# Thoughts on taking BGL as part of your assessment.



## Iowaemtb (Nov 25, 2012)

When you have a call and it's medical or even a mva, do you routinely check the BGL? Why or why not?  Is it part of your protocols? Just your routine assessment?


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## TransportJockey (Nov 25, 2012)

Unknown medical I usually do it. Unconscious unresponsive I do it... And any time I start an IV I get one from the stick.
Edit: of course any diabetic call gets a CBG stick.


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## NYMedic828 (Nov 25, 2012)

Syncope, unconscious, unknown, diabetic history.

It's minimally invasive and can't hurt...


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## Iowaemtb (Nov 25, 2012)

NYMedic828 said:


> Syncope, unconscious, unknown, diabetic history.
> 
> It's minimally invasive and can't hurt...



We do it for those reasons as well.  We did a stick on a guy who had a minor accident on the interstate, he was confused, sweating profusely, etc.  One of the not so bright firemonkey's said he was drunk and that was  that, I took his BGL and it was 40, he was still conscious, administered Glucose on the way to the hospital he was coherent by the time we got there.  

I don't see it as invasive, yet some states think it is and it is not a B level skill.


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## CANDawg (Nov 25, 2012)

I would definitely do it for any trauma, especially MVCs. (Who knows WHY she crashed into a tree?) As for medical, I would even say most medical patients should get it too. It's very minimally invasive, and can sometimes come in VERY handy.

You have a 65 y/o male, hx of angina complaining of chest pain? May not seem related, but maybe he hasn't eaten recently because of the pain. He could be on the verge of AMS without you even knowing it.  One stick and all of a sudden you're ahead of the curve instead of struggling to catch up to something you could have prevented.


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## leoemt (Nov 25, 2012)

I wish I could do it, but even though its a Basic skill here in WA State - King County doesn't allow basics to do it. Have to call a medic which makes no sense to me.

I have had two patients in the last week that unresponsive due to being Hypoglycemic. One patient was a legitimate Medic call - didn't even respond to IV Glucacon (or what ever it is you medics give).


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## TransportJockey (Nov 25, 2012)

leoemt said:


> I wish I could do it, but even though its a Basic skill here in WA State - King County doesn't allow basics to do it. Have to call a medic which makes no sense to me.
> 
> I have had two patients in the last week that unresponsive due to being Hypoglycemic. One patient was a legitimate Medic call - didn't even respond to IV Glucacon (or what ever it is you medics give).



D50. And i still can't understand basics not being allowed to check a CBG... our basics in nm do it all the time


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## CANDawg (Nov 25, 2012)

TransportJockey said:


> D50. And i still can't understand basics not being allowed to check a CBG... our basics in nm do it all the time



I agree. It seems so weird. There must be some type of mental barrier in the brains of some medical directors about 'breaking the skin'. 

Odd. :wacko:


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## Fish (Nov 25, 2012)

Iowaemtb said:


> When you have a call and it's medical or even a mva, do you routinely check the BGL? Why or why not?  Is it part of your protocols? Just your routine assessment?



I do it if I have a reason to, altered, unresponsive, CVA, seizure....... stuff along those lines. I don't follow the "it can't hurt" I do stuff for a reason. If I followed the "couldn't hurt" mentality, I would also perform stroke scales, 12Leads, and a tilt test on every single patient as well. But I don't, I do these skills or assessments as indicated.

I do not do it for traumas, unless they had a medical cause to them. Had a seizure then crashed, got dizzy and crashed. Not, I was texting while driving and ran into the guard rail. I would slap someone trying to stick me with a lancet in a collision that I didn't even cause just because it was ther "routine" I think it hurts to get your sugar checked, and I do not like it.

I don't do it on every patient as part of my normal vitals, checking a BGL stings and it is another added cost to the patient's bill.


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## TransportJockey (Nov 25, 2012)

dbo789 said:


> I agree. It seems so weird. There must be some type of mental barrier in the brains of some medical directors about 'breaking the skin'.
> 
> Odd. :wacko:



I dunno.. then again nm has an extremely broad definition of BLS


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## NYMedic828 (Nov 25, 2012)

I don't actually take it on every patient with diabetes like a hospital does. BUT, if I am RMAing a patient I do everything but a 12 lead (unless its a chest pain or something)


For the record to the above posts, anything that breaks the skin is considered invasive even if it is as minimal as a fingerstick.


