Читать книгу Emergency Medical Services - Группа авторов - Страница 370

The EMS physician, and all prehospital clinicians, must approach the prehospital management of the patient with AMS in a systematic fashion. A broad differential diagnosis must be considered and maintained throughout the patient encounter. Ongoing evaluation must occur even while treatment steps are accomplished. Attention must be given to supporting the patient’s vital functions and to reversing those disorders that can be treated in the field.

Basic life support protocols for patients with AMS should focus on the evaluation and treatment of airway and breathing problems while assessing vital signs for further clues as to the etiology of the AMS. BLS personnel also have the ability to identify and treat opioid overdose with naloxone and to treat hypoglycemia with oral glucose in many jurisdictions.

Advanced life support clinicians may provide fluid resuscitation, IV dextrose to patients with hypoglycemia, other possible antidotes for suspected overdose, and many other medications to treat the suspected underlying cause of AMS. The advanced clinician’s greatest tool, however, is his or her education and ability to maintain a high degree of suspicion for multiple possible contributors to a patient’s AMS. The appropriate EMS protocol for AMS is one that prioritizes rapid and thorough assessment and management of vital signs, allows for the correction of conditions that are reversible in the field, and branches to consider other protocols based on the likely underlying causes of AMS.