# Bgl invasive



## emergancyjunkie (Sep 13, 2011)

Does anyone know why an emt-b in pa can give an epi-pen but can not check a bgl

Sent from my Desire HD


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## Katy (Sep 13, 2011)

emergancyjunkie said:


> Does anyone know why an emt-b in pa can give an epi-pen but can not check a bgl
> 
> Sent from my Desire HD


You said it yourself, it is considered invasive and therefore EMT's aren't allowed to do it. Why that is, I don't know.


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## WoodyPN (Sep 13, 2011)

So when the medic starts the IV, take the catheter from him/her and use the bit of blood on it to get the glucose.


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## CAOX3 (Sep 13, 2011)

There are still places thst don't allow EMTs to measure BGL?


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## medicdan (Sep 13, 2011)

CAOX3 said:


> There are still places thst don't allow EMTs to measure BGL?



Yep! In fact there are places that don't allow EMTs to give epi pens.

Sent from my DROID2 using Tapatalk


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## emergancyjunkie (Sep 13, 2011)

CAOX3 said:


> There are still places thst don't allow EMTs to measure BGL?



Yea in pa we can't do bgl on a bls unit

Sent from my Desire HD


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## Yarbo (Sep 13, 2011)

I'm thankful for being a Canadian EMT... lol can do a whole lot more skills at the basic level.


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## CAOX3 (Sep 13, 2011)

emt.dan said:


> Yep! In fact there are places that don't allow EMTs to give epi pens.
> 
> Sent from my DROID2 using Tapatalk



I've seen damage done with epi pens, but BGL seems ridiculous.


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## 18G (Sep 13, 2011)

I am on the fence with EMT's checking a BGL. 

I admit it is an obviously simple skill I just don't see how it changes outcomes on the BLS level. If you get a decent history and pt. presents as diabetic, then treat as such. If patient is so altered and no family is around to give a history, treat as diabetic if your assessment steers you that way. Physical signs are present with a lot of hypoglycemia patients (diaphoresis, rapid pulse and breathing). I don't think the numerical value from a glucometer will effect treatment or prevent a diabetic from getting glucose as a BLS provider.

Would it be a nice thing to have? I think it would be nice but thinking clinically I don't see any improvement in treating patients. And if its not gonna change the patient care provided as an EMT than why do it? Maybe that is the level of thinking. 

With that said, I do think it is extremely stupid that family calls EMS and the EMT's can't assess blood sugar and they have to ask the family to do it. When I was an EMT in PA I asked the family for the glucometer and did it myself. Technically not supposed to but oh well... slap my wrist.   

I don't know if measuring BGL is going to be apart of the new EMT level or not. As an AEMT I know it will be in PA. 

That is just my opinion on EMT's and glucometers in PA. Im not opposed to it and don't see a problem with it in and of itself Im just not seeing a real clinical benefit and that is where my mind is at. A Medic is more times than not gonna recheck it anyway when they arrive prior to treatment.

And more specific to your question comparing BGL assessment to Epi-Pens... an Epi-Pen has a significant clinical effect and is life saving. An Epi-Pen can mean life and death to a patient. The glucometer doesn't make a real difference in treatment rendered and can wait the few minutes for ALS to arrive.


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## JPINFV (Sep 13, 2011)

I'd like to point out that the "invasive/non-invasive" discussion, as a matter of delineating between EMT level and paramedic level intervention is a red herring.


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## ArcticKat (Sep 13, 2011)

JPINFV said:


> I'd like to point out that the "invasive/non-invasive" discussion, as a matter of delineating between EMT level and paramedic level intervention is a red herring.



Agreed, "basic" EMS is just a lower form of advanced in most cases.

Our PCPs are able to insert King tubes, administer nitrous oxide, BGL, insert a Foley, 12 Leads, and CPAP.  SubQ Epi, and several other meds.


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## rmabrey (Sep 13, 2011)

My biggest issue is that it essentially forces my partner to take runs that I could take. Once we check a BGL its an ALS run even if the BGL is fine. And I hate that, especially on nights where hes down 8\\ or 9 runs and I havent had any.


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## Anjel (Sep 13, 2011)

18G said:


> I am on the fence with EMT's checking a BGL.
> 
> I admit it is an obviously simple skill I just don't see how it changes outcomes on the BLS level. .



Whether it changes anything or not. It's nice to know exactly why your pt is unconscious or has an altered mental status. 

We have oral glucose. And we can have a patient eat something. Why should they have to wait for ALS or to get to a hospital with something that is sometimes an easy fix. 

Yes we could treat it without knowing the exact number. But I am more comfortable knowing exactly what I am dealing with. When it is something very easy to find out.


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## bigdogems (Sep 13, 2011)

It is a result of a bigger problem in EMS. There is no standard from state to state. When I worked in WI an EMT-B could check blood sugar, give oral glucose, glucagon, draw up EPI, Albuterol, Atrovent,ASA, Pt assist nitro. Combi/king tube. Then there are other states where they aren't allowed to give any meds.


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## CAOX3 (Sep 13, 2011)

Anjel1030 said:


> Whether it changes anything or not. It's nice to know exactly why your pt is unconscious or has an altered mental status.
> 
> We have oral glucose. And we can have a patient eat something. Why should they have to wait for ALS or to get to a hospital with something that is sometimes an easy fix.
> 
> Yes we could treat it without knowing the exact number. But I am more comfortable knowing exactly what I am dealing with. When it is something very easy to find out.



If there conscious I agree give them something to eat it will at least maintain their sugar.

As for unconscious diabetic its nice to know but it doesnt matter assist ventilations if need be and call for ALS, if your giving glucagon at the BLS level then yes a BGL is a must.


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## Katy (Sep 13, 2011)

CAOX3 said:


> if your giving glucagon at the BLS level then yes a BGL is a must.


This right here is what I find very odd, you can give oral glucagon yet you cannot check the patient's BGL ?


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## CAOX3 (Sep 13, 2011)

Happy said:


> This right here is what I find very odd, you can give oral glucagon yet you cannot check the patient's BGL ?



Glucagon is not given po, its given IM.


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## 18G (Sep 13, 2011)

Anjel1030 said:


> Whether it changes anything or not. It's nice to know exactly why your pt is unconscious or has an altered mental status.



I agree it is "nice to know" but is it essential and does it change anything? It could help as a triage tool I will admit especially if ALS is not available. You could than walk into the ED with a BGL reading of 20mg/dl and get the patient treated a little faster.


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## Katy (Sep 13, 2011)

CAOX3 said:


> Glucagon is not given po, its given IM.


Oops, I meant to write glucose.


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## Anjel (Sep 13, 2011)

CAOX3 said:


> If there conscious I agree give them something to eat it will at least maintain their sugar.
> 
> As for unconscious diabetic its nice to know but it doesnt matter assist ventilations if need be and call for ALS, if your giving glucagon at the BLS level then yes a BGL is a must.



Our protocol states for any unconscious pt with the reason being hypoglycemia we are to give oral glucose buccally.

And before I start putting a sticky substance in an unconscious persons mouth...I want to know that it is actually their bgl that is the problem.


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## Handsome Robb (Sep 13, 2011)

Anjel1030 said:


> Our protocol states for any unconscious pt with the reason being hypoglycemia we are to give oral glucose buccally.
> 
> And before I start putting a sticky substance in an unconscious persons mouth...I want to know that it is actually their bgl that is the problem.



Everyone's gonna hate you for that one! haha 

but.........

No reason you can't put them in left lateral and use some suction unless they are on a mask.


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## Anjel (Sep 13, 2011)

NVRob said:


> Everyone's gonna hate you for that one! haha
> 
> but.........
> 
> No reason you can't put them in left lateral and use some suction unless they are on a mask.



I don't agree with that protocol. And depending on how low the bgl was and how close I was to an ER which is never more than 10 minutes away. I probably would never do it. 

I am just pointing out that it is protocol and I want a BGL before I do it.


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## Handsome Robb (Sep 13, 2011)

I like the D50 I can give as an Intermediate much better, just saying that's how I'd do it if I was stuck in a bad spot.


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## Anjel (Sep 13, 2011)

NVRob said:


> I like the D50 I can give as an Intermediate much better, just saying that's how I'd do it if I was stuck in a bad spot.



Yea I agree.


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## Anjel (Sep 13, 2011)

> EMT/SPECIALIST
> 3.  If the patient is alert but demonstrating signs of hypoglycemia, measure blood
> glucose level, if available.
> A.  If less than *60 mg/dl administer *oral high caloric fluid.
> ...