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## Fish (Nov 25, 2012)

TransportJockey said:


> I dunno.. then again nm has an extremely broad definition of BLS



Round these here parts our Basics can check BGL, give ASA, Albuterol, Nitro, Epi 1:1000 IM(by drawing it up, not an EPI pen) Oral Glucose, and Oxygen. They give a good amount of life saving drugs.


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## leoemt (Nov 25, 2012)

TransportJockey said:


> D50. And i still can't understand basics not being allowed to check a CBG... our basics in nm do it all the time



We can do it in the rest of the State. When I work in Whatcom County I can do it. 

Whats weird is King County wont let me check a BGL but I can transport a patient with running D50  and I can calculate and adjust drip rates based on doctors orders. I think that is probably a lot more risky than giving someone a finger stick. 

I can also have the patient or their family check the BGL for me and administer Oral Glucose based on that.


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## NYMedic828 (Nov 25, 2012)

In NYC basics can't check BGL. In NYS, they can.

It's really stupid. Would save me a lot of runs to BLS CVA jobs that the BLS crew assumes to be a diabetic... Granted they should still know better without BGL but it can be tricky sometimes...


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## Fish (Nov 25, 2012)

leoemt said:


> We can do it in the rest of the State. When I work in Whatcom County I can do it.
> 
> Whats weird is King County wont let me check a BGL but I can transport a patient with running D50  and I can calculate and adjust drip rates based on doctors orders. I think that is probably a lot more risky than giving someone a finger stick.
> 
> I can also have the patient or their family check the BGL for me and administer Oral Glucose based on that.



Weird


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## Fish (Nov 25, 2012)

NYMedic828 said:


> In NYC basics can't check BGL. In NYS, they can.
> 
> It's really stupid. Would save me a lot of runs to BLS CVA jobs that the BLS crew assumes to be a diabetic... Granted they should still know better without BGL but it can be tricky sometimes...



We can't call a Code stroke without getting a BGL first, since it can mimmick. The stroke centers want us to rule out hypoglycemia before we activate the team at the Hosp.

We run off of the LA Stroke Scale


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## NYMedic828 (Nov 25, 2012)

Fish said:


> We can't call a Code stroke without getting a BGL first, since it can mimmick. The stroke centers want us to rule out hypoglycemia before we activate the team at the Hosp.
> 
> We run off of the LA Stroke Scale



I don't think anyone should competently activate a stroke team without ensuring it is not a hypoglycemic event. It takes all of 30 seconds and you look pretty dumb to top it off if it ends up in fact being a hypoglycemic and you don't check. People remember...

But for BLS units to not be capable of the same diagnostic a patient can perform on themselves, which may save 20 minutes in me having to show up to reassess the patient for them and allow for more extensive cerebral damage, is ridiculous.

The state allows EMTs to do glucometry for the last 3 years. The city has not adopted it.


Though the city does allow our EMTs to administer an epi pen for asthma and the state does not.

The state just started BLS narcan pilots and the city has not.


It's all ridiculous. One of my biggest gripes with EMS is how insanely diverse our scopes of practice are. As a medic my scope changes notably within 20 miles of my home in either direction between 3 sets of protocols.

It's fine when a provider is competent and works by clinical knowledge and experience and not a cookbook but it still leaves room to get in trouble when I go to give Valium for a seizure and forget it isn't a standing order where I volunteer and is where I employ.


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## Fish (Nov 25, 2012)

NYMedic828 said:


> I don't think anyone should competently activate a stroke team without ensuring it is not a hypoglycemic event. It takes all of 30 seconds and you look pretty dumb to top it off if it ends up in fact being a hypoglycemic and you don't check. People remember...
> 
> But for BLS units to not be capable of the same diagnostic a patient can perform on themselves, which may save 20 minutes in me having to show up to reassess the patient for them and allow for more extensive cerebral damage, is ridiculous.
> 
> ...



I agree, a trained Medical professional should most certainly be able to on standing orders do a simple skill that people do on themselves all of the time. And Heck, they don't even clean the site first!


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## Refino827 (Nov 25, 2012)

We're actually required to take BGL as a part of our normal patient assessment. The only times we really don't are in the case of something like a lift assist, etc.


