First Due Academy GeneralEMREMTAEMTParamedic

Altered Mental Status — Utah 2025 Protocol

Rule out reversible causes first — glucose, opioids, hypoxia, stroke.

Steps by Cert Level

ALL: Blood glucose check MANDATORY. Assess AEIOU-TIPS. Airway protection priority.
EMT: Oral glucose if patient can swallow and BGL < 60.
AEMT: IV/IO access. D10W 250mL IV or D50W 25g IV for hypoglycemia. Naloxone 0.4mg IV/IO/IM if opioid OD suspected.
PARAMEDIC: Thiamine 100mg IV BEFORE dextrose if Wernicke's suspected (chronic ETOH). Naloxone 0.4mg IV/IO/IM (repeat q2–3min). Intubation if airway compromised.