So we have to have it. 

I don't understand what the big deal is. It is p ricking a finger.


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## emergancyjunkie (Sep 13, 2011)

Ok knowing protocal. If I were to respond to a patient and they state they have diabetes can we ask them if they have a glucometer and if they do can I have them do the bgl on themself. It's technically not me doing it. That way I have a bgl on them and know if I should give them oral glucose... Man I wish pa had AEMT as one of the levels. Al we have is emt-b paramedic and PHRN



Sent from my Desire HD


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## rmabrey (Sep 13, 2011)

emergancyjunkie said:


> Ok knowing protocal. If I were to respond to a patient and they state they have diabetes can we ask them if they have a glucometer and if they do can I have them do the bgl on themself. It's technically not me doing it. That way I have a bgl on them and know if I should give them oral glucose... Man I wish pa had AEMT as one of the levels. Al we have is emt-b paramedic and PHRN
> 
> 
> 
> Sent from my Desire HD



yes.


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## Handsome Robb (Sep 13, 2011)

A lawyer could say you gave the pt medical advice and have it come back to bite you.. just playing the devils advocate. 95% of the time if their sugar is low enough to make you pucker they wont be capable of doing it themselves, in my experience at least.


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## emergancyjunkie (Sep 13, 2011)

rmabrey said:


> yes.



Ok so if that is done how would it be documented so I can save myself from a lawsuit or in the future my cert

Sent from my Desire HD


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## ArcticKat (Sep 13, 2011)

Happy said:


> This right here is what I find very odd, you can give oral glucose yet you cannot check the patient's BGL ?



Why is that odd?  Even basic first aid training says when in doubt, give sugar.  If a patient is hypoglycemic at 2 mmol/L and is given oral glucose  he might come up to 5 mmol/L and you'd have saved a few million brain cells.  If he's hyperglycemic at 15mmol/L and you give suger you're not going to cause any further harm by bumping it up a few more points.


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## JPINFV (Sep 13, 2011)

emergancyjunkie said:


> Ok so if that is done how would it be documented so I can save myself from a lawsuit or in the future my cert
> 
> Sent from my Desire HD




Pt's BGL ____ per ____ @ [time]. 

Helpful for SpO2 as well at SNFs.


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## rmabrey (Sep 13, 2011)

emergancyjunkie said:


> Ok so if that is done how would it be documented so I can save myself from a lawsuit or in the future my cert
> 
> Sent from my Desire HD



Never had to do it, but "BGL per Pt 107 @ whatever time"  should be sufficient. Your a basic and cant check it anyway, so i see this being no different then asking when the last time they checked their sugar was and what it was.


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## Yarbo (Sep 14, 2011)

ArcticKat said:


> Agreed, "basic" EMS is just a lower form of advanced in most cases.
> 
> Our PCPs are able to insert King tubes, administer nitrous oxide, BGL, insert a Foley, 12 Leads, and CPAP.  SubQ Epi, and several other meds.



I enjoy this!, as much as I wish I was trained to do IVs instead of foleys!


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## ArcticKat (Sep 14, 2011)

EMT 34 said:


> I enjoy this!, as much as I wish I was trained to do IVs instead of foleys!



Didn't your PCP education include IV initiation?  Don't be surprised to see it coming down the pipe in the not too distant future.


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## Yarbo (Sep 14, 2011)

ArcticKat said:


> Didn't your PCP education include IV initiation?  Don't be surprised to see it coming down the pipe in the not too distant future.



Well, we learned about securing, managing, and discontinuing the line just not introducing it. Now that the ICP/EMT-A program is gone out of popular locations Saskatoon/Regina I hope someone steps up and adds PCP IV insertion into a protocol.


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## ArcticKat (Sep 14, 2011)

EMT 34 said:


> Well, we learned about securing, managing, and discontinuing the line just not introducing it. Now that the ICP/EMT-A program is gone out of popular locations Saskatoon/Regina I hope someone steps up and adds PCP IV insertion into a protocol.



Hmm, I thought SIAST included initiation in the training.  Give it a couple of years, it's coming, I guess there's just a more significant education module to develop.


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## Tigger (Sep 14, 2011)

NVRob said:


> A lawyer could say you gave the pt medical advice and have it come back to bite you.. just playing the devils advocate. 95% of the time if their sugar is low enough to make you pucker they wont be capable of doing it themselves, in my experience at least.



Agreed. While asking the patient to check is BGL works and is nice to have on arrival at the ED, if you're thinking "damn I wonder what this guy's sugar is?" you are not going to be getting him to check it for you. Maybe if you're lucky he can speak coherently.

For the record, both CO and MA allow for basics to check BGL, I honestly see no issue with this as it should be unlikely to delay treatment or transport if done correctly. And as another poster mentioned, it's great on P/B trucks to help divide the patient load (if appropriate). having the basic be able to use the glucometer is also useful during IV initiation, the medic can finish the IV while the basic checks the sugar quickly. 

Incidentally, I've heard that BLG monitors need to be calibrated differently to use blood from an IV. Is this true? And is there such a difference between the numbers that it would make any difference clinically? Despite hearing this, not once have I ever been on a truck (ALS or BLS) that carried anything beyond your standard OneTouch meter.


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## Yarbo (Sep 14, 2011)

Tigger said:


> Agreed. While asking the patient to check is BGL works and is nice to have on arrival at the ED, if you're thinking "damn I wonder what this guy's sugar is?" you are not going to be getting him to check it for you. Maybe if you're lucky he can speak coherently.
> 
> For the record, both CO and MA allow for basics to check BGL, I honestly see no issue with this as it should be unlikely to delay treatment or transport if done correctly. And as another poster mentioned, it's great on P/B trucks to help divide the patient load (if appropriate). having the basic be able to use the glucometer is also useful during IV initiation, the medic can finish the IV while the basic checks the sugar quickly.
> 
> *Incidentally, I've heard that BLG monitors need to be calibrated differently to use blood from an IV. Is this true?* And is there such a difference between the numbers that it would make any difference clinically? Despite hearing this, not once have I ever been on a truck (ALS or BLS) that carried anything beyond your standard OneTouch meter.



Hope not. lol


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## JPINFV (Sep 14, 2011)

Tigger said:


> Incidentally, I've heard that BLG monitors need to be calibrated differently to use blood from an IV. Is this true? And is there such a difference between the numbers that it would make any difference clinically?



Technically yes, as capillary blood is going to have different properties than venous blood. I, however, don't think it's enough of a difference to be concerned about if you know it's present, but I'm sure someone will jump on the chance to prove me wrong.


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## Yarbo (Sep 14, 2011)

JPINFV said:


> Technically yes, as capillary blood is going to have different properties than venous blood. I, however, don't think it's enough of a difference to be concerned about if you know it's present, but I'm sure someone will jump on the chance to prove me wrong.




Good news! lol 

Random sources from other forums; I'd take these posts with a grain of salt though.



> Our medical control has us do a capillary blood glucose (CBG) aka finger stick. I know it's a common practice to use blood from the IV site for a D-Stick. Our medical control says that there is a difference in glucose readings between serum glucose from the IV and a finger stick (CBG). They want us to do finger sticks for the reading. So, instead of one stick for everything, the patient has pain twice. The hospitals go by serum glucose readings. Of course their methods of reading serum glucose are more sophisticated than a glucometer.
> 
> Thought I'd throw my nickels worth in here.
> 
> "





> As for those of you using IV flash or venous blood syringes to take your glucose readings from, you MUST make sure that your glucometer can recognize and read venous blood, which is much different from capillary blood. If not, this will give you false readings.





> You are right. There is a difference between venous and capillary blood. Many machines now days are calibrated for either.


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## DesertMedic66 (Sep 14, 2011)

CAOX3 said:


> There are still places thst don't allow EMTs to measure BGL?



Here we can "measure" the BGL. We just aren't allowed to poke their finger to get it. After the medic gets an IV then I automatically grab the flash blood and measure that. I've seen many EMTs here go "out of their scope" and poke the patients finger.


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## truetiger (Sep 14, 2011)

EMT's should be allowed to check a BGL. While on a basic/basic truck you may not be able to do anything about it, its an important vital sign. On a medic/basic truck, its one more thing I can delegate to my partner to do while I do other things. For example, a BLS pumper beats you to the scene of a possible stroke. They can quickly perform a stroke scale, check the BGL, and determine onset before I arrive. With this information I can go ahead and launch the helicopter to take this patient to the proper facility while I'm still en route. I show up, quickly verify the findings, and won't be spending much time waiting for the helicopter.


