556 PEDIATRIC ALTERED MENTAL STATUS

• NOTE:
  MAINTENANCE OF STABLE VITAL SIGNS IS ALWAYS THE FIRST PRIORITY. UNSTABLE VITAL SIGNS MANDATE THE USE OF OTHER PROTOCOLS.

In pediatric patients in coma, with evolving neurological deficit, or with altered mental status:

1. Begin Basic Life Support Altered Mental Status procedures.

   During transport, or if transport is delayed:

2. Administer Glucagon 1.0 mg, IM. (See Appendix J.)

3. Begin an IV (IO) infusion of Ringer's Lactate (RL), to keep vein open. Attempt IV or IO only once each.

4. Administer 25% Dextrose 0.5 gm/kg IV (IO) bolus. (See Appendix J.)

5. If there is no change in neurological function, administer Naloxone 2.0 mg, IV (IO) bolus, in patients two (2) years of age or older. Use half the amount (1.0 mg) of this drug in patients less than two (2) years of age. (See Appendix J.)

6. If the patient continues to have an altered mental status, repeat Naloxone 2.0 mg, IV (IO) bolus, in patients two (2) years of age or older. Use half the amount (1.0 mg) of this drug in patients less than two (2) years of age. (See Appendix J.)

7. If IV access has not been established, administer Naloxone 2.0 mg, IM, in patients two (2) years of age or older. Use half the amount (1.0 mg) in patients less than two (2) years of age. (See Appendix J.)

8. Transportation decision.