# Blood sugar?



## dhpd9807 (Feb 16, 2006)

Of late I have been subjected to a trend of RN's and doctors asking me if I did a blood sugar on every effing pt I bring through the door, regardless of the nature of the illness/injury. Is this ridiculous practice limited to my corner of the world or is it happening everywhere?


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## rescuecpt (Feb 16, 2006)

No, it happens in a lot of places.  I usually politely say "No, I didn't, it's not in the protocols for this patient".  That's usually enough.

I tend to D-stick anyone who has a history, who feels lightheaded, anyone AMS, (+) Loss of consciousness, sometimes people who were in car accidents but aren't sure how it happened (with their permission).  But the typical "I stubbed my toe"... no way.  Waste of a perfectly good lancet.


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## RALS504 (Feb 18, 2006)

I know in the ER I work in we draw a BMP (basic metabolic panel) right off the bat for almost all patients with the exception of a lac. or dislocation. I also know that most of our doctor look down on EMS for doing BGLs on non-diabetic patients. I follow the rule of treat your patient and it holds true for the field and the ER. If you do a BGL for because you think the patient needed it and the patient did not there really is no foul; However, if you miss a hypoglycemic/altered LOC well the consequences are severe.


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## TTLWHKR (Feb 18, 2006)

Protocols or not, it could be pertinent to any patient, if you think about it.

I fell and cut my forehead one night... It could be the fact that I tripped over a cat toy, or that I didn't have the lights on... or that I was hypoglycemic.

All three.

MVA? Did the person black out? Were they dazed and not paying attention?

Chest Pain? Is it a panic attack brought on by the inability to function?

SOB? Is it caused by extreme hypoglycemia

Hypotension?

Hypertension?

I'd check it anyway.. Only takes a minute.

Just checked my own.. 92. I should probably eat something, while it is WNL, it's too low for me. Should be in the 120-130 region.


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## coloradoemt (Feb 19, 2006)

This is becoming somewhat of a trend here as well. I agree with what goddess has to say. I suppose it could become a basic standard. I can deffinately see how it can help decide treatments with a wide variety of pts, but I can also see it being added to the list for those who simply like to practice cookbook medicine...


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## Jon (Feb 19, 2006)

Most times the medics start a line, they get a BgL from the venous blood. not perfect, but gives you a "high" "medium" and "low" range.


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## rescuecpt (Feb 19, 2006)

MedicStudentJon said:
			
		

> Most times the medics start a line, they get a BgL from the venous blood. not perfect, but gives you a "high" "medium" and "low" range.



I've never seen anyone do that, and I don't do it.  Sounds kinda messy to me.


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## dhpd9807 (Feb 20, 2006)

If someone is altered, sure, I can see it. If your pt. is not altered, tachy or diaphoretic I just can't see the point. Not to mention that regardless of what I tell the ED staff they are going to check BGL before they treat anyhow. Hey coloradoEMT, my last encounter occured at MCA and I thought this fool doc was going to sock me for not doing a BGL. I wanted to tell him it wouldn't have made him (the doc) any taller. Can't wait for the day when I don't have to hold my tongue.


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## MedicPrincess (Feb 20, 2006)

rescuecpt said:
			
		

> I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.


 
Our medics here do it.  There is a little blood in the end of the part of the IV that you pull out to leave the catheter in...just drop some on the test strip.

If they don't do an IV they do the finger stick.  But not on every patient.


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## Celtictigeress (Feb 20, 2006)

Its reasons like this I wear my Med ID..

I tend to monitor it but at least if for some reason *knocks on wood* I black out or become disoriented, they can read my bracelet and goo "Mmmmhmmmm" and handle the buisiness.... Like it was stated if they fell (could be over a cattoy) best to check but its a waste of time if say for example, someone steps on a patch of ice and busts their Arses... because they didnt see the ice to begin with yanno?


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## dgueldner (Feb 20, 2006)

We used to have some medics that used an ink pen at the end of the safety cap and push a small drop out it was dangerous.  However you are not by far alone in the every pt must have a CBG as you can tell.  I used to tell the doc, my pt is Awake, Alert and Oriented, and that was usually enough, but remember you can never go wrong by doing one.


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## rescuecpt (Feb 20, 2006)

EMTPrincess said:
			
		

> Our medics here do it.  There is a little blood in the end of the part of the IV that you pull out to leave the catheter in...just drop some on the test strip.
> 
> If they don't do an IV they do the finger stick.  But not on every patient.