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## rmabrey (Sep 14, 2011)

JPINFV said:


> Technically yes, as capillary blood is going to have different properties than venous blood. I, however, don't think it's enough of a difference to be concerned about if you know it's present, but I'm sure someone will jump on the chance to prove me wrong.



I have been told there can be up to 30 mm/dl difference, possibly more. Of course if we check BGL before the IV nobody really ever checks again so who really knows.


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## 18G (Sep 14, 2011)

rmabrey said:


> I have been told there can be up to 30 mm/dl difference, possibly more. Of course if we check BGL before the IV nobody really ever checks again so who really knows.



Correct. Unless the glucometer is made for venous sampling the blood should be capillary from a finger stick. 

And I have heard also a difference of 20-30mg/dl difference between venous and capillary samples.


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## Tigger (Sep 14, 2011)

18G said:


> Correct. Unless the glucometer is made for venous sampling the blood should be capillary from a finger stick.
> 
> And I have heard also a difference of 20-30mg/dl difference between venous and capillary samples.



Is there any research proving this?


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## 18G (Sep 14, 2011)

Capillary blood hasn't been "used" yet. Venous blood has. 


Here is one study on the issue...:

http://emj.bmj.com/content/22/3/177.abstract

... and this. 

III. Clinical Issues of Blood Glucose Monitoring  

Regardless of where a specimen is obtained, be it venous, capillary, or arterial, the integrity of this specimen is crucial for obtaining accurate reliable results. Venous specimens should only be used on meters that are not affected by low oxygen concentrations. Those meters which use the enzyme glucose oxidase, use oxygen to react with the glucose. Therefore, these meters should not be used with venous specimens. Capillary specimens have a high oxygen concentration and a slightly higher glucose than venous specimens. It’s important to remember a number of key concepts when collecting a capillary specimen:

Patient should have adequate circulation and warm hands.
The site should be cleaned with alcohol or warm soapy water.
Be sure to wipe the first drop off the finger before analyzing the second drop for a glucose concentration.
Arterial blood draws also have a high oxygen concentration and will give a slightly higher glucose reading than a venous specimen. Make sure the meter is compatible with heparin if one is using a blood gas specimen.

IV line draws should also be mentioned here. If one must use a line draw, it should be flushed with at least a 5 mL blood draw before collection of the specimen. If one is suspect that any glucose solutions have been administered through the line, using an alternate type specimen is recommended.


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## DrParasite (Sep 14, 2011)

18G said:


> With that said, I do think it is extremely stupid that family calls EMS and the EMT's can't assess blood sugar and they have to ask the family to do it. When I was an EMT in PA I asked the family for the glucometer and did it myself. Technically not supposed to but oh well... slap my wrist.


Yeah I always felt embarrassed that I, as the trained professional could not check a patient's sugar, but her 10 year old was able to.  and I had to ask the 10 year old to do with because I was not permitted to.

I actually had a call once for a known diabetic with an altered mental status and CVA like symptoms.  by know, i mean, I had personally been to her home when he BGL was 30, IV dextrose was administered, and she RMAs.  This time I am thinking she is having a CVA, but I can't rule out hypoglycemia because I don't have a BGL on her.  we get there, load her up to carry her to the truck (and apply oxygen, because everyone gets a NRB), and are waiting for ALS to do their full assessment, call the doctor (why the medic did this before checking BGL I still have no idea), when the only thing we needed them to do was check BGL, since everything else needed to be done at the hospital.  BGL turned out to be normal, and she was having a CVA.  but we could have been off the scene and enroute to the hospital for definitive care 10 minutes sooner if BLS could have checked BGLs...


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## the_negro_puppy (Sep 15, 2011)

BGL/BSL check should be part of every EMTs scope. Really its a tiny p-rick on the finger and if people are so concerned about their health to call 000/911 should they really be concerned about a tiny pin p-rick used to medically assess them? Even if an EMT cant give IV glucose or glucagon they can assist with oral glucose or even have a cause of the ALOC available for when ALS comes so they cant start treatment sooner.

Most patients of mine get a BSL check. You would be surprised how many abnormal levels you can find i.e the pt said they checked theirs 4 hours ago and it was ok, you do a check at its 20.0 mmol/L. I've even caught hypoglycaemic pts after MVAs by checking out their BSL once a hx of DM is obtained.


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## CAOX3 (Sep 15, 2011)

At the BLS level here EMTs can check BGLs administer oral glucose and glucagon.


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## joeshmoe (Sep 15, 2011)

I know when volunteering for my local MFRs I cant take BG on a call. I always assumed it was considered a liability because of a possible needle stick, since the lancet has to be disposed of, and if someone did get stuck, who is gonna pay for testing? What the reason would be for not letting basics do it on a rig I have no idea.


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## attnondeck (Sep 21, 2011)

hey.  the word "assisted" comes in handy here.  have the pt hold the lancet and push there finger into it(after you clean with a prep).  then you have the blood droplet.

our ems captain states that we(as basics) are allowed to test blood glucose levels.  he states out medical director has given us permission.  this makes me nervous because its not in our protocols....  but if need be, an assisted d-stick works.  just document that!


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## Jay (Sep 23, 2011)

EmergencyJunkie, a few points from a fellow Pennsylvanian:

First, I got good news, AEMT is coming to PA after the new year. I have access to a lot of training resources in the state due to the nature of the program that I am involved in. For example, literally within a few months of the EMR-EMT Bridge rollout, our entire crew who happened to be EMR's got to take the course and become EMT's, this was one of the first in the state. Now, here is the bad news, AEMT is a loooooooong course, I heard over 400 hours but that is just an estimate. It is also a fairly tough course and you will really need to put time in to study so if you are working a full time job and in school it will suck but like anything else in EMS it will pay off in the end  All I know for certain is that AEMT is just around the corner for us, so please hang in there!

Next, BGL vs. EPI-Pen in PA is relatively simple. The core purpose of BLS in PA [and elsewhere] is to *provide care to stabilize the Pt using immediate lifesaving measures*. For example, using a pseudo-ALS analogy, which is going to be more effective in saving your Pt's life CPR or pushing salt-water through their veins? *Anaphylaxis is an immediate life threat* and needs to be tended to as such, for testing purposes in PA for EMT-B certification one mut go through Vitals, SAMPLE, at least QRS to compare to after the EPI is administered but the state also knows that *on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it*. See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go *straight to the oral glucose to once again resolve the immediate life threat*. That's all it boils down to is rapidly making an attempt to stabilize immediate life threats, in the BGL case it is by skipping the reading (_*since the Pt can also deteriorate over that time, this can make oral administration a contraindication*_) and go for the administration of both oral glucose and O2 (not necessarily in that order, everyone usually gets O2 first).

I hope that clears things up a bit!

I am also interested in any thoughts on the above. This was pretty much the consensus that I heard through our EMS-I chain near Philly. This is a fairly common question though.


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## emergancyjunkie (Sep 23, 2011)

Jay said:


> EmergencyJunkie, a few points from a fellow Pennsylvanian:
> 
> First, I got good news, AEMT is coming to PA after the new year. I have access to a lot of training resources in the state due to the nature of the program that I am involved in. For example, literally within a few months of the EMR-EMT Bridge rollout, our entire crew who happened to be EMR's got to take the course and become EMT's, this was one of the first in the state. Now, here is the bad news, AEMT is a loooooooong course, I heard over 400 hours but that is just an estimate. It is also a fairly tough course and you will really need to put time in to study so if you are working a full time job and in school it will suck but like anything else in EMS it will pay off in the end  All I know for certain is that AEMT is just around the corner for us, so please hang in there!
> 
> ...



It makes sense now. Now that I know AEMT is coming to pa I'm going to put off starting paramedic and go for that

Sent from my Desire HD


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## Tigger (Sep 24, 2011)

Jay said:


> EmergencyJunkie, a few points from a fellow Pennsylvanian:
> 
> First, I got good news, AEMT is coming to PA after the new year. I have access to a lot of training resources in the state due to the nature of the program that I am involved in. For example, literally within a few months of the EMR-EMT Bridge rollout, our entire crew who happened to be EMR's got to take the course and become EMT's, this was one of the first in the state. Now, here is the bad news, AEMT is a loooooooong course, I heard over 400 hours but that is just an estimate. It is also a fairly tough course and you will really need to put time in to study so if you are working a full time job and in school it will suck but like anything else in EMS it will pay off in the end  All I know for certain is that AEMT is just around the corner for us, so please hang in there!