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## Fish (Nov 25, 2012)

Refino827 said:


> We're actually required to take BGL as a part of our normal patient assessment. The only times we really don't are in the case of something like a lift assist, etc.



Strange, so if I get rear ended at 5mph your gonna poke my finger?


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## TransportJockey (Nov 25, 2012)

Fish said:


> Round these here parts our Basics can check BGL, give ASA, Albuterol, Nitro, Epi 1:1000 IM(by drawing it up, not an EPI pen) Oral Glucose, and Oxygen. They give a good amount of life saving drugs.



Our basic have a very similar scope to yours


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## NYMedic828 (Nov 25, 2012)

Fish said:


> Strange, so if I get rear ended at 5mph your gonna poke my finger?



I'd slap you. Those freakin lancets hurt! I'd take an IV over a finger stick any day. (I've been an IV dummy quite a few times)


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## Fish (Nov 25, 2012)

NYMedic828 said:


> I'd slap you. Those freakin lancets hurt! I'd take an IV over a finger stick any day. (I've been an IV dummy quite a few times)



Thats what I am sayin


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## Shishkabob (Nov 25, 2012)

Iowaemtb said:


> When you have a call and it's medical or even a mva, do you routinely check the BGL? Why or why not?  Is it part of your protocols? Just your routine assessment?



If signs, symptoms or complaints indicate something could be glucose level related, yes.  

If I'm running to the hospital with a GSW, then I have more important things to worry about unless they've unconscious.


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## wigwag (Nov 25, 2012)

NYMedic828 said:


> In NYC basics can't check BGL. In NYS, they can.
> 
> It's really stupid. Would save me a lot of runs to BLS CVA jobs that the BLS crew assumes to be a diabetic... Granted they should still know better without BGL but it can be tricky sometimes...



Actually, it's NOT in Westchester Co's protocols either.


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## Thricenotrice (Nov 25, 2012)

Check it if its indicated by presentation  

Or if you've already stuck them. Might as well at that point


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## Akulahawk (Nov 26, 2012)

As a normal part of my patient assessment? No. Just because I showed up at your door doesn't mean that you're going to have your finger stuck. Now if I'm going to start an IV line on you because you've suddenly met some criteria that says that an IV is indicated, I'm going to get a BGL, but it's going to likely be venous if my glucometer is certified for venous blood. Why? I've already poked you, you're likely to lose a drop or two anyway, so why not put those wasted blood drops to good use? Now if I don't have to start a line, I'm not going to poke you for a BGL unless something tells me that it's indicated. One way it's a "nice to get" result that is a happy byproduct of another procedure, the other is invasive all by itself. 

If you're coherent, warm, pink, dry... and have no complaints that make me think "check BGL," I'm going to leave the lancets well enough alone...


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## JPINFV (Nov 26, 2012)

NYMedic828 said:


> In NYC basics can't check BGL. In NYS, they can.
> 
> It's really stupid. Would save me a lot of runs to BLS CVA jobs that the BLS crew assumes to be a diabetic... Granted they should still know better without BGL but it can be tricky sometimes...




Never had a hypoglycemic mimic a stroke? Without a BGL, both CVA and hypoglycemia are squarely in the differential, one of which a paramedic can easily treat or rule out.


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## NYMedic828 (Nov 26, 2012)

JPINFV said:


> Never had a hypoglycemic mimic a stroke? Without a BGL, both CVA and hypoglycemia are squarely in the differential, one of which a paramedic can easily treat or rule out.



Are you asking if I ever had a hypoglycemic mimic a stroke or are you stating that you never have?

I realize and understand the different signs and symptoms of each process but it is not my choosing to constantly be called to the scene of a CVA patient that the BLS crew presumes may be having a diabetic event. Granted they are wrong, but if they at least had the capability of checking the patient's BGL they could confidently rule out hypoglycemia on their own and save the patient another 20 minutes.

Mind you I find it hard to differentiate CVA from hypoglycemia when a patient is entirely unconscious in both scenarios. Granted, it seems to be a rare occurrence in a CVA.


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## Veneficus (Nov 26, 2012)

Refino827 said:


> We're actually required to take BGL as a part of our normal patient assessment. The only times we really don't are in the case of something like a lift assist, etc.



Somebody needs to insert a facepalm picture.


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## JPINFV (Nov 26, 2012)

NYMedic828 said:


> Are you asking if I ever had a hypoglycemic mimic a stroke or are you stating that you never have?


