›First 5 minutes workflow
›Monitoring and access
›Cardiac monitor
›Continuous pulse oximetry
›Noninvasive BP cycling
›IV access x 2
›Airway and breathing
›Oxygen titration to SpO2 >= 94% unless chronic hypercapnia concern
›Bag valve mask ventilation if RR < 8 or inadequate tidal volume
›If GCS <= 8 or airway reflex absent, prepare RSI local protocol dependent
›Circulation
›If SBP < 90 or MAP < 65, isotonic crystalloid bolus 500 mL to 1000 mL
›If persistent hypotension after fluids, norepinephrine infusion local protocol dependent
›Immediate reversible causes
›Capillary glucose
›If glucose < 4.0 mmol/L, dextrose IV
›If opioid toxidrome, naloxone titration
›Temperature management
›Active warming if hypothermia
›Active cooling if hyperthermia
›Reversal agents and antidotes
›Dextrose
›D10W 250 mL IV
›Recheck glucose in 10 minutes
›Thiamine
›100 mg IV
›If malnutrition or alcohol use risk
›Naloxone
›0.04 mg IV
›Repeat every 2 to 3 minutes to RR and airway protection
›If no IV, intranasal 2 mg to 4 mg
›Flumazenil avoidance
›Contraindicated in chronic benzodiazepine use
›Contraindicated in mixed overdose with seizure risk
›Seizure treatment pathway
›Benzodiazepine first line
›Lorazepam 2 mg IV
›Repeat once after 5 minutes if ongoing
›Second line antiseizure
›Levetiracetam 60 mg/kg IV maximum 4500 mg
›Valproate IV local protocol dependent
›Refractory seizure
›Airway control
›Continuous infusion local protocol dependent
›Shock management
›Broad spectrum antibiotics within 1 hour if septic shock concern local protocol dependent
›Lactate guided resuscitation
›Source control planning
›Diagnostic sequence
›Glucose first
›ECG early
›VBG and electrolytes early
›CT head early if focal findings or trauma risk
›Reassessment loop
›Neuro checks every 15 minutes until stable
›Vitals every 5 minutes if unstable
›Repeat glucose every 30 to 60 minutes if hypoglycemia risk
›Repeat VBG and lactate within 2 hours if shock concern