Bgl invasive

[JPINFV]

Just curious, waveform capnography or colometric capnography? If it's waveform, how much training is required?

 

[imadriver]

Waveform. Well, really, I would suppose it's more of an "ALS Assist" type thing. We have LifePaks we use. Basically, we are taught what the numbers are, where about the should be, and the best ways to correct it if it's high or low. Also, (not sure if this is everywhere) but we are taught to make sure it's good using the number / waveform, make sure we get a good strip on the waveform, and that we need to pull it if the cap is bad. We usually do it for the medics once they intubate themselves, but we are able to use them for our Kings. That way it frees up the medic for IV's or whatever else.

 

[Akulahawk]

Here in Florida, I went to school and work. I was taught that sp02 was a basic skill? Didn't realize it wasn't everywhere else??


Anyway, the BGL I think would be important to a Emergency BLS crew... I work an ALS system so never really encountered it. but our EMT's in Florida are allowed to use Kings, start IV's (if trained), use sp02, use Capnography on our kings, and even IO once trained and cleared directly by our MD. But we can't check BGL's... There is always the "trick" with the IV needle, although, I've herd of a few arguments about that. Since the Glucose Meter is gauged for Capillary blood, it does indeed give a different reading SOMETIMES from what I've personally tested. But then again it could be chalked up to other causes too.

Not all glucometers are calibrated ONLY for capillary blood. Some are also calibrated for venous blood samples and some of those can apply a correction to the sampled level to provide an equivalent to capillary blood level. This is just one of those "know your equipment" things and what it's set up to do. If I know my glucometer is able to use venous samples, I'll check that using a blood sample from my IV start, if that's available, so that I don't have to stick someone to get that checked.

I'm not at all concerned about Basics doing BGL measurements. They just have to learn which patients it's a good idea to check, otherwise they'd be sticking EVERYONE for a BGL when most don't necessarily need to be checked or checking the BGL every time that vitals are done. That's an awful lot of sticks for likely little benefit.

I'm not concerned with Basics doing capnography or SpO2 on patients that have had an "advanced airway" placed either by them or by a medic. Why? The knowledge to do the SpO2 and capnography should be embedded into the courses that certify the Basic to use a King Tube or assist with (or do) OTI. If you use those airway tools, you should also know how to monitor the patient... If you don't know how or why, you shouldn't be able to do the skill that calls on the additional knowledge to monitor said skill.

 

[ArcticKat]

Just curious, waveform capnography or colometric capnography? If it's waveform, how much training is required?

It would actually be colormetric capnometry, not capnography. Although the terms capnography and capnometry are sometimes considered synonymous, capnometry suggests measurement (ie, analysis alone) without a continuous written record or waveform.

When imadriver stated capnography he would be referring to a waveform or other continuous record, not a colourmetric device.

 

[systemet]

We have LifePaks we use. Basically, we are taught what the numbers are, where about the should be, and the best ways to correct it if it's high or low.

Be very careful with this. Not everyone needs a PETCO2 of 35-45mmHg.

 

[pa132399]

i was always given the reason us emt's in PA cant start ivs and do bgl readings is that the phlebotomist's unions had a fit saying it was there job and we were infiltrating their scope of practice... hope fully that makes some sense and in pa emts are not allowed to administer drugs we are allowed to assist the pt in taking there own drugs such as epi-pens, nitro and inhalers the only drug we are allowed to administer is o2 and technically it should be high flow because we cant diagnose either. gotta love ems in PA propbably why im in medic school

 

[systemet]

Ok. Would a patient present with one sided difficulty in a diabetic emergency.