Asking if you've ever had one? I had one when I was working IFT. Granted, receiving facility was as close as paramedics thus paramedics weren't indicated under the circumstances. However I did feel like an ignorant schmuck when my "CVA" patient had complete symptom relief with a dose of D50. 



> I realize and understand the different signs and symptoms of each process but it is not my choosing to constantly be called to the scene of a CVA patient that the BLS crew presumes may be having a diabetic event. Granted they are wrong, but if they at least had the capability of checking the patient's BGL they could confidently rule out hypoglycemia on their own and save the patient another 20 minutes.
> 
> Mind you I find it hard to differentiate CVA from hypoglycemia when a patient is entirely unconscious in both scenarios. Granted, it seems to be a rare occurrence in a CVA.



So, how do you rule out hypoglycemia in a patient with a history of diabietes and taking hypoglycemic agents, including but not limited to insulin (this is, of course, ignoring the differential of insulinomas)? Patients lie, patients misremember, patients accidentally take two doses of their medications. More importantly, how many EMTs know which medications can induce hypoglycemia and which can't? It certainly isn't in the education beyond "Diabetic, think hypoglycemia if altered." 

Is it not presumptuous to, absent of data leading elsewhere, exclude a valid emergency level differential? If you have a patient presenting with unilateral neurological signs, would you just call a code stroke and not get a BGL? 

If the patient is entirely unconscious, thus presumably no or very limited HPI, then how are you going to narrow a differential down to hypoglycemia vs CVA anyways, instead of adding the other bajillion differentials that can lead to an unconscious state?


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## NYMedic828 (Nov 26, 2012)

JPINFV said:


> Asking if you've ever had one? I had one when I was working IFT. Granted, receiving facility was as close as paramedics thus paramedics weren't indicated under the circumstances. However I did feel like an ignorant schmuck when my "CVA" patient had complete symptom relief with a dose of D50.
> 
> 
> 
> ...



I'm pretty sure we are agreeing on the same point... My point is that EMTs not being equipped with glucometers is ridiculous for this reason. The only definitive way we can rule out hypoglycemia to differentiate from CVA in an ambulance is a glucometer. One of the simplest skills to perform and we do not allow EMTs to do it. Which results in an extended time to definitive care for the patient if the BLS crew calls for an ALS unit, solely to rule out hypoglycemia over transporting to the ER.

When I was an EMT, I would ask the family member to check the patients BGL for me with their home glucometer or I would do it myself off the record... Not everyone is comfortable doing that when the family member tells you they can't do it. I just can't fathom why we wouldn't equip all of our BLS units with an invaluable $50 tool that literally spills a single drop of blood. An epi-pen is far more invasive and its on standing orders for BLS anaphylaxis and severe asthmatics...


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## JPINFV (Nov 26, 2012)

NYMedic828 said:


> The only definitive way we can rule out hypoglycemia to differentiate from CVA in an ambulance is a glucometer.



is not compatible with 



> It's really stupid. Would save me a lot of runs to BLS CVA jobs that the  BLS crew assumes to be a diabetic... Granted they should still know  better without BGL but it can be tricky sometimes.



How should they "know better" if they can't check a BGL and rule out hypoglycemia? If mimics happen, how can they always be wrong? Does it not make sense that if an emergent differential is present that paramedics can rule out and treat, that paramedics should be called assuming that an ED is not within a reasonable distance (in terms of time) from the EMT crew's location?


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## NYMedic828 (Nov 26, 2012)

JPINFV said:


> is not compatible with
> 
> 
> 
> How should they "know better" if they can't check a BGL and rule out hypoglycemia? If mimics happen, how can they always be wrong? Does it not make sense that if an emergent differential is present that paramedics can rule out and treat, that paramedics should be called assuming that an ED is not within a reasonable distance (in terms of time) from the EMT crew's location?



I suppose you are right and I was a bit contradictive there but by know better I didn't literally mean it in the sense of they should be magically capable of presumptively diagnosing one over the other.

In NYC we are usually no more than 5-10 from a hospital. Calling for ALS to differentiate one over the other without extreme suspicion for hypoglycemia will hinder the patient reaching care. If the cause turns out to be CVA, I can still do nothing more than the BLS crew could. If they had a glucometer, this problem wouldn't exist. But unfortunately it does, and people need to realize transporting is sometimes more valuable than waiting for someone else to show up who still only have a 50% chance of treating that problem.