Gasp! A mid-level provider course that actually requires time to be spent on it! 400 hours is not all that long given the expected scope of any level above basic, and I am going to bet it doesn't include any sort of A&P requirement either. 



> Next, BGL vs. EPI-Pen in PA is relatively simple. The core purpose of BLS in PA [and elsewhere] is to *provide care to stabilize the Pt using immediate lifesaving measures*. For example, using a pseudo-ALS analogy, which is going to be more effective in saving your Pt's life CPR or pushing salt-water through their veins? *Anaphylaxis is an immediate life threat* and needs to be tended to as such, for testing purposes in PA for EMT-B certification one mut go through Vitals, SAMPLE, at least QRS to compare to after the EPI is administered but the state also knows that *on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it*. See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go *straight to the oral glucose to once again resolve the immediate life threat*. That's all it boils down to is rapidly making an attempt to stabilize immediate life threats, in the BGL case it is by skipping the reading (_*since the Pt can also deteriorate over that time, this can make oral administration a contraindication*_) and go for the administration of both oral glucose and O2 (not necessarily in that order, everyone usually gets O2 first).
> 
> I hope that clears things up a bit!
> 
> I am also interested in any thoughts on the above. This was pretty much the consensus that I heard through our EMS-I chain near Philly. This is a fairly common question though.



Not everyone needs to get 02 first even if they are having a diabetic emergency. Diabetic emergency =/= respiratory emergency. 

How long does it really take to get a BLG? Maybe thirty seconds if the two drops of blood are slow in coming. Nothing wrong with multi-taking, it is fairly easy to get the BGL during a stroke test. The "seconds" saved in skipping getting the measurement are not going to be clinically significant, and I'd rather have a better understanding of my patients condition than save fifteen seconds.


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## JPINFV (Sep 24, 2011)

Jay said:


> *on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it*.



Except "the street" doesn't hold any special properties that makes seconds count. Sorry, in the vast majority of cases, including emergencies, seconds don't count. If seconds count in a hypoglycemia case, then a paramedic would be needed as IV dextrose solutions are infinitely faster than buccal or oral glucose administration. 



> See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go *straight to the oral glucose to once again resolve the immediate life threat*.


Since hypoglycemia can mimic a stroke, how are you ruling out hypoglycemia with out a blood glucose test? 



> everyone usually gets O2 first).



Only because the powers that be believe that EMS providers are too stupid to determine if a patient is hypoxic and EMS providers are too impotent to prove them otherwise.


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## Jay (Sep 24, 2011)

Tigger said:


> Gasp! A mid-level provider course that actually requires time to be spent on it! 400 hours is not all that long given the expected scope of any level above basic, and I am going to bet it doesn't include any sort of A&P requirement either.


 
Tigger, I am [G-d willing] planning on taking this course when it becomes available next year, I agree that in the grand scheme 400 hours is not long compared to EMT-P and other vocations however, I am talking from a married guy's perspective with a family and a full time job which sort of makes medic school out of the question [at least at this particular juncture]. Having such obligations means that AEMT *is an option* but having so many responsibilities does make time a huge factor. I also own and run a small business so I didn't realize until fairly recently how precious time really is and how easy it is to burn out for taking an extra hour to finish everything.



Tigger said:


> How long does it really take to get a BLG? Maybe thirty seconds if the  two drops of blood are slow in coming. Nothing wrong with multi-taking,  it is fairly easy to get the BGL during a stroke test. The "seconds"  saved in skipping getting the measurement are not going to be clinically  significant, and I'd rather have a better understanding of my patients  condition than save fifteen seconds.


 
Again, not my view, this is coming from the state directly, our group was involved in some talks on a regional level not too long ago and this exact question came up. Perhaps the state feels that a BLS provider doesn't have the training to manage the Pt if things go South over those 30 seconds? I sort of agree with them and also kind of don't. I think *it should be an option* and *the EMT-B should be able to take a BGL on the stable Pt* but it should be *out for a "Priority" Pt*.

*In PA even SpO2 is not generally allowed for a BLS provider and what does that take... 10 seconds... If that?* The state does recognize the ACLS-B course and does allow BLS providers to take an SpO2 after having their ACLS-B certificate (8 hours) but they can very well yank your numbers for doing this without the ACLS-B training. I know it is sort of stupid but you probably know that there are *some EMT-B's out there that can barely do their current scope of practice and anything else will confuse them*, well guess what, the state of PA [and a ton of other ones out there] will hold off these *simple* procedures for what, maybe 5% of the certified population of Basics. It does suck, I agree with you but everything here is coming from information that I either heard or read on the state level!


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## Jay (Sep 24, 2011)

JPINFV said:


> Since hypoglycemia can mimic a stroke, how are you ruling out hypoglycemia with out a blood glucose test?



Just the opposite, a Basic would rule out stroke, e.g. with a quick Cincinnati stroke scale; since you can rule out many of the other issues and can get a good to fair educated guess that hypoglycemia is the issue than a little sugar probably wont hurt them even if it was something else. I know that there are rare issues that upping the glucose can interfere but the majority of the time, perhaps over 99% of the time this is not an issue and would be out of the scope of an EMT-B anyhow.



JPINFV said:


> Only because the powers that be believe that EMS providers are too  stupid to determine if a patient is hypoxic and EMS providers are too  impotent to prove them otherwise.



I agree with you and that was what I was trying to explain to _*Tigger*_ is that *in Pennsylvania **ALL priority Pt's get high flow O2*. You and I both know that the AHA says that is not the case but this is on the books for the EMT-B protocol. 

Now I have noticed that in Philly the medics and up (ED staff) will listen to you if your a Basic and you have proven yourself. I don't know if this goes for other places as well?

The one big thing here is that your in CA and PA is mostly rural so their BLS protocols play the rule of averages and assume that medics are over 30 minutes away in most cases and the EMT-B has to act with a sense of urgancy. This doesn't really apply to me since I am in Philly. Pittsburgh and for a lesser degree Scranton are the same way but the remainder of this huge state is mainly utilizing a Basic EMS system using QRS and the like for its First Responders... Is Cali similar in that respect, I know that there is a lot of more city area so I would think that they have EMT-P's factored higher into their protocols in general? Tell me if this is so I am real curious to know.


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## Jay (Sep 24, 2011)

emergancyjunkie said:


> It makes sense now. Now that I know AEMT is coming to pa I'm going to put off starting paramedic and go for that
> 
> Sent from my Desire HD



One more quick point for you, the AEMT curriculum will be on the books soon enough however it doesn't mean that the schools will be ready to teach them that quickly. When the EMR-EMT Bridge came about it took maybe 8 months before I was able to take it and that was a special pilot program at that. I would guess that at best the AEMT program will be rolled out for schools to teach in 2013... Does this change your mind any?


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## emergancyjunkie (Sep 24, 2011)

Jay said:


> One more quick point for you, the AEMT curriculum will be on the books soon enough however it doesn't mean that the schools will be ready to teach them that quickly. When the EMR-EMT Bridge came about it took maybe 8 months before I was able to take it and that was a special pilot program at that. I would guess that at best the AEMT program will be rolled out for schools to teach in 2013... Does this change your mind any?



good point. but i still would like to get some field experiance in after the state test before i just jump straight into medic school or for that Matter AEMT school


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## Jay (Sep 24, 2011)

Are you certified yet as either an EMR or an EMT?

Also, you may want to get some good con-ed such as ACLS-B and maybe train to become an instructor because it will really help you know the topics in a whole new way. There is a lot of training out there and yes, hands on is highly recommended


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## Akulahawk (Sep 24, 2011)

Jay said:


> Just the opposite, a Basic would rule out stroke,* e.g. with a quick Cincinnati stroke scale; since you can rule out many of the other issues and can get a good to fair educated guess that hypoglycemia is the issue than a little sugar probably wont hurt them even if it was something else. *I know that there are rare issues that upping the glucose can interfere but the majority of the time, perhaps over 99% of the time this is not an issue and would be out of the scope of an EMT-B anyhow.
> 
> 
> 
> ...


So you can determine that a patient is having a CVA vs BGL problem from doing the Cincinnati Stroke Scale? Mind if I as you a quick question then? Since brain cells don't work when they don't have sufficient glucose entering them and they don't work when they don't have sufficient oxygen entering them, how is it possible to determine which is which without a glucometer to tell you what the blood glucose level is?

You see, the Cincinnati Stroke Scale is only going to be of diagnostic value when the patient normoglycemic... so in a patient with CVA symptoms, I'm going to try to rule out the most obvious problem: blood sugar levels that are too low.