OK, nevermind me being dumb, but are you talking about blood that remains on the needle?  So you're trying to maneuver a used needle around?

Or are you talking about blood that comes out of the cath prior to hooking up the IV if you don't tampenade well enough?

I am confused, and a little scared.


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## MedicPrincess (Feb 20, 2006)

No no...not screwing around with a used needle.  When they pull the needle out, there is a little metal piece that covers the needle on the end.  Blood collects there, hold it over the test strip, some drops out.

I guess you'd have to see it...or I will have to get some more expierience and be able to figure out what the heck I am talking about.  I can do it, just don't make me explain it.  :wacko:


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## TTLWHKR (Feb 20, 2006)

rescuecpt said:
			
		

> I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.


 

I do it. When I get the flash in the cath, I remove the needle, draw my labs, and before I connect the tubing, I let a drop of blood on the tip of the test strip.

Quick. Saves the patient any unnecessary pain.


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## MMiz (Feb 21, 2006)

EMTPrincess said:
			
		

> No no...not screwing around with a used needle.  When they pull the needle out, there is a little metal piece that covers the needle on the end.  Blood collects there, hold it over the test strip, some drops out.
> 
> I guess you'd have to see it...or I will have to get some more expierience and be able to figure out what the heck I am talking about.  I can do it, just don't make me explain it.  :wacko:



I've seen this in the field.  The person in charge of our Our CQI committee reviewed our glucometer documentation and found that using the blood from this method could give readings of +/- 30.  It is now standard policy to do a finger poke.


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## mofiremedic (Feb 21, 2006)

rescuecpt said:
			
		

> I've never seen anyone do that, and I don't do it.  Sounds kinda messy to me.


our iv's have a flash tube built in to them and all you have to do is push on a white button with a pen and blood comes out of the syringe. it's very clean and controlled and saves the pt a stick.


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## mofiremedic (Feb 21, 2006)

MMiz said:
			
		

> I've seen this in the field.  The person in charge of our Our CQI committee reviewed our glucometer documentation and found that using the blood from this method could give readings of +/- 30.  It is now standard policy to do a finger poke.


the research that i have read shows that venous glucose is 10 points higher than a finger stick. however keeping an open mind i would be interested in your cqi committee's resourses


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## MedicPrincess (Feb 21, 2006)

mofiremedic said:
			
		

> our iv's have a flash tube built in to them and all you have to do is push on a white button with a pen and blood comes out of the syringe. it's very clean and controlled and saves the pt a stick.


 
RescueCPT....that is exactly what I was trying to say.  

Thanks mofire.


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## rescuecpt (Feb 21, 2006)

Ah, ok.  I don't think ours are capable.  We have the nifty needles where you press the white button and the spring sucks the needle back into the handle... and that's it.  No more needle, no more blood.

We don't draw labs, and a lot of my patients are bleeders (damn thinners) so that's why I could imagine it being messy to take a sample from the cath site before hooking up the tubing.

Thanks for the explanations everyone.


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## squid (Feb 22, 2006)

This might a totally dumb assumption, but I wonder if giving everyone a blood sugar is an overreaction to not having done that in the past? We've (I mean, people in my region) run into trouble before assuming a patient is drunk. There have been people who died in jail becuase it was assumed they were "just another drunk Native," which is tragic and criminal. I wonder if anything similar is going on in other places.

Or is it info the hospital can use... nah, they'd do their own if they needed it. At least here.

Of course, yeah, all bets are off if you don't have an altered LOC or anything other signs or symptoms. I'm not saying every paitent *needs* a CBG, just that there might be a push for them that's gone a bit far.


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## RALS504 (Feb 24, 2006)

rescuecpt said:
			
		

> I've never seen anyone do that, and I don't do it.  Sounds kinda messy to me.



I have started an IV and used the needle (or go strait to the freshly placed cath.) for a venous blood sample for a BGL reading since 2001. This works quite well and is not at all messy. I also had someone show me a new trick while working in the ER. If you are going to draw blood from your IV, take an unprimed NS lock (Heparin lock to some of you), start your IV, then hook up your NS lock, lock it closed, remove the buffalo cap, attach a vaccutainer hub or syringe, open the slide lock, let the NS lock prime with blood rather than NS, draw all the desired test tubes, lock the slide lock, replace the cap, and flush the line. When I drew blood off of my IV in the field I always put the vacutainer hub directly to the newly place IV cath. I find this new way neater because you do not have to tamponade off the vien, you have a control valve. I know we do not draw blood all that often in EMS, but if you switch to the hospital or need to draw blood it is a neat little trick. Also per my hospital BGL policy we may use a capilary, venous, or arterial blood sample with the same range 60-120 mg/dl.