Id rather that unit get a potential CVA patient to the ER 20-30 minutes faster and find out that the patient just needed some sugar than to have that CVA patient wait around at home for an extra 30 minutes.


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## EpiEMS (Nov 26, 2012)

Refino827 said:


> We're actually required to take BGL as a part of our normal patient assessment. The only times we really don't are in the case of something like a lift assist, etc.





Veneficus said:


> Somebody needs to insert a facepalm picture.



Now I see why you guys don't want BLS providers doing BGLs. Finger sticks for everyone make about as much sense as O2 and full spinal immobilization for everyone.


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## Clare (Nov 28, 2012)

A BGL should be part of your assessment for patients where you suspect dysglycaemia as a cause of their problem.

Examples where I'd routinely check a BGL include seizures with no known history of seizures, unconscious or altered level of consciousness with no other obvious cause and patients who feel generally unwell where DKA or non ketone hyperosmolar hyperglycaemia is suspected.

Some people say to check blood sugar on all patients who have a seizure but honestly, if your patient has a known history of seizures and a good acute exacerbating event for a seizure (such as being ill, medication change or other predisposing factor known to cause a seizure such as too much XBOX or Japanese seizure robots) then I don't think its necessary.

Same goes for syncope, if a patient faints and then recovers that is not hypoglycaemia.  

There may be a role for checking a blood sugar on patients who you suspect are having a myocardial infarction or are septic however I am unsure of the pathological basis for such a test (probably has something to do with anaerobic metabolism) but I don't know any more than that.


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## Jon (Nov 28, 2012)

I do finger sticks on anyone that, through assessment, is having an unknown problem or might be diabetic.

I grab blood from the IV site for the glucometer on almost every IV stick. It's quick and easy, and sometimes I'll find something interesting.


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## Earthworm Jim (Nov 28, 2012)

I agree, BGL is really quick and easy to do and may reveal pertinent information, but of course it depends on the situation.


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## Clare (Nov 28, 2012)

Jon said:


> I grab blood from the IV site for the glucometer on almost every IV stick. It's quick and easy, and sometimes I'll find something interesting.



Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood and it increases the risk of a needle stick.


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## Medic Tim (Nov 28, 2012)

Clare said:


> Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood and it increases the risk of a needle stick.



The ones we use are good for venous blood and the caths we use allow us to get the blood from the flash chamber without risk of a needle stick.


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## Tigger (Nov 28, 2012)

Clare said:


> Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood and it increases the risk of a needle stick.



Sounds like it may time to upgrade to "safety caths," which is probably a good idea anyway. Also I'm that most glucometers are able to read both blood types.


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## the_negro_puppy (Nov 28, 2012)

I do BGLs on:

- Nearly all diabetics
- Altered conscious state
- post-seizures
- hx of poor oral intake
- suspected sepsis or serious infections
- 'unknown' problems
- head injured & intox/drug affected pt's


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## Milla3P (Nov 29, 2012)

the_negro_puppy said:


> I do BGLs on:
> 
> - Nearly all diabetics
> - Altered conscious state
> ...



"Nearly All Diabetics"

I like this. I find that I check BGL far less often on diabetics than a do for any of the other listed categories above.


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## Clare (Nov 29, 2012)

I think it goes without saying that a diabetic patient who is unwell should have a blood sugar checked; but just because a patient is diabetic does not mean they need a blood sugar tested.


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## Veneficus (Nov 29, 2012)

Clare said:


> Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood and it increases the risk of a needle stick.



The difference between capilary and venous blood isn't that significant. maybe 5-10mg/ml, depending on the machine. 

If 5-10 makes or breaks a decision on what to do, then I would wager the providers are not very astute clinicians and require a more extensive FTO period. (or one to begin with) 

As for needle sticks, well. Be safe or get a safer device.


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## Clare (Nov 29, 2012)

Veneficus said:


> The difference between capilary and venous blood isn't that significant. maybe 5-10mg/ml, depending on the machine.
> 
> If 5-10 makes or breaks a decision on what to do, then I would wager the providers are not very astute clinicians and require a more extensive FTO period. (or one to begin with)
> 
> As for needle sticks, well. Be safe or get a safer device.