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## emergancyjunkie (Sep 24, 2011)

Jay said:


> Are you certified yet as either an EMR or an EMT?
> 
> Also, you may want to get some good con-ed such as ACLS-B and maybe train to become an instructor because it will really help you know the topics in a whole new way. There is a lot of training out there and yes, hands on is highly recommended



Believe it or not I hold no ems cert as of now the most medical training I had before starting this was first aid merit badge in bsa and cpr

Sent from my Desire HD


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## JPINFV (Sep 25, 2011)

Jay said:


> Just the opposite, a Basic would rule out stroke, e.g. with a quick Cincinnati stroke scale; since you can rule out many of the other issues and can get a good to fair educated guess that hypoglycemia is the issue than a little sugar probably wont hurt them even if it was something else. I know that there are rare issues that upping the glucose can interfere but the majority of the time, perhaps over 99% of the time this is not an issue and would be out of the scope of an EMT-B anyhow.



Personally, I find it hard to believe that oral glucose is going to cause an abundance of harm if the patient was having a stroke. My problem is that a patient who is hypoglycemic can be a false positive under Cincinnati, and if I had to take a bet with a diabetic patient who was positive under Cincinnati and an unknown BGL, I'd bet that the patient was hypoglycemic, not suffering from a CVA. 




> I agree with you and that was what I was trying to explain to _*Tigger*_ is that *in Pennsylvania **ALL priority Pt's get high flow O2*. You and I both know that the AHA says that is not the case but this is on the books for the EMT-B protocol.


Looking through PA's BLS protocol, first there's the standard 'deviate if need be, contact med control if possible, document' line. It looks like BLS services can be approved for pulse oxymetry, so that's a place where I would make use of the 'get out of jail' card, and document my justification based off of AHA 2010 guidelines (actually based on 201, chest pain with a BP >100 isn't a "priority condition" requiring administration of high concentrations of oxygen. 

I'll also note that the PA protocols exemplify everything wrong with the current EMS thought process. If a provider needs strict guidelines requiring the use of oxygen, then they shouldn't be in a position to operate without direct oversight. 





> The one big thing here is that your in CA and PA is mostly rural so their BLS protocols play the rule of averages and assume that medics are over 30 minutes away in most cases and the EMT-B has to act with a sense of urgancy. This doesn't really apply to me since I am in Philly. Pittsburgh and for a lesser degree Scranton are the same way but the remainder of this huge state is mainly utilizing a Basic EMS system using QRS and the like for its First Responders... Is Cali similar in that respect, I know that there is a lot of more city area so I would think that they have EMT-P's factored higher into their protocols in general? Tell me if this is so I am real curious to know.



California has a highly regionalized system based off of the counties. So the protocols and policies of one area can vary greatly from another area in the state. The urban areas are pretty much all paramedic first response, while the rural areas can vary, including a few that use an intermediate level (EMT-II). 


Personally, when an emergency is occurring based off of assessment I agree that a sense of urgency needs to occur, but I don't think a sense of urgency can be required through protocols or policy. It has to happen because the provider is operating off of his or her education, training, and assessment of the situation. Additionally, very rarely is an emergency so serious that action needs to be taken without being able to conduct a decent assessment. The respiratory arrests, respiratory failures, and cardiac arrests are the exception, and then in those the initial stabilizing interventions should be self-evident.


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## emergancyjunkie (Sep 25, 2011)

Akulahawk said:


> So you can determine that a patient is having a CVA vs BGL problem from doing the Cincinnati Stroke Scale? Mind if I as you a quick question then? Since brain cells don't work when they don't have sufficient glucose entering them and they don't work when they don't have sufficient oxygen entering them, how is it possible to determine which is which without a glucometer to tell you what the blood glucose level is?



Wouldn't the smell of the persons breath help tell you if its a diabetic emergancy or a cva

Sent from my Desire HD


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## JPINFV (Sep 25, 2011)

emergancyjunkie said:


> Wouldn't the smell of the persons breath help tell you if its a diabetic emergancy or a cva
> 
> Sent from my Desire HD



Only a specific hyperglycemic emergency, but not all hyper or hypoglycemic emergencies.


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## Jay (Sep 25, 2011)

Akulahawk said:


> So you can determine that a patient is having a CVA vs BGL problem from doing the Cincinnati Stroke Scale? Mind if I as you a quick question then? Since brain cells don't work when they don't have sufficient glucose entering them and they don't work when they don't have sufficient oxygen entering them, how is it possible to determine which is which without a glucometer to tell you what the blood glucose level is?
> 
> You see, the Cincinnati Stroke Scale is only going to be of diagnostic value when the patient normoglycemic... so in a patient with CVA symptoms, I'm going to try to rule out the most obvious problem: blood sugar levels that are too low.



The Cincinnati Stroke Scale by design is a strong indicator and will be 70% accurate per supporting studies. The main difference aside from this is that with a CVA you will more than likely see one-sided difficulty vs. two-sided due to the nature of the CVA. Besides you should have some kind of an indicator of hypoglycemia, the Pt themselves, family, a medic-alert tag or something and if that is the case of course you would be leaning towards hypoglycemia but then again what if someone is hypoglycemic (mild to moderate) and experiencing a CVA, wouldn't they more than likely be experiencing either right or left sided difficulty (along with a possible indicator of their BGL having an issue, e.g. their breath)?


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## emergancyjunkie (Sep 25, 2011)

JPINFV said:


> Only a specific hyperglycemic emergency, but not all hyper or hypoglycemic emergencies.



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

Sent from my Desire HD


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## Jay (Sep 25, 2011)

JPINFV said:


> Personally, I find it hard to believe that oral glucose is going to cause an abundance of harm if the patient was having a stroke. My problem is that a patient who is hypoglycemic can be a false positive under Cincinnati, and if I had to take a bet with a diabetic patient who was positive under Cincinnati and an unknown BGL, I'd bet that the patient was hypoglycemic, not suffering from a CVA.
> 
> 
> 
> ...



Huh? That's exactly what I said! That a little sugar won't hurt anybody and that according to the latest AHA protocols the Pt usually won't require O2, I was saying that in PA they do for some odd reason. But that's PA for you! Read again what I wrote, for some reason your stating the complete opposite. Also, I know what you are talking about with the SpO2 requirements in PA but that is by unit approval only. For individuals look up the state matrix, it will show everyone from FR through Medic and what they can and cannot do, SpO2 is listed for BLS providers with training only and is a number or asterisk on the form. I will try that for my "Get out of jail card" 

Thanks for cleaning up about CA but remember that there are no Intermediate providers here yet, just BLS or ALS and most crews in rural areas run BLS only! AEMT will be the first ever intro to EMT-I level providers in the state.


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## Jay (Sep 25, 2011)

emergancyjunkie said:


> Believe it or not I hold no ems cert as of now the most medical training I had before starting this was first aid merit badge in bsa and cpr
> 
> Sent from my Desire HD



Are you in school now for EMT?


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## emergancyjunkie (Sep 25, 2011)

Jay said:


> Are you in school now for EMT?



Yeah. Had the option back in high school but passed on it for welding

Sent from my Desire HD


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## JPINFV (Sep 25, 2011)

emergancyjunkie said:


> Ok. Would a patient present with one sided difficulty in a diabetic emergency.
> 
> Sent from my Desire HD





Jay said:


> The main difference aside from this is that with a CVA  you will more than likely see one-sided difficulty vs. two-sided due to  the nature of the CVA.



It can present 1 sided, and is one of the reasons why the Los Angeles Prehospital Stroke Scale includes hypoglycemia as a rule out (it's specificity and sensitivity are both in the mid to upper 90%s).


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## JPINFV (Sep 25, 2011)

Jay said:


> Huh? That's exactly what I said! That a little sugar won't hurt anybody and that according to the latest AHA protocols the Pt usually won't require O2, I was saying that in PA they do for some odd reason. But that's PA for you!



I'm actually saying, based off the oxygen administration and BLS assessment section (201 and 202) that administration of high concentration of supplemental oxygen is not required unless the patient is hypotensive. 




> Thanks for cleaning up about CA but remember that there are no Intermediate providers here yet, just BLS or ALS and most crews in rural areas run BLS only! AEMT will be the first ever intro to EMT-I level providers in the state.



To be fair, the EMT-II level was only recognized in maybe 2 or 3 counties n the entire state (we've since moved to AEMT, but the EMT-IIs are grandfathered in at their old scope), and there were so few that they might as well not have existed for the vast majority of the state.


