's meds? Use of wife's valium, narcotic, anti-anxiety med?

I know the Narcan wouldn't effect it, but ETOH? Or did I miss that?

Is there an increase and improvement of resp?

[BEorP]

So following our ALOC unknown cause protocol, we push .4mg Narcan IV.

Are you saying that everyone who is unconscious for an unknown reason gets narcan where you work?

[CBEMT]

Are you saying that everyone who is unconscious for an unknown reason gets narcan where you work?

Strictly by the book, any "impaired consciousness" qualifies for 100mg Thiamine, 25g D50, and 2mg of Narcan (in that order) under my protocols.

It's written that way because glucometers are not required equipment on any ambulance.

Now, are most providers in this area smart enough to check vitals, BGL, and pupils before pushing all that, and thus typically avoid doing so? Of course.

But that's the protocol.

[BEorP]

Strictly by the book, any "impaired consciousness" qualifies for 100mg Thiamine, 25g D50, and 2mg of Narcan (in that order) under my protocols.

It's written that way because glucometers are not required equipment on any ambulance.

Now, are most providers in this area smart enough to check vitals, BGL, and pupils before pushing all that, and thus typically avoid doing so? Of course.

But that's the protocol.

I've read about the old "coma cocktail" before but thought that it was long gone. Even though most providers may be smart enough not to blindly administer medications, it is scary to think that your protocols are written so you can.

[fireflymedic]

There is no longer a place for unconscious/unknown protocol because with the medications you are administering, there should be no question as to being unknown. Check your pupils - pinpoint along with other s/s of narcotic od, then give narcan, check blood sugar - at 205 do you really want to be giving this guy an amp of D 50 it's obvious he's not hypoglycemic ! Thiamine, well is he an alcoholic? If so, perhaps an alcohol induced seizure, but thiamine is given to help with absorbtion of D 50 in alcoholics....it scares me that you still maintain these protocols. My suggestion to your med director would be let's update these puppies !

[CBEMT]

My medical director has nothing to do with it. He has no authority to change them- protocols come from the state. No subtractions, no additions.

There was a state "Medical Consultant" MD that signed off on all the protocols and basically functioned as the state Medical Director, but the funding for his position was eliminated recently due to the state budget deficit. Even if I wanted to make suggestions, there's nobody to enact it.

When you think about it, the protocol couldn't be updated until glucometers were required equipment. Since that won't happen, we're stuck with a protocol written not necessarily for the lowest denominator of provider, but for the lowest denominator of service. The provider has no control over whether or not his or her superiors decide that glucometers are an acceptable expenditure- and my former employer did not for almost 15 years.

As long as situations like that are possible, the Coma Cocktail protocol will still be in effect, I think.