Good points, and I am not suggesting the difference between the two is so significant as to change the course of treatment, but it is something that has been decreed as unacceptable so be it I guess.

I would also think that if the patient has a glycaemic problem requiring intravenous access for medicine or fluid that a blood sugar has been taken before it is decided necessary to put in an IV.  For example many hypoglycaemic patients don't even require IV glucose here, something sweet to eat/drink or some glucagon does the trick most of the time, so that means you must take a normal capillary blood glucose.  If the patient is unwell with hyperglycaemic osmotic diuresis then you need to establish they are actually hyperglycaemic before treating them so again, you need to take a BGL before putting in an IV.

But then again I suppose it's not the end of the world if you want to use blood from an IV needle to get a blood sugar ...


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## Veneficus (Nov 29, 2012)

Clare said:


> For example many hypoglycaemic patients don't even require IV glucose here, something sweet to eat/drink or some glucagon does the trick most of the time, so that means you must take a normal capillary blood glucose.  If the patient is unwell with hyperglycaemic osmotic diuresis then you need to establish they are actually hyperglycaemic before treating them so again, you need to take a BGL before putting in an IV.



Your experience with hypoglycemic patients not requiring IV glucose(dextrose) is similar to mine.

However, when I see a person who clinically appears dehydrated, starting an IV is usually one of the first things I do. I do not wait for diagnositcs to begin treating that. (drives the nurses nuts actually) 

It is also my experience that most "diabetics" I have seen are actually hyperglycemic. They are often previously undiagnosed with type II diabtetes.


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## RocketMedic (Nov 29, 2012)

TransportJockey said:


> I dunno.. then again nm has an extremely broad definition of BLS



The first time I saw my partner pick up narcs I nearly pooped myself lol.


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## Christopher (Nov 29, 2012)

Clare said:


> Using the cannula needle for glucometery is now severely frowned upon (at least locally) because the glucometer is not calibrated for venous blood...



The literature supports the claim that "there exists a _statistically significant _difference between blood glucose measurements from arterial, venous, and interstitial samples".

The literature does not support the claim that "there exists a *clinically significant* difference between blood glucose measurements from arterial, venous, and interstitial samples".

As with any test you may get a falsely low, falsely normal, or falsely high reading; correlate results of tests with clinical judgement. Our SOP for any "critical value" is to get a second reading (preferably with a second device) from a second location/source.



Clare said:


> ...and it increases the risk of a needle stick.



Sounds like crappy catheters to me. It'd take crushing them to open the barrels of our catheters to get to the needle. Some neighboring services use "safety" catheters that basically amount to a small metal tab over the needle tip, which are a needle stick waiting to happen (but cheap, and cheap is good right?).


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## NYMedic828 (Nov 29, 2012)

Christopher said:


> Sounds like crappy catheters to me. It'd take crushing them to open the barrels of our catheters to get to the needle. Some neighboring services use "safety" catheters that basically amount to a small metal tab over the needle tip, which are a needle stick waiting to happen (but cheap, and cheap is good right?).



I assume you generally use the BD spring loaded catheters. I use those where I volunteer and use the "safety tip" you described with FDNY.

For actual usage, I prefer the safety tip because those catheters have a removable flash cap and are ultimately shorter allowing for a bit more ambidextrous usage.

Safety though, the spring loaded ones may as well be their own sharps container.

I would have to assume the safety tip is substantially cheaper... I have accidentally on a couple of occasions pressed the release button on the spring loaded ones prior to advancing my cath. What a mess that made...


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## Christopher (Nov 29, 2012)

NYMedic828 said:


> I assume you generally use the BD spring loaded catheters. I use those where I volunteer and use the "safety tip" you described with FDNY.
> 
> For actual usage, I prefer the safety tip because those catheters have a removable flash cap and are ultimately shorter allowing for a bit more ambidextrous usage.
> 
> ...



No I hate the spring loaded BD ones, wearing glasses has saved me some blood splatters when those were used (especially large bore).

We use the Protectiv IV safety catheters, you manually advance the catheter by pushing on a tab which pulls the barrel over trochar (you can also pull back on the barrel while advancing to do it all in one fluid motion).


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## NYMedic828 (Nov 29, 2012)

Christopher said:


> No I hate the spring loaded BD ones, wearing glasses has saved me some blood splatters when those were used (especially large bore).
> 
> We use the Protectiv IV safety catheters, you manually advance the catheter by pushing on a tab which pulls the barrel over trochar (you can also pull back on the barrel while advancing to do it all in one fluid motion).



