Treating hyperglycemia on a BLS level.

[Summit]

Many medical devices are calibrated by barometric pressure.

For my equipment including any blood testing devices, I calibrate by two barometric pressure measuring devices in the Pulmonary lab as well as a check with the local authorized weather reporting agency to ensure accuracy.

Right, but finger stick instant check units are not laboratory instruments. The only option most finger stick units have is to put in the cal strip which calibrates the unit to a particular batch of test strips. There is no option to calibrate based on barometric pressure. Thinking in terms of chemistry and physics, I'm not getting how the measurement of a nonvolatile like glucose would be significantly affected by barometric pressure. I'd think that humidity and temp would have much larger effects! Anyways, altitude screwing up finger stick units it certainly isn't a worry that I've ever heard before living up high (and we talk about altitude affects all the time). Maybe I need to research how blood glucose is measured by these devices. It does make me wonder, does patient hydration level or crit have a significant affect? Those are two things affected by short and long term exposure to higher altitudes.

I'd be more worried that at extremely high altitudes (above 18K) you might have units failing as tiny air bubbles trapped in the ICs when they were manufactured at sea level expand stressing and fracturing the interconnects (most consumer electronics are guaranteed to about 10K for this reason, but seem to work above that without issue that I've ever seen).

 

[VentMedic]

Right, but the only option most finger stick units have is to put in the cal strip which calibrates the unit to a particular batch of test strips. There is no option to calibrate based on barometric pressure. Thinking in terms of chemistry and physics, I'm not getting how the measurement of a nonvolatile like glucose would be significantly affected by barometric pressure. I'd think that humidity would have a bigger affect! Anyways, altitude screwing up finger stick units it certainly isn't a worry that I've ever heard before living up high (and we talk about altitude affects all the time).

Basic fundamentals of relative humidity and barometric pressure affect any measurements for liquids and gases as well as the sensitive sensors in the equipment. Even the oxygen your breathe includes a barometric pressure measurement in the calculation.

When you are do a cal strip, that machine is performing that cal at the barometric pressure you are at. If you fly or climb at altitude where the pressure changes, you may have to do another cal. This is also an issue with other POC machines for flight teams.

The manual for your equipment should explain this.

 

[Summit]

When you are do a cal strip, that machine is performing that cal at the barometric pressure you are at. If you fly or climb at altitude where the pressure changes, you may have to do another cal. This is also an issue with other POC machines for flight teams.

The manual for your equipment should explain this.

Well the manual said to check the piece of paper found in the test strip box. The paper in the test strips said:

"When should I calibrate my monitor? You must calibrate your monitor each time you open and use a new box of test strips."

"Clinical testing demonstrates that altitudes up to 7200ft do not affect results."

Interesting. Maybe I will call the manufacturer since I only operate between 8,000-14,500ft ASL. Maybe I'll break one of those units open and see if I see a barometric pressure sensor (which would certainly indicated an accompanying temperature sensor). I find it surprising a unit would contain those sensors with no ability to calibrate them or at least to check calibration.

 

[Scriptor]

Bgl >2000

When I was diagnosed my BGL was over 2000 (~2100 or so). ALS tried to get me some IV fluids to combat the extreme dehydration, but because i was so dehydrated my veins wouldn't hold. Ultimately, I was hospitalized in ICU for about a week with a steady drip of insulin. The blindness was the worst part, i think. That and the smell of insulin all around me. As for BLS treatment, comfort is key. Keep the feet warm, the periphrel blood vessels become so inflamed that blood flow to the extremities is dangerously low. In most cases, anyway. Trust me, if you BGL is anything over 1000, it's difficult to remain awake and oriented. And remember vision problems. Any more questions about diabetes please let me know. I am always happy and eager to share information about the subject.

On another note, how can I go about changing standing orders to allow EMT-b and even EMT-p to administer glucagon injections for low BGL emergencies? We can't do much else for them. If a diabetic is unconsious, it's a matter of how fast one can drive that determines the likely hood of saving the pt from death and possible permanent brain damage. With one shot of this stuff, that diabetic will be awake and puking in your truck in a matter of seconds. There's no prescribed dosage for the injection, it just requires a little mixing and is intermuscular (much like the epipen we carry, only it's in a real syringe). Any ideas questions or comments please let me know.