Sent from my Desire HD

I should also point out that this can also be a transient finding following some seizures, e.g. Todd's paresis

http://www.ninds.nih.gov/disorders/toddsparalysis/toddsparalysis.htm
http://www.ncbi.nlm.nih.gov/pubmed/20236802

 

[Tigger]

i was always given the reason us emt's in PA cant start ivs and do bgl readings is that the phlebotomist's unions had a fit saying it was there job and we were infiltrating their scope of practice... hope fully that makes some sense and in pa emts are not allowed to administer drugs we are allowed to assist the pt in taking there own drugs such as epi-pens, nitro and inhalers the only drug we are allowed to administer is o2 and technically it should be high flow because we cant diagnose either. gotta love ems in PA propbably why im in medic school

The idea that a basic must only provide high flow 02 is also asinine, made even more so by the reasoning that basics can't "diagnose." Sure, the basic's training does not provide near enough knowledge to figure out the underlying cause of respiratory distress, but how does that matter? I am going to correct the respiratory distress with supplemental oxygen (hopefully). If the patient is in slight distress, they aren't getting much supplemental 02, so they are getting a nasal. I fail to see how I have diagnosed anything here, I am just using the proper tool to control a symptom.

 

[pa132399]

i also agree that it is asanine along with many other thing that we are limited to as well i have also put pt's on nasals if they were recieving supplemental oxygen. if the pt requires high flow it most likely should be being transported with a medic on board because there is a bigger problem than i can handle in most cases.

 

[18G]

i was always given the reason us emt's in PA cant start ivs and do bgl readings is that the phlebotomist's unions had a fit saying it was there job and we were infiltrating their scope of practice... hope fully that makes some sense and in pa emts are not allowed to administer drugs we are allowed to assist the pt in taking there own drugs such as epi-pens, nitro and inhalers the only drug we are allowed to administer is o2 and technically it should be high flow because we cant diagnose either. gotta love ems in PA propbably why im in medic school

Phlebotomists Union? I highly doubt that. Phlebotomists take blood, they don't start IV's. Two similar but different skills. Who ever told you that didn't know what they were talking about. And why would a phlebotomist care about who takes a FSBGL when they don't even perform that skill?

And in PA, EMT"s do primarily administer a med. BLS ambulances have the option of carrying Epi-Pens and administering the Epi based on their own assessment.

And the O2 comments... at least the ALS protocols and Im pretty sure the BLS protocols are the same, but they don't absolutely require high-flow oxygen. Titration of oxygen is specified in the protocols and is needs based. Have you read and performed the required protocol update?

Pennsylvania has one of the most progressive EMS systems and protocols that allow Paramedics to be Paramedics and utilize their own clinical judgement. BLS protocols are decent as well.

 

[emergancyjunkie]

i was always given the reason us emt's in PA cant start ivs and do bgl readings is that the phlebotomist's unions had a fit saying it was there job and we were infiltrating their scope of practice... hope fully that makes some sense and in pa emts are not allowed to administer drugs we are allowed to assist the pt in taking there own drugs such as epi-pens, nitro and inhalers the only drug we are allowed to administer is o2 and technically it should be high flow because we cant diagnose either. gotta love ems in PA propbably why im in medic school

Yeah according to protocal we can carry and give epi-pens. As my teacher says read your protocal

Sent from my Desire HD

 

[pa132399]

well yeah well maybe i was misinformed but hey its just what i was told. but hey i still believe that we shouold be able to take bgl readings as emt's but thats too much for the emt scope of practice if it is defined as invasive. and yes i also agree that pa is very progressive but also we do have our own issues with different ems councils then specific medical directors if we could only have a universal system i think it would make life simpler.

 

[pa132399]

my hometown bls service does carry epi pens on the ambulance but we technically in all emt training that you will recieve is emt's can assist the pt not directly give even if the pt cant lift there arm to stick the epi pen in there leg we were told put it in there hand and assist them. but hey different instructors say different things.

 

[emergancyjunkie]

my hometown bls service does carry epi pens on the ambulance but we technically in all emt training that you will recieve is emt's can assist the pt not directly give even if the pt cant lift there arm to stick the epi pen in there leg we were told put it in there hand and assist them. but hey different instructors say different things.

Yeah that's true. I will find out for sure tomorrow for sure if its assisting or actually giving the epi pen. And I did find out if the patient has a family member that knows how to do a BGL they can do it if there present at the time of the call

Sent from my Desire HD

 

[emergancyjunkie]

well yeah well maybe i was misinformed but hey its just what i was told. but hey i still believe that we shouold be able to take bgl readings as emt's but thats too much for the emt scope of practice if it is defined as invasive. and yes i also agree that pa is very progressive but also we do have our own issues with different ems councils then specific medical directors if we could only have a universal system i think it would make life simpler.

