›Immediate stabilization workflow
›Cardiac monitor
›Pulse oximetry
›IV access for unstable patients
›Point of care glucose within 5 minutes
›Temperature measurement within 5 minutes
›If altered mental status
›Escalate to resuscitation bay
›Immediate glucose correction if low
›Test and consult pathway
›If focal deficit or sudden onset
›CT head immediately
›Stroke protocol activation per local protocol
›If hyperthermia with clonus or rigidity
›CK
›Electrolytes
›Toxicology review
›If seizure concern
›EEG pathway
›Antiseizure medication per protocol
›Syndrome directed treatment
›Alcohol withdrawal
›Benzodiazepine dosing per local protocol
›Thiamine before glucose when feasible
›Serotonin syndrome
›Stop serotonergic agents
›Benzodiazepines for agitation
›Active cooling for hyperthermia
›Neuroleptic malignant syndrome
›Stop dopamine blockers
›Aggressive supportive care
›Dantrolene use per local protocol
›Enhanced physiologic tremor
›Treat trigger
›Fluids for dehydration if indicated
›Essential tremor symptomatic options
›Propranolol PO 10 mg to 20 mg
›Titrate based on heart rate and blood pressure
›Avoid in asthma or bradycardia
Monitoring and reassessment loop
›Reassessment triggers and timing
›Neuro reassessment every 30 to 60 minutes if evolving symptoms
›Repeat vitals every 15 to 30 minutes if toxidrome concern
›Repeat glucose after correction within 15 minutes
›Repeat CK and creatinine every 6 to 8 hours if rhabdomyolysis risk
›Specialty involvement criteria
›Neurology
›New focal deficit
›New disabling movement disorder
›Toxicology
›Suspected serotonin syndrome
›Suspected NMS
›Unknown ingestion
›Critical care
›Hyperthermia
›Autonomic instability
›Status epilepticus