 

[Nycxice13]

I really, really do not need you tell me that I don't know how to care and treat diabetic patients and that my question "reflects the lack of knowledge" that I posses.

I am not yet an EMT and I have not yet taken an EMT class. I'm an explorer who is trying to learn a few things about patient care.

If you didn't mean that as an insult, I apologize for jumping out on you like that....

Anyways,

Let's say the pt is not diabetic, and has a BGL of 220 and is "not feeling right"... What can cause that? And once again, there is nothing that can be done for the pt? Is there anything that can cause a false-high reading?

Give o2 and transport....

 

[OzAmbo]

i believe that aussiephils protocols for hyperglycemia and an altered conscious state were NS 10ml/kg, but unsure if this is this case now.
Other than that, its the only pre-hospital treatment i have seen writen up for a hyper.

 

[DevilDuckie]

Treat the associated symptoms as best as possible, as well as giving appropriate attention to comfort and take them in. I didn't read all the posts, but I don't believe under current protocols, anything can be done prehospital to directly lower the blood sugar.

 

[medic417]

If patient is very high with s/s of such, pretty much at BLS be prepared to suction if patient begins to drool or vomit. O2. And call ALS.

When ALS gets on scene they will establish IV. Run fluid bolus. 12 lead. Double and triple check reading you get for glucose level. Administer insulin. Possibly will intubate to protect airway.

 

[DevilDuckie]

I have yet to see an ALS unit w/ Insulin

 

[ffemt8978]

I have yet to see an ALS unit w/ Insulin

Same here.

Isn't insulin normally supposed to be refrigerated? If so, how would you keep it refrigerated on the rig?

 

[Sasha]

Same here.

Isn't insulin normally supposed to be refrigerated? If so, how would you keep it refrigerated on the rig?

Read back in this thread and you'll see where akflightmedic mentioned his service in Alaska carried insulin.

 

[DevilDuckie]

People live in Alaska? :unsure:

 

[Sasha]

People live in Alaska? :unsure:

Apparently!

In igloos!

 

[medic417]

Same here.

Isn't insulin normally supposed to be refrigerated? If so, how would you keep it refrigerated on the rig?

We have fridges on our ambulances, they remain powered either by shore line or inverter. Hopefully so do you if you have RSI as those drugs also require being kept cool.

I can not believe any MICU 911 ambulance would not have insulin. Makes no sense not to have means to start correcting the problem which is one of the most common calls EMS gets.

 

[medic417]

I have yet to see an ALS unit w/ Insulin

Sad to hear that. Sounds like maybe they are not true ALS as diabetic emergencys are one where EMS can do so much for the patient.

 

[ffemt8978]

We have fridges on our ambulances, they remain powered either by shore line or inverter. Hopefully so do you if you have RSI as those drugs also require being kept cool.

I can not believe any MICU 911 ambulance would not have insulin. Makes no sense not to have means to start correcting the problem which is one of the most common calls EMS gets.

And not every 911 ALS unit is a MICU...

I know for a fact that none of the ALS rigs in the area have refrigerators on them.

 

[medic417]

And not every 911 ALS unit is a MICU...

I know for a fact that none of the ALS rigs in the area have refrigerators on them.

Do they not perform RSI? Or are they improperly storing their drugs? We have a number of drugs that have to be refrigerated.

 

[CAOX3]

I know for a fact that none of the ALS rigs in the area have refrigerators on them.

Then where the hell do you keep the beer. You guys really need to become more progressive:lol:

 

[ffemt8978]

Then where the hell do you keep the beer. You guys really need to become more progressive:lol:

Since we're a fire department, we have a 5000 gallon tender for that.

 

[medic417]

Since we're a fire department, we have a 5000 gallon tender for that.

Wondered why fire medics always seemed off balance.