I agree a universal system would be easier.

Sent from my Desire HD

 

[pa132399]

i wish it wasnt such a pipe dream to ask for the system to be universal or if in my case paramedic is taught and tested to a national level. it would be lovely to learn these skills and drugs and such but it is very discouraging that i have to throw a bunch of what i will learn out the window the day i pass the registry and relearn what my local protocols are.

 

[18G]

i wish it wasnt such a pipe dream to ask for the system to be universal or if in my case paramedic is taught and tested to a national level. it would be lovely to learn these skills and drugs and such but it is very discouraging that i have to throw a bunch of what i will learn out the window the day i pass the registry and relearn what my local protocols are.

Not sure where you are getting your information but you may want to look for a new source.

Paramedic education is taught to a national standard and curriculum. National Registry is a standardized exam given to the majority of Paramedic candidates. Each state doesn't maintain their own Paramedic curriculum. The objectives are set and the same for everyone. Granted some programs may go above the minimum objectives.

I assure you that everything you learn in your Paramedic program will be of some value. And just because certain drugs aren't in your protocols doesn't mean it's not important to know how they work. If you end up being an IFT Paramedic you will definitely want to know as much pharmacology as possible. For example, as an IFT Medic I can transport, monitor, and switch out blood products. 911 Medics obviously don't deal with that but it's important for me to know about transfusion reactions and what to do about them. So don't dismiss anything your learning.

A drug may not be in the drug box now but it could be 6 months from now. So learn as much about drugs as you can.

I went to Paramedic school in Maryland and did field time in Maryland so naturally became accustomed to Maryland protocol. But it wasn't a big deal to review and learn the PA ALS protocols. It actually makes you more diverse as a provider since you have an awareness of other system EMS protocols and how they are implemented (ie if you ever work in that state).

And a push is in the works for a standardized EMS education delivery. Just takes some time. Learn all you can and apply it wherever you end up.

 

[18G]

my hometown bls service does carry epi pens on the ambulance but we technically in all emt training that you will recieve is emt's can assist the pt not directly give even if the pt cant lift there arm to stick the epi pen in there leg we were told put it in there hand and assist them. but hey different instructors say different things.

Please, if a patient is in severe anaphylaxis with an altered mental status and they can't lift their arm or follow instruction and an Epi-Pen is right there... give it to them!. Don't mess around with trying to hold their hand around the Epi-Pen based on some technicality.

I haven't seen an actual definition for "assist" as it is applied in the Epi-Pen protocol. Assist can mean any number of ways.

 

[JPINFV]

Paramedic education is taught to a national standard and curriculum. National Registry is a standardized exam given to the majority of Paramedic candidates. Each state doesn't maintain their own Paramedic curriculum. The objectives are set and the same for everyone. Granted some programs may go above the minimum objectives.

Not necessarily. There is plenty of variety in the scope and education standards among states that do accept/use NREMT exams. The question is how much does each state that utilizes NREMT surpass the standards that NREMT uses to develop their exam?

And a push is in the works for a standardized EMS education delivery. Just takes some time. Learn all you can and apply it wherever you end up.

Why would you want that? Variations between different schools is not necessarily a bad thing. In terms of medical education, how each medical school delivers their content can vary wildly, with the caveat that they all meet the standard of the accreditation boards and meet the demands of the appropriate licensing exam.

 

[18G]

Not necessarily. There is plenty of variety in the scope and education standards among states that do accept/use NREMT exams. The question is how much does each state that utilizes NREMT surpass the standards that NREMT uses to develop their exam?


Why would you want that? Variations between different schools is not necessarily a bad thing. In terms of medical education, how each medical school delivers their content can vary wildly, with the caveat that they all meet the standard of the accreditation boards and meet the demands of the appropriate licensing exam.

That's pretty much what I was saying. They currently meet a standard DOT curriculum. Some may add to that. But all in all the learning objectives are the same.