blood glucose levels...

[Explorer127]

how low should someone's blood glucose level be before you adminster glucose?

 

[EMTgurl911]

I heard anything below 65
The regular is 80 to 120 I believe, but that's what I heard.

 

[Ridryder911]

It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl.

Remember, we treat the patient not the numbers.

R/r 911

 

[EMT007]

Our policy calls for oral glucose when a patient has an altered level of consciousness that is possibly due to hypoglycemia and the pt has no signs of stroke.

Thats it - we dont' carry a glucometer yet, but thats in the planning stages. Once we get that, I assume we will set a numerical standard as well as the current ALOC indication.

 

[Jon]

Omars.... are you intending this to be a BLS level discussion or ALS discussion?

It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl.

Remember, we treat the patient not the numbers.

R/r 911

Amen.

If the patient is CAOx4, trying OJ and food (if available) is probably in the patient's best intrest. Patients usually prefer food to glucose paste and the paramedic's IV's.

If the patient has a decreased LOC and is unable to swallow and maintain their airway, then oral glucose is contraindicated.

Being a BLS service, we don't carry or use glucometers.

 

[emtwacker710]

It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl.

Remember, we treat the patient not the numbers.

R/r 911

I couldn't agree more, always check to see what the number is but if they are presenting signs of hypoglycemia then administer glucose, in accordance with your local protocols of course.

 

[Katie]

our protocol is 70 mg/dl for adults, 30 mg/dl for children under 2 months

 

[hitechredneckemt]

jon im a little confused are glucometers not used by bls personal in your area
In Ohio it is a bls skill. Our protocals say under 70 and the patient be able to swallow

 

[Jon]

jon im a little confused are glucometers not used by bls personal in your area
In Ohio it is a bls skill. Our protocals say under 70 and the patient be able to swallow

Nope. In PA, gulcometers are reserved for ALS.

 

[hitechredneckemt]

Thats interesting ,I did not think what other states protocols where. Im not far from PA never thought that much difference so close. Glad to have learned that

 

[Katie]

here an emt-b can use a glucometer but it is not required. it's up to the stations if they want to carry them on their units and many do not. for the most part it is an als skill, which is sad because it is quite easy to use.

 

[emtd29]

Glucometers in New York are an ALS ONLY thing.

In order for your service to have and use them a "Limited Laboratory License " is required from the state.

 

[paramedix]

It completely depends on the patient itself. You may for instance have a patient with a BGL that is 5.0mmol/L and present with some signs of hypoglycemia. Then like Rid said (treat your patient not the numbers), if you treat the numbers not your patient, why would he have those symptoms, because that falls in the normal range.

What I'm trying to get across is that every patient differs from each other. The given values are only guidelines and whats high for the one patient, might be low for the other.

Treat the patient and not the monitor...

 

[emtwacker710]

Glucometers in New York are an ALS ONLY thing.

not anymore, it is becoming BLS, my agency just got approval to use them for BLS, we of course had to put every member through an "in service" training of it and submit the proper paperwork to the state but we should have them in the rig for BLS use by the end of this month.

 

[ERnurse17]

Treat the pt not the number. if the sugar is 50 and they are alert times 4 why bother with their sugar. but if they are 65 and not alert then i would administer glucose.

 

[Jeremy89]

Last week my sister passed out at a fast food restaurant. The FD that responded was BLS and didn't have a medic (that I saw). They took her BS and it was about 65. She was A&O, at times joking with the FF's. We denied transport, got our food and drove to the ER, just to get her checked out (which worked out well because I got a chance to talk to a tech about getting a job there...)

...but if they are 65 and not alert then i would administer glucose.

Correct me if I'm wrong, but I was aware that the pt had to be alert in order to administer oral glucose. Unless there is another form IM or IV or something.

 

[ERnurse17]

I didnt mean oral glucose i meant another form like glucogon for D50. Sorry for the misunderstanding

 

[JPINFV]

here an emt-b can use a glucometer but it is not required. it's up to the stations if they want to carry them on their units and many do not. for the most part it is an als skill, which is sad because it is quite easy to use.

Well, 12 leads are easy to use (especially under the California model of using the machine interpretation to determine AMI), why don't we allow basics to do a 3 hour course and use 12 leads as well?

 

[Ridryder911]

Well, 12 leads are easy to use (especially under the California model of using the machine interpretation to determine AMI), why don't we allow basics to do a 3 hour course and use 12 leads as well?

I realize you were being sarcastic.... Dummy boxes are for just that..... dummies. I have seen them interpret a SR to be V-tach and I don't know how many inferior AMI, BBB that are truly ST elevation. Anyone using such is a fool and dangerously practicing medicine. I realize LA uses them as a interpretation guide and hence why they have a poor reputation.

It is not the skill, but rather the knowledge behind the whole process and the skills accompanied them. Too many emphasize the skills portion which is the easiest to obtain, repeated practice and stamina anyone can do them... obviously.

R/r 911

 

[JPINFV]

I realize you were being sarcastic....

I'm not going for sarcastic, but rhetorical since there are systems out there that rely on machine interpretations (yes, Los Angeles and Orange County, CA). Since this essentially waters down 12 leads to "attach wires, press a button, read top right corner," it's no different than the standard argument for Basics using pulse oximetry or blood glucose monitoring since it's "easy to use." I do agree, how ever, that the knowledge of physiology that should be required to use diagnostic instruments is generally lacking from the Basic curriculum.