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## TTLWHKR (Feb 24, 2006)

RALS504 said:
			
		

> I know we do not draw blood all that often in EMS


 

Every time I start an IV, I draw four vacutainer tubes of blood for labs.. It's my protocol.


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## RALS504 (Feb 25, 2006)

TTLWHKR said:
			
		

> Every time I start an IV, I draw four vacutainer tubes of blood for labs.. It's my protocol.


 That sounds like very forward thinking protocols you have. I think we under estimate the value of drawing labs early for the best possible patient outcomes. Your system may have hospitals that do not accept your blood draws, so be it. But draw them anyway, label them (date/time,initials, and agency), and tape them to the IV bag this way they have to decide to get rid of a perfectly drawn labs. I mean how nice is it to roll into your local ER with a level one trauma and have a purple top test tube ready to go to the blood bank to get typed and screened.


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## TTLWHKR (Feb 25, 2006)

The hospital system could care less.. I meant that it's something that I personally do, on every call. Saves the patient from getting stuck twice. If it's a trauma, I try to not only get labs, but both IV's.. again.. so they don't have to go through it while everything else is going on. If the trauma victim doesn't get field labs locally, they draw them from the femoral artery.... which hurts like an SOB.. :unsure:


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## emtbass (Mar 29, 2006)

In my part of the world... we do a d-stick on EVERY patient that gets an IV regardless of hx.  When you start the IV... you get the blood from the catheter (you can stick your pen in one end and a drop of blood from your flash chamber comes out the other).  alot of transfers we'll get a d-stick as well... I would say 98% of the pts get a d-stick.


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## EMTI&RESCUE (Mar 29, 2006)

I might be labeled a "randy rescue" but if their sick enough or hurt enough to get in the back of my bus then their going to get the full work up. IV, D-stick, and all the vitals. Its "CYA" by doing them I think. It will help keep you out of court, or looney bin if ya dont do them and your patient dies on your bed. That and it gives me something to do on the way to the E.R.


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## AVParamedic1 (Jul 7, 2014)

Standard assessment of a Pts for AV includes Blood Glucose so yes we do it on all Pts


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## joshrunkle35 (Jul 7, 2014)

dhpd9807 said:


> Of late I have been subjected to a trend of RN's and doctors asking me if I did a blood sugar on every effing pt I bring through the door, regardless of the nature of the illness/injury. Is this ridiculous practice limited to my corner of the world or is it happening everywhere?




If it could be blood sugar related, or something could be masking a blood sugar issue (like a patient that appears to be clearly dehydrated and "feels like they are going to pass out" and hasn't consumed any fluids while the exercised for several hours on a hot day) then I take a blood sugar. If it might be relevant to treatment later, like if they have the flu, I take a blood sugar. I don't take a blood sugar if it's something like a patient with a broken hand, etc.


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## 9D4 (Jul 7, 2014)

rescuecpt said:


> I've never seen anyone do that, and I don't do it.  Sounds kinda messy to me.


That's what I was taught. Every time you start a line, use a drop from the flash chamber for BGL. If it's not normal, get a more accurate one by finger stick (although in my limited experience it's never a noticeable difference).


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## ABQmedic (Jul 7, 2014)

dhpd9807 said:


> Of late I have been subjected to a trend of RN's and doctors asking me if I did a blood sugar on every effing pt I bring through the door, regardless of the nature of the illness/injury. Is this ridiculous practice limited to my corner of the world or is it happening everywhere?



It's interesting you ask that.  Here in NM, I am finding that checking a patient's blood glucose is becoming a clinical expectation, maybe even standard of care.  Obviously, we check one on diabetics, AMS patients, and ETOH'ers.  Think of this, though... hyperglycemia can occur in up to 50% of all STEMI patients (even with no diagnosis of type II DM).  

You can also find patients with sepsis, or who are otherwise critically ill, to have acute hyperglycemia

Anymore, I check BGL's on all patients.  That way the both the patient and myself are covered.

Posts linked to studies to follow...Stay tuned


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## ABQmedic (Jul 7, 2014)

STEMI and hyperglycemia link

http://circ.ahajournals.org/content/115/18/e436.full

Sepsis and hyperglycemia link

http://www.medscape.com/viewarticle/507661


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## usalsfyre (Jul 7, 2014)

Elevated BGL is part of inflammatory response.