Those look pretty cool.

That's another good point on the spring loaded, the splashing. I'm not fond of automatic syringes for that reason either... 

Any time I use either I pull the needle before pressing the button. The manufacturer recommends pressing it and having it remove itself...


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## Tigger (Nov 29, 2012)

Christopher said:


> Sounds like crappy catheters to me. It'd take crushing them to open the barrels of our catheters to get to the needle. Some neighboring services use "safety" catheters that basically amount to a small metal tab over the needle tip, which are a needle stick waiting to happen (but cheap, and cheap is good right?).



The Braun Introcaths that we use have a pretty large metal cap that ends up over the needle. While I think that the totally enclosed system is better, it would be pretty hard to stick yourself with these.


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## Christopher (Nov 29, 2012)

Tigger said:


> The Braun Introcaths that we use have a pretty large metal cap that ends up over the needle. While I think that the totally enclosed system is better, it would be pretty hard to stick yourself with these.



We use those during scope of practice exams because of how easy it is to deactivate the safety feature and not waste catheters. Just takes a little bit of finger nail available.


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## Thricenotrice (Nov 29, 2012)

The protect iv ones are great. Need to cut a stylet and push it on the rear to use it on a glucometer though.


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## Christopher (Nov 29, 2012)

Thricenotrice said:


> The protect iv ones are great. Need to cut a stylet and push it on the rear to use it on a glucometer though.



I use a ballpoint pen.


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## Clare (Nov 29, 2012)

Veneficus said:


> It is also my experience that most "diabetics" I have seen are actually hyperglycemic. They are often previously undiagnosed with type II diabtetes.



Likewise, in my experience most diabetics are chronically hyperglycaemic, not acutely so from DKA or non ketone hyperglycaemia but just in general from very poor control of their diabetes.

The Maori and Pacific populations have rampant diabetes epidemic and most would only require dietary adjustment and maybe some oral antihypoglycaemics at the severe end of the sale but their control is very suboptimal so most have BGL which chronically high.


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## Bullets (Nov 30, 2012)

Thricenotrice said:


> The protect iv ones are great. Need to cut a stylet and push it on the rear to use it on a glucometer though.





Christopher said:


> I use a ballpoint pen.



We use this model and that is pretty much the way to go. use the pen to push on the white cap.


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## EMT B (Nov 30, 2012)

Fish said:


> Round these here parts our Basics can check BGL, give ASA, Albuterol, Nitro, Epi 1:1000 IM(by drawing it up, not an EPI pen) Oral Glucose, and Oxygen. They give a good amount of life saving drugs.



where is this?


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## Christopher (Nov 30, 2012)

EMT B said:


> where is this?



I don't know where he is, but in NC that is pretty standard (excepting IM epi is thru autoinjectors only). They used to refer to it as "expanded scope" but now we just call it "basic life support".


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## STXmedic (Nov 30, 2012)

EMT B said:


> where is this?



Texas. Many can also do King tubes and IOs.


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## Fish (Dec 5, 2012)

EMT B said:


> where is this?



Texas, everything is bigger in Texas....... Including a Basic's scope!


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## b2dragun (Dec 6, 2012)

I do it anytime it is obviously indicated, anytime I start a line, and on all medical calls.  BGL can be indicative for more then just mental status; people having MI's may not show on the ekg but a high BGL can be indicative.  As the muscle tissue dies it releases glycogen stores which increases BGL, so non-diabetics with abnormally high BGL should get a second look.  Treat the pt not the monitor...one more thing to throw into the bag of tricks.  Like everyone else is saying, it is non-invasive and can help you out.  I would also point out that checking off your IV stick should be done carefully, some BGL monitors ar specifically for capillary blood.  My rule of thumb is if it reads high/low check it off a finger also...BGL of 120 off a IV stick is good enough for me though.


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## ATFDFF (Dec 6, 2012)

Christopher said:


> I don't know where he is, but in NC that is pretty standard (excepting IM epi is thru autoinjectors only). They used to refer to it as "expanded scope" but now we just call it "basic life support".



Pretty much the same here in Wisconsin, except our system prefers DuoNebs, and BLS has CPAP.  Rumor has it EMTs are getting Narcan next protocol update.


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