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## Akulahawk (Sep 25, 2011)

JPINFV said:


> It can present 1 sided, and is one of the reasons why the Los Angeles Prehospital Stroke Scale includes hypoglycemia as a rule out (it's specificity and sensitivity are both in the mid to upper 90%s).


And thus the reason why I check blood glucose levels. Ruling out blood sugar problems as a cause of the symptoms allows the test greater accuracy. CPSS just isn't as sensitive or specific as the LAPSS is, as JP indicates above.


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## Tigger (Sep 26, 2011)

Jay said:


> I think *it should be an option* and *the EMT-B should be able to take a BGL on the stable Pt* but it should be *out for a "Priority" Pt*.



I fail to follow your reasoning on why only the less sick patients should get a full set of vitals. Sorry, but if you have a sick patient and you suspect a hypo/hyperglycemic cause, a BGL should be obtained. The patient could do it themselves, there is no reason that a competent basic trained (shown) the use of glucometer should not be able to do this. Seconds rarely, if ever count in an emergency and thinking they do will only lead to rushed, less than excellent care. 

Also, what is this with categorizing patients as "priority" and "stable." Treat the patients symptoms. If the patient is sick and you're on a BLS truck and out of treatments, get medics or initiate transport.



> *In PA even SpO2 is not generally allowed for a BLS provider and what does that take... 10 seconds... If that?* The state does recognize the ACLS-B course and does allow BLS providers to take an SpO2 after having their ACLS-B certificate (8 hours) but they can very well yank your numbers for doing this without the ACLS-B training. I know it is sort of stupid but you probably know that there are *some EMT-B's out there that can barely do their current scope of practice and anything else will confuse them*, well guess what, the state of PA [and a ton of other ones out there] will hold off these *simple* procedures for what, maybe 5% of the certified population of Basics. It does suck, I agree with you but everything here is coming from information that I either heard or read on the state level!



Wait, you need a class to use a pulse oximeter? That's terrible. SpO2 is non-invasive and I look at as just another vital sign. Could I do without the reading? Of course I can, but it is really useful for telling off protocol monkeys that insist on giving 02 to every remotely sick patient regardless of respiratory status. I know the patient doesn't need supplemental 02 from my assessment, but if I my partner still questions me I can show him the reading and suddenly he believes me...




> I agree with you and that was what I was trying to explain to _*Tigger*_ is that *in Pennsylvania **ALL priority Pt's get high flow O2*. You and I both know that the AHA says that is not the case but this is on the books for the EMT-B protocol.
> 
> Now I have noticed that in Philly the medics and up (ED staff) will listen to you if your a Basic and you have proven yourself. I don't know if this goes for other places as well?



I have not placed someone on an NRB in the last four months, and I absolutely, positively refuse to put someone on 02 just because that's what my textbook said to. A NC is usually sufficient to remedy any respiratory distress, should it be present. Oxygen is not a wonder drug, if it's not indicated my patient isn't getting it.

One of the best ways to show the ER staff that you are better than average bottom-feeding basic is to utilize your critical thinking skills and determine what interventions will actually benefit the patient. The ER staff is not going to think you (plural) are a good provider/are cool because you put someone on oxygen "just in case," they are going to think you (plural) are a moron that is incapable of doing anything besides religiously following the protocol book.

As JP noted, nearly every protocol book makes it very clear that the protocols are "treatment guideline" that one can deviate from provided it is justifiable and in the patient's best interest. Incidentally, the Massachusetts protocols no longer call for blanket 02 treatments, it leaves that up to the discretion of the provider.


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## 18G (Sep 26, 2011)

Jay said:


> *In PA even SpO2 is not generally allowed for a BLS provider and what does that take... 10 seconds... If that?* The state does recognize the ACLS-B course and does allow BLS providers to take an SpO2 after having their ACLS-B certificate (8 hours) but they can very well yank your numbers for doing this without the ACLS-B training. I know it is sort of stupid but you probably know that there are *some EMT-B's out there that can barely do their current scope of practice and anything else will confuse them*, well guess what, the state of PA [and a ton of other ones out there] will hold off these *simple* procedures for what, maybe 5% of the certified population of Basics. It does suck, I agree with you but everything here is coming from information that I either heard or read on the state level!



I was an EMT for about 15yrs in South-Central, PA and EVERY BLS ambulance and most QRS units had a pulse oximeter. And what is the ACLS-B course? Being a PA EMS provider since I was a teen-ager I have never even heard of this course in PA let alone it being a requirement to use a pulse oximeter. Is this new in the past year? 

The only requirement that I am aware of in PA for EMT's to use pulse oximetry is learning it through some form of continuing education. Honestly, the majority of EMT's never had formal education on using a pulse oximeter. I never did when I was an EMT... Granted I think EMT's should have formal education on using it (should be included in Basic).

And also, the new PA protocol are very specific in addressing the oxygen needs of the patient. No longer is the blanket treatment of 100% O2 in the protocols. It specifically states titrate SpO2 >94% in many of the protocols.


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## CAOX3 (Sep 26, 2011)

We never had spo2 up until about five years ago, I use it now because it's a required vital sign for asnt suspected respiratory distress patient. The problem I see is new providers rely on it, some couldn't even distinguish between rales and a wheeze.

They get all wound up in numbers, blasting someone with high flow oxygen even if they live in the high 80's.  Your not going to fix thirty years of lung damage on a ten minute trip to the hospital, make them comfortable if thats spo2 of 88 or 98.


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## Tigger (Sep 26, 2011)

Yes, the loss of assessing someone's respiratory status is a risk with using the pulse ox. If someone is relying on a 40 dollar finger clip to make clinical decisions, a larger problem is afoot. That said, I'm still happy to be provided with one.

Sent from my out of area communications device.


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## JPINFV (Sep 26, 2011)

Tigger said:


> Yes, the loss of assessing someone's respiratory status is a risk with using the pulse ox. If someone is relying on a 40 dollar finger clip to make clinical decisions, a larger problem is afoot.



Using a pulse ox to assist in making a clinical decision is not the same as failing to asses a patient's respiratory status. The people (I hesitate to use the term "provider") who fail to assess the patient's respiratory status are either ignorant, new, lazy, incompetent, or a combination. A pulse oximeter adds to the respiratory assessment, not replaces it.


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## johnmedic (Sep 26, 2011)

I've seen basics completely botch checking blood glucose levels, using lancets like scalpels etc.. some people find it easy to make a simple skill dangerous or at least very complicated. Our basics could read sp02, check bg & place combi tubes a few years ago in one county immediately after emt certification and I think it did infinitely more good than bad, idk if that's still the case as I'm no longer in that county.

Sent from my G2X on tapatalk. Forgive my typos. ; )


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## imadriver (Sep 26, 2011)

johnmedic said:


> I've seen basics completely botch checking blood glucose levels, using lancets like scalpels etc.. some people find it easy to make a simple skill dangerous or at least very complicated. Our basics could read sp02, check bg & place combi tubes a few years ago in one county immediately after emt certification and I think it did infinitely more good than bad, idk if that's still the case as I'm no longer in that county.



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.


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## JPINFV (Sep 26, 2011)

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


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## imadriver (Sep 26, 2011)

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.


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## Akulahawk (Sep 26, 2011)

imadriver said:


> 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.


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## ArcticKat (Sep 27, 2011)

JPINFV said:


> 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.


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## systemet (Sep 27, 2011)

imadriver said:


> 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.


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## pa132399 (Sep 27, 2011)

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


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## systemet (Sep 27, 2011)

emergancyjunkie said:


> 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


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## Tigger (Sep 27, 2011)

pa132399 said:


> 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.


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## pa132399 (Sep 27, 2011)

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.


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## 18G (Sep 27, 2011)

pa132399 said:


> 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.


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## emergancyjunkie (Sep 27, 2011)

pa132399 said:


> 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


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## pa132399 (Sep 27, 2011)

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.


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## pa132399 (Sep 27, 2011)

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.


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## emergancyjunkie (Sep 27, 2011)

pa132399 said:


> 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


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## emergancyjunkie (Sep 27, 2011)

pa132399 said:


> 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


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## pa132399 (Sep 27, 2011)

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.


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## 18G (Sep 27, 2011)

pa132399 said:


> 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.


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## 18G (Sep 27, 2011)

pa132399 said:


> 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.


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## JPINFV (Sep 27, 2011)

18G said:


> 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.


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## 18G (Sep 28, 2011)

JPINFV said:


> 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.