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## jwk (Jul 8, 2014)

9D4 said:


> That's what I was taught. Every time you start a line, use a drop from the flash chamber for BGL. If it's not normal, get a more accurate one by finger stick (although in my limited experience it's never a noticeable difference).



Why would it be different?


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## jwk (Jul 8, 2014)

ABQmedic said:


> It's interesting you ask that.  Here in NM, I am finding that checking a patient's blood glucose is becoming a clinical expectation, maybe even standard of care.  Obviously, we check one on diabetics, AMS patients, and ETOH'ers.  Think of this, though... hyperglycemia can occur in up to 50% of all STEMI patients (even with no diagnosis of type II DM).
> 
> You can also find patients with sepsis, or who are otherwise critically ill, to have acute hyperglycemia
> 
> ...



ANY lab test should be done for indications, not as a matter of routine, and certainly not for every single patient.  You're going backwards with the "evidence based medicine" concept.

Now - you're citing several valid indications, which I have no problem with.  It's the "I check BGL's on all patients" that I think is absurd.


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## tred1956 (Jul 8, 2014)

If I start a line I check BGL. Why not? I however don't start a line on every patient and only check a BGL if I feel it is warranted. While I have never been told to always check a BGL, now that you mention it, I am asked more often lately if I did?

Doug


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## jwk (Jul 8, 2014)

tred1956 said:


> If I start a line I check BGL. Why not? I however don't start a line on every patient and only check a BGL if I feel it is warranted. While I have never been told to always check a BGL, now that you mention it, I am asked more often lately if I did?
> 
> Doug



My point is that "because I started an IV" is not an indication for getting a glucose level. 

Curious - do you charge the patient for that test or are your charges all bundled together?


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## tred1956 (Jul 8, 2014)

No additional charge. I agree total that starting a line does not indicate the need for BGL. However it being already available (with no further invasive procedure of patient) it does on some rare occasions reveal valuable information.

Doug


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## Aprz (Jul 9, 2014)

jwk said:


> Why would it be different?


It depends if the glucometer is calibrated for venous blood samples, capillary blood samples, or both. I would say most modern ones are now calibrated for both.

I think I've read before that if distal circulation is poor, venous blood may be more accurate to use, however, I read that from a blog rather than from a study or something super legit so I am not sure how true that is.

I'm trying to think about this logically. There should be more glucose in the capillary sample versus the venous sample because more glucose should be used by then. Although I guess metabolism isn't super fast anyhow so I guess it wouldn't be significant. More fluids in venous "diluting" the glucose in venous versus capillary because some fluid is in interstitial space while passing through the capillary due to hydrostatic pressure? So I am guessing overall the glucometer that is calibrated for only capilary blood samples would think there is less glucose than there really is? Right?

Damn, just noticed this thread is hecka old thanks to the next poster. I saw this page was all new posts, didn't read the first post, and just posted to answer that question in regard to why should it be any different. My bad.


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## Underoath87 (Jul 9, 2014)

AVParamedic1 said:


> Standard assessment of a Pts for AV includes Blood Glucose so yes we do it on all Pts



This thread is 8 years old...


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## ABQmedic (Jul 10, 2014)

jwk said:


> ANY lab test should be done for indications, not as a matter of routine, and certainly not for every single patient.  You're going backwards with the "evidence based medicine" concept.
> 
> Now - you're citing several valid indications, which I have no problem with.  It's the "I check BGL's on all patients" that I think is absurd.



I apologize for using the qualifier "all" when I should have used "most."  Anecdotally, checking a BGL on patients without the usual "valid indications" as you put it, has revealed abnormal values and subsequent diagnoses of new onset type ll diabetes in patients who "just didn't feel well."  We don't charge the patient extra for the test.  I hope that's less absurd in your observation.


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## Akulahawk (Jul 10, 2014)

jwk said:


> My point is that "because I started an IV" is not an indication for getting a glucose level.
> 
> Curious - do you charge the patient for that test or are your charges all bundled together?


Waaay back when, I usually got a BGL as part of the process of starting a line. However, the fact that I started a line isn't the reason I'm getting the BGL sample... I had a reason for starting the line (never precautionary) and if I can articulate why I'd get an FSBG, I can articulate why I'd get a BGL from the IV instead. If I'm going to need that info anyway, why stick the patient twice when I can get a clean sample with one stick and establish an IV all at once?


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## jwk (Jul 11, 2014)

ABQmedic said:


> I apologize for using the qualifier "all" when I should have used "most."  Anecdotally, checking a BGL on patients without the usual "valid indications" as you put it, has revealed abnormal values and subsequent diagnoses of new onset type ll diabetes in patients who "just didn't feel well."  We don't charge the patient extra for the test.  I hope that's less absurd in your observation.



I'm playing devils advocate as much as anything, but this is something that's hard to teach, especially when I have new anesthetists and docs straight out of training jumping into my private practice.  If you don't charge extra for it, that's fine, and since it's not invasive if you're doing it with an IV start, it's pretty much no harm, no foul.

In the hospital, we need an indication for everything, which is quite different than the way it used to be.  35 years ago, every patient that was admitted to the hospital got an admission chest X-ray, EKG, CBC, UA, and what is now called a BMET.  That applied to the healthy 18 yr old male and the 96 year old female and everything in between.  Sure, we occasionally found something important, and something that changed our management of the patient.  Most of the time we didn't.  When they started adding up the cost of all these "routine tests", the totals were astronomical.  

Also - I don't know how government regulations are intertwined with EMS on this type of thing - but I can't even perform a fingerstick in my hospital.  Even with a master's degree, a PA license, and nearly 40 years experience, I have to be "trained" to use a specific glucometer, possess a bar code on my nametag that can be read by the scanner on the glucometer, and must pass annual "competency exams" on BG policies and procedures.  Bite me - I'll let the nurse do it.    And of course EVERY finger stick we do in the hospital and read by the glucometer is transmitted wirelessly to the lab so a charge can be generated for each and every fingerstick.

Even so, with the BG -  I'm curious how often do your findings alter your management, outside of perhaps the diabetic patient?  My guess would be not much.


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## Carlos Danger (Jul 11, 2014)

jwk said:


> In the hospital, we need an indication for everything, which is quite different than the way it used to be.  35 years ago, every patient that was admitted to the hospital got an admission chest X-ray, EKG, CBC, UA, and what is now called a BMET.  That applied to the healthy 18 yr old male and the 96 year old female and everything in between.  *Sure, we occasionally found something important, and something that changed our management of the patient.  Most of the time we didn't.  When they started adding up the cost of all these "routine tests", the totals were astronomical.*



Not only that, but the unnecessary treatment that can result from unnecessary testing has been shown to cause much more harm than good.

Absent clinical signs of hypoglycemia, I really have no idea why you'd bother checking a BGL.


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## DesertMedic66 (Jul 11, 2014)

Our hospitals still draw bloods on every patient who takes a seat on their beds. They still want us to draw bloods on all prehospital patients who we start a line on.


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## MonkeyArrow (Jul 11, 2014)

DesertEMT66 said:


> Our hospitals still draw bloods on every patient who takes a seat on their beds. They still want us to draw bloods on all prehospital patients who we start a line on.



So do you not have fast track? It seems awfully inefficient to draw labs on the 33 year old healthy male that came in because of abrasions to the knee via a trip and fall at a 5k. At my hospital, labs are drawn out of necessity. Our fast track probably draws labs at a 1 out of every 30 patients rate. But with the i-stats coming into use, I see that number going up a bit.


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## DesertMedic66 (Jul 11, 2014)

MonkeyArrow said:


> So do you not have fast track? It seems awfully inefficient to draw labs on the 33 year old healthy male that came in because of abrasions to the knee via a trip and fall at a 5k. At my hospital, labs are drawn out of necessity. Our fast track probably draws labs at a 1 out of every 30 patients rate. But with the i-stats coming into use, I see that number going up a bit.



Those patients are seen/treated/ and released from the triage area and never set foot in the actual ER. 

Now if for some reason that patient was brought in by EMS and not sent to the triage area or the patient was taken into the actual ER there is a 99% chance they will get an IV and a rainbow blood draw.


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## MonkeyArrow (Jul 11, 2014)

DesertEMT66 said:


> Those patients are seen/treated/ and released from the triage area and never set foot in the actual ER.
> 
> Now if for some reason that patient was brought in by EMS and not sent to the triage area or the patient was taken into the actual ER there is a 99% chance they will get an IV and a rainbow blood draw.



Do you guys also prescribe meds (narcos in particular) from triage too? Is it staffed with a mid-level