blood glucose levels...

[Kimmy Schaub]

Normal glucose levels usually fall between 70 and 150 mg.

 

[R-Katt]

Our protocols call below 60. But then I have had a pt. in the back who was acting a little sluggish, not really complaining much,with no altered mental and I was kinda at a standstill (wishing I was a medic :saduntil I checked his BGL level and it was 27:unsure:

Uh....can you say "uh-oh"?

Of course I checked it again to make sure it was correct and sure enough it was the same.After a little oral glucose paste he was right as rain on a summer night!A lot more alert and feeling better!!

Glucometers are very unpredictable and love to give you a hard time!

You have to be aware and use your good judgement.

If yours says 20 but your pt. is fine with no symptoms then you might want to ? your Glucometer.
Always treat the pt!! (which is the best advice!!)

 

[Ridryder911]

Part of the problem of glucometers is most do not calibrate them daily. Otherwise their pretty accurate.

R/r 911

 

[piranah]

my protocol is under 60 administer oral glucose and if contraindicated. admin
glucagon 1mg/dose IM per med control

 

[Epi-do]

Our protocols state that BLS can administer oral glucose for a "patient showing signs of hypoglycemia, and is in control of his/her own airway."

At the ALS level it states "if blood glucose suggests hypoglycemia" so the medic can still use his/her own judgement as to whether or not D-50 is the right route to go.

We actually do not have a diabetic protocol. It is actually an altered level of consciousness protocol and includes when narcan would be indicated to use as well.

 

[mikeylikesit]

Well remeber as diabetics are all different where they keep their BGL at the number varies. what is too low for one patient say 50 is ok for another. i go with 50 being a diabetic myself. some people are completely coherant at 35, so it all veries but a safe number is always 50 that way no harm done.

 

[JPINFV]

I just wanted to point this out since it seems to be a subtle piece of information. There are conditions besides DM that cause hypoglycemia. They may be a lot rarer than DM, but they do exist.

 

[mikeylikesit]

well for instance drinking alcohol dramatically raises the blood sugar before slamming it down acting as a synthetic insulin. also sleep deprivation and stress after the exhaustion stage and the depletion of the glycogen reserves.

 

[Raf]

In MA it is required that all basic ambulances carry oral glucose (paste or tablets). However it is not mandatory that we have glucometers, but services can opt to have them available. I have never seen a basic use a glucometer, probably because of money and maintanence.

Same thing with pulse oximetry, optional for basic units, but I have never seen a basic use one. We just grab the pulse ox for the paper work when we get to the ER at the triage station.

 

[sabbymedic]

I do not have U.S. Value's but I can give Canadian values and we will administer glucose if the BG is < 4.0 mmol or equal to it depending on the pt's state of GCS. As a primary care medic I can give Glucagon at the above mentioned values if the pt is not responding well. If the pt is responding ok and I can get them to eat or drink I do that instead it is less invasive.

 

[PapaBear434]

Just thought I'd chime in and say that here in Virginia, BSL are able to use glucometers, though it's not necessary. If the patient shows signs of hypoglycemia and is able control the airway, hook them up with some pink goo.

But every rig is equipped with a meter, and they see quite regular use by Basics. Just seems like a Basic skill, though diabetes runs high in my family so maybe it's just simple because of my familiarity.

 

[philfry]

Kentucky required additional training for BLS providers to utilize glucometers. Most services here have these protocols in place. Our local protocol is to administer oral glucose if below 80 and patient is conscious and able to swallow the med. Otherwise, it would move to the ALS procedures for hypoglycemia (D-50, Glucogen).

 

[PapaBear434]

Kentucky required additional training for BLS providers to utilize glucometers. Most services here have these protocols in place. Our local protocol is to administer oral glucose if below 80 and patient is conscious and able to swallow the med. Otherwise, it would move to the ALS procedures for hypoglycemia (D-50, Glucogen).

Ah, the good ol' D-50. I am doing my ALS intro clinical right now, and saw my classmate blow an IV and push D-50. Of course, we didn't know he infiltrated until after the skin got all red, irritated, and of course eventually necrotic.

It wasn't bad, though, as our proctor caught it before it could get real bad. Just some irritation as far as the patient is concerned, and she was really nice to a couple of nubs like us.

 

[BossyCow]

We had an unconscious pt. Bystanders said he had heart surgery a month prior. Before losing consciousness, he clutched his chest and said he had the worst pain he'd ever had in his life, then passed out. His buddies called 911.

We arrive to a scene where there are 4 guys, 1 of them passed out in a chair and the thick smell of wacky tobaccy in the air. Pt is alert only to verbal, ABCs intact. Skin grey, sweaty, no medic alert bracelet. We called for ALS support immediately upon hearing 'unconscious pt', but ALS is 15 - 20 minutes away. As we start our assessment, give the guy some O2, he starts coming around, sits up, is able to talk to us, but is slightly combative, only complaint is chest pain 10:10. Our protocols insist on a glucose stick and turns out our guy has a blood sugar of 33. By the time we met up with ALS, his blood sugar was up to 60 somthing and was no longer combative.

Yes he still needed ALS, but my point is that ALS got a much more stable pt due to BLS intervention. Without the glucometer and our MPDs standing orders to check sugar, we probably would have thought cardiac on this one and not given sugar causing the pt to deteriorate further.

 

[scottmcleod]

I do not have U.S. Value's but I can give Canadian values and we will administer glucose if the BG is < 4.0 mmol or equal to it depending on the pt's state of GCS. As a primary care medic I can give Glucagon at the above mentioned values if the pt is not responding well. If the pt is responding ok and I can get them to eat or drink I do that instead it is less invasive.

"4 to 8, feelin' great" ;-)

Google's cache has a chart

http://72.14.205.104/search?q=cache...+dl&hl=en&ct=clnk&cd=1&gl=ca&client=firefox-a

 

[alex71]

80 to 120 is normal

 

[JPINFV]

80 to 120 is normal

It all depends on the units, otherwise just about any unit less number could be considered "normal" or "abnormal."

 

[daedalus]

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

I work in an ALS 911 system in LA right now as transport for Fire. I can't stand the fire medics here if you can even call them medics. I am better at 12 lead interpretation than they are. I once pointed out A Fib and was promptly told that if the machine doesn't see it than it doesn't exist. But than again these medics go to a six month Paramedic Program run by the county of LA. I have only taken a formal college class on ECG interpretation through the local RN program...

 

[sabbymedic]

Well see there is a difference some medics practice clinitian based medicine while others go stricktly by the standing orders and what the machine says. The level of training and how far an individual is willing to take it says a lot to your dedication to this field.

I am a Primary Care Medic in Ottawa Canada and I interpret 12 Leads in order to DX STEMI's so we can bipass ER's and go straight to the heart institute. We have been trained and practice our training ever year twice a year in Base Hospital CME's to make sure we are up on the interpretation.

I think the heart is a cool vital organ and love to practice studying it.

 

[skyemt]

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.

this is not accurate... in many areas of NY, it is not becoming BLS at all.
it has been allowed in NY for some time, but it is the county level that decides whether or not it will be a BLS skill for their EMT's , and most have decided that it is not.