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## pa132399 (Sep 28, 2011)

i agree i need a new source and im not implying that i would put it in the patients hand to administer an epi pen it was just how my emt class was taught it doesnt mean that i would do it that way. technically even if you do it you are assisting the patient in taking there own medication so i understand what you are getting at and yes the drugs i agree we do need to know. but i sat with one of my medic partners and she went through the pile of drug card and narrowed them down to what we carry and also what i definately need to know. so in turn i am also taking a pharmocology class next semester and i do hope to learn as much as i can possibly implant in my nuerons.


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## 18G (Sep 28, 2011)

Cool. I'm not trying to oppose everything ya say but almost everything you relayed was heresy and I don't want you believing stuff that isn't true. 

Your Paramedic partner should know that even though the drug cards you have aren't for drugs in the drug box at the station, they are still drugs on the National Registry exam and you still need to know them since you may have to answer test questions that deal with them. Disregard that advice she gave you and study all of your drug cards.


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## MedicJon88 (Sep 29, 2011)

firefite said:


> Here we can "measure" the BGL. We just aren't allowed to poke their finger to get it. After the medic gets an IV then I automatically grab the flash blood and measure that. I've seen many EMTs here go "out of their scope" and poke the patients finger.



We didn't measure anything technically, same as the poking part its above our "supposed understanding"- we did it under the medics supervision- its stupid but its still not in our scope of pratice... and it common pratice for them to hand us the glucometer along with the lancet... you are going to get a look if you tell them "its out of my scope"- same as setting up a flush,spike the NS/LR/D5, administering SL nitro,and a 4 lead... sometimes when they are feeling kind- EMTs get to set up nebulizer and CPAP get a 12lead... but its always under the supervision of the P-medic...

I heard they are thinking about adding BGL and Pulse Ox to the EMTb scope of pratice... bt 2014...


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## usalsfyre (Sep 29, 2011)

Doing a mix of IFT and 911 I carried meds that weren't in my drug box daily. Just knowing what's in your protocols is a good sign of a technician skill monkey...


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## CAOX3 (Sep 30, 2011)

Is anyone using glucagon at the BLS level?


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## emergancyjunkie (Sep 30, 2011)

CAOX3 said:


> Is anyone using glucagon at the BLS level?



I think in pa that is an als assist skill

Sent from my Desire HD


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## MassEMT-B (Sep 30, 2011)

CAOX3 said:


> Is anyone using glucagon at the BLS level?



Rhode Island is.


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## CAOX3 (Sep 30, 2011)

emergancyjunkie said:


> I think in pa that is an als assist skill
> 
> Sent from my Desire HD



So your allowed to a administer it under  the supervision of a paramedic?


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## 18G (Sep 30, 2011)

No, glucagon IS NOT a BLS primary or assist skill in Pennsylvania.


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## emergancyjunkie (Sep 30, 2011)

18G said:


> No, glucagon IS NOT a BLS primary or assist skill in Pennsylvania.



Yeah another skill that's considered invasive. Just read that portion of the BLS protocal.

Sent from my Desire HD


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## 18G (Sep 30, 2011)

emergancyjunkie said:


> Yeah another skill that's considered invasive. Just read that portion of the BLS protocal.
> 
> Sent from my Desire HD



Glucagon is an injection so yes, invasive. More importantly it has positive chronotropic and inotropic effects (ie increases heart rate and force of hearts contraction). 

Patient's receiving glucagon should be on a cardiac monitor preferably.


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## JPINFV (Sep 30, 2011)

The following is in regards to California's scope of practice for EMTs. 



AchilliesOmega3 said:


> same as setting up a flush,spike the NS/LR/D5, administering SL nitro,and a 4 lead...



One of these things is not like the others. One of these things just doesn't belong. 

Also, "Setting up for ALS procedures" is very much a part of the scope of practice for EMTs. CCR Title 22, Div. 9, Ch. 2, § 100063 (a)(12)





> I heard they are thinking about adding BGL and Pulse Ox to the EMTb scope of pratice... bt 2014...




If you wanted to play amature lawyer, you could argue that, especially with the pulse ox, that they could fall under (a)(3) "Obtain diagnostic signs to include, but not be limited to." I believe this is how Orange County is justifying allowing EMTs to utilize pulse oximetry. 

Additionally, there are optional scope of practice packages for the following:



Perilarygeal airways
Naloxone
Epinephrine autoinjectors (not patient assist)
Atropine and Pralidoxime Chloride


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## emergancyjunkie (Sep 30, 2011)

18G said:


> Glucagon is an injection so yes, invasive. More importantly it has positive chronotropic and inotropic effects (ie increases heart rate and force of hearts contraction).
> 
> Patient's receiving glucagon should be on a cardiac monitor preferably.



Can't an emt-b prepare the glucagon for the paramedic. From what my instructor has showed the class it comes in such a matter that it has to be mixed

Sent from my Desire HD


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## 18G (Sep 30, 2011)

emergancyjunkie said:


> Can't an emt-b prepare the glucagon for the paramedic. From what my instructor has showed the class it comes in such a matter that it has to be mixed
> 
> Sent from my Desire HD



You are right. Glucagon has to be reconstituted (mixed) prior to giving since it comes in powder form. I would not allow an EMT to prepare the glucagon when they are not used to handling a syringe, needle, and withdrawing the med. It's far from a difficult task but most EMT's aren't aware of how to draw up the medication, handle sharps, prevent contamination, etc, etc. 

Plus, Pennsylvania does not allow EMT's to draw up medication.


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## Akulahawk (Sep 30, 2011)

emergancyjunkie said:


> Can't an emt-b prepare the glucagon for the paramedic. From what my instructor has showed the class it comes in such a matter that it has to be mixed
> 
> Sent from my Desire HD


If the EMT is setting up a line, pulling out and assembling a preload, or grabbing a vial and syringe... I'm OK with that. If the EMT is actually drawing or mixing/preparing meds, that I'm not OK with because it's _my_ License on the line. In the case of glucagon, if I ask for it, I expect to be handed the whole package so that _I_ can reconstitute it. Preloads and stuff like that, I'll look for it to be assembled correctly and check (more than once) that the Epi I asked for is exactly the Epi that I asked for and not a different med altogether.


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## MedicJon88 (Oct 1, 2011)

-- 





JPINFV said:


> Also, "Setting up for ALS procedures" is very much a part of the scope of practice for EMTs. CCR Title 22, Div. 9, Ch. 2, § 100063 (a)(12)



Thanks, I know my scope of practice- I'm just saying that we wouldn't be able to do these things without paramedic resources- their box and Monitor. Its always with just "Assists"- We don't carry AEDs in our rigs- They are not Required for EMT level Ambulances- you can have them but its not required. Same with oral glucose, We don't carry those either... We're basically reduced to 1st responders- with ALS assist skills. LA County is A**backwards.

With regards to Local-Expanded Scope of Practice... At one time LA County EMS was progressive- then the Firefighters drop the collective competence of EMTs in LA... now everything is restricted or removed. Riverside, Kern, San Bernadino, even Orange County's scope is better than ours. 

Regarding our neighbor OC County's Scope:

2-Pam and Atropine in Duodote or Mark I kit would only be use for organophosphate poisoning.

They added Pulse ox- good for them

Didn't see Narcan and PLA yet but:

Narcan- although very useful, should not be given to BLS providers- There is something to be said about maintaining a patent airway and provide rescue breathing- instead of waking up a junkie that will be very VERY VERY angry with you for ruining his narcotic stupor. Plus the patient should be on cardiac monitor after the administration of Narcan; Benzos would be good to have incase they start to seize...

LMA- or PLA in my opinion is the same thing as King LT... and just the same restricted to ALS only in LA county... god-its time to move.

Our County's justification for limiting our scope of practice is that- Hospitals or ALS resources are plentiful and transport times are short enough that EMTs don't need to implement these skills- Although Hospitals and ALS resources are certainly there- I just don't see the wisdom of dumbing down the provider- the decision of whether or not to do a full assessment and stablizing on scene or initiating trapid transport should be weighted inregards to transport time by the provider, oh wait that would require clinical judgement- but thats unnecessary in LA... I've seen enough times where the medics fail to intubate a patient x3 that had patent airways with OPAs...delaying transport- and they wonder why they want to remove intubation in LA County... too many bad apples in the bunch around here... well with the amount of Apples that are in LA that wants to be oranges but are force to be apples... its no wonder.... Some of them Government Oranges that are forced in Apple rigs can't even do CPR properly... and i'm not just talking about the recent update...


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## CAOX3 (Oct 1, 2011)

We use IM and IN narcan at the BLS level here, you simply want to return spontaneous respirations, which can be achieved quite easily.

If I can achieve that  before the medics arrive then we cancel them.

Never had an issue, if I cant return respirations to an acceptable level then the medics can transport.


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## MedicJon88 (Oct 2, 2011)

CAOX3 said:


> We use IM and IN narcan at the BLS level here, you simply want to return spontaneous respirations, which can be achieved quite easily.
> 
> If I can achieve that  before the medics arrive then we cancel them.
> 
> Never had an issue, if I cant return respirations to an acceptable level then the medics can transport.



We can never cancel the medic especially when medication has been administered... I know just how easy it is for narcan to work- which is the problem... titrate to effect but not bring the person all the way back... or if they are opioid dependent you can cause other problems with narcan...


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## HMartinho (Oct 6, 2011)

So, the bgl is considered an invasive procedure ... Are they afraid that the patient will bleed to death with just an little needle bite?


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## MrBrown (Oct 6, 2011)

WoodyPN said:


> So when the medic starts the IV, take the catheter from him/her and use the bit of blood on it to get the glucose.



Please don't do this, it makes me want to smash my head on the wall

I was having this discussion the other day with one of the guys I am mentoring for his Paramedic (ICO) assignments.  As JP rightly said, venous blood is different from capillary blood and although the difference is small the glucometer is not  calibrated for venous blood.

It also increases the risk of a needlestick injury.

This was covered in the Ambulance clinical newsletter _Clinical Matters_ (Issue 6, December 2009)



> Q:  Is it acceptable to use blood on the end of the needle just used for IV cannula insertion for the purposes of measuring blood glucose?
> 
> A:  No – it is not. It has come to our attention that this is common practice in some areas and it must stop.
> 
> ...


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## CAOX3 (Oct 6, 2011)

AchilliesOmega3 said:


> We can never cancel the medic especially when medication has been administered... I know just how easy it is for narcan to work- which is the problem... titrate to effect but not bring the person all the way back... or if they are opioid dependent you can cause other problems with narcan...



Why?

Why would you tie up  another ambulance, especially a medic truck with a patient who's problem has been corrected?

And what other problems are you going to cause?  A combative patient, not if your administering it correctly, vomiting, occluded airway? I can address those issues just as well if need be.

The problem is the latter generation of EMT with their compressed training and education has come to rely completely on paramedics, independent thought has been removed, replaced with call a paramedic even if the patient doesn't need one.

When I went to school there wasnt a medic truck on every corner and our education reflected that, we were educated/trained as sole providers able to care for patients, I simply don't drop back and punt if the complaint is in my grasp, we are are able to administer multiple medications, use advanced airways and such.  I don't have to call a medic everytime I administer a medication, if it had the desired effect I take them to the hospital if it doesn't I contact  some who can address it further.


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## MrBrown (Oct 6, 2011)

CAOX3 said:


> Why would you tie up  another ambulance, especially a medic truck with a patient who's problem has been corrected?



Now now stop talking logical sense, we can't be having any of that! 

And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.


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## CAOX3 (Oct 6, 2011)

MrBrown said:


> Now now stop talking logical sense, we can't be having any of that!
> 
> And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.



I've have only given narcan with obvious respiratory complications, I'm not of the belief of ruining someones high just because I can.

We don't tube them, we take the edge off, hopefully return some sort of respiratory function and take them to the hospital, I would be more apt to leave them home if I believed for a second they wouldn't cop again and start the whole vicious cycle all over again.


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## Akulahawk (Oct 6, 2011)

MrBrown said:


> Please don't do this, it makes me want to smash my head on the wall
> 
> I was having this discussion the other day with one of the guys I am mentoring for his Paramedic (ICO) assignments.  As JP rightly said, venous blood is different from capillary blood and although the difference is small the glucometer is not  calibrated for venous blood.
> 
> ...


If the glucometer is also calibrated for venous blood, you're OK on that end of things. There aren't many needle systems that I know of that you can easily get a venous sample from, after safing the introducer needle. If I'm working with a system that you can easily get a sample, it's a trivial matter to do it. Any other system and I'll just set the glucometer up before the start and get my drop right out of the catheter itself. 

Now if my glucometer is NOT calibrated for venous blood and if I need something to base Tx on, I'll get it the "correct" way.


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## 18G (Oct 6, 2011)

CAOX3 said:


> We use IM and IN narcan at the BLS level here, you simply want to return spontaneous respirations, which can be achieved quite easily.
> 
> If I can achieve that  before the medics arrive then we cancel them.
> 
> Never had an issue, if I cant return respirations to an acceptable level then the medics can transport.



I am not a fan at all with cancelling ALS or at least transporting BLS on a drug overdose where Narcan had to be given for a few reasons. 

One, if you give just enough to return respiratory drive and are successful in doing that, chances are some alteration is still going to be present and possibly some negative hemodynamic effects as well from the opiate.

Two, some narcotics effects will outlast that of Narcan. We never really know how much of a illicit substance was taken. 

Three, what if it is a polypharmacy overdose? Say a narcotic was taken along with some stimulants and now since you blocked the opposing narcotic, we now have the stimulant causing tachycardia, agitation, and hypertension?

Four, who is going to be with these OD patients that just received Narcan? Their junkie friends? By allowing the patient to refuse are we possibly instilling a false sense of confidence that if something bad happens they can just call EMS who will do a quick fix and everything is back to normal?

Five, it is our job to advocate for our patient and determine their needs when they are not in a condition to do so themselves. By transporting to the hospital at least the patient is in an environment where intervention services are available and can be offered. Granted quite a few of these patient types will refuse hospital services and just want to leave, but what about the few who maybe do want help but never knew where to turn or was afraid to ask for help? At least we can get the patient to the people who can get them the help they really need.

A patient who overdosed on heroin or whatever has problems that run much deeper than one single episode. We need to be getting these patients to the hospital.


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## 18G (Oct 6, 2011)

MrBrown said:


> Now now stop talking logical sense, we can't be having any of that!
> 
> And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.



I believe the pre-hospital environment has a need for Narcan. Yes, we can manage their airway and ventilate them but why subject the patient to all that when you can give the Narcan and reduce some of the risks associated with assisted ventilations, airway control, vomiting, aspiration, hypotension, etc, during the trip to the hospital especially if it's a 20-30min transport?


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## Handsome Robb (Oct 6, 2011)

18G said:


> I believe the pre-hospital environment has a need for Narcan. Yes, we can manage their airway and ventilate them but why subject the patient to all that when you can give the Narcan and reduce some of the risks associated with assisted ventilations, airway control, vomiting, aspiration, hypotension, etc, during the trip to the hospital especially if it's a 20-30min transport?



Seconded. Narcan is a pretty benign med when it comes down to it. Yes you can cause seizures or vomiting if you slam it but other than that? I'd rather be stuck with a needle than have a plastic tube jammed down my throat and into my trachea assisted by a giant metal blade that can chip teeth or cause oral trauma that could threaten my airway if the provider is unable to secure the tube.

Why *not* give narcan prehospitally, Brown?


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## JPINFV (Oct 6, 2011)

MrBrown said:


> Now now stop talking logical sense, we can't be having any of that!
> 
> And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.




The argument against furosemide and an argument against naloxone are two completely different arguments.


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## Calichic (Oct 23, 2011)

emergancyjunkie said:


> Does anyone know why an emt-b in pa can give an epi-pen but can not check a bgl
> 
> Sent from my Desire HD


We have the same protocol in CA as well


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## DesertMedic66 (Oct 23, 2011)

Calichic said:


> We have the same protocol in CA as well



It's slowly changing in Cali depending on your county. As of next year we can start doing BGL and they are probably gonna put a BG meter on all BLS rigs in my county along with pulse ox and AED.


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## emergancyjunkie (Oct 23, 2011)

Calichic said:


> We have the same protocol in CA as well



It is a bad idea to not let emt-b check bgl. It's been said in this thread why tie up a medic unit just to see if they have low or high blood sugar

Sent from my Desire HD


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## JPINFV (Oct 23, 2011)

emergancyjunkie said:


> It is a bad idea to not let emt-b check bgl. It's been said in this thread why tie up a medic unit just to see if they have low or high blood sugar
> 
> Sent from my Desire HD




Because the things that can cause an altered mental status can often benefit from the education, intervention, or the safety net (in case the patient significantly deteriorates) that the paramedic brings to the patient.

Additionally, if the patient is hypoglycemic to the point that they can't be administered oral glucose, then you're going to need paramedics anyways to administer IV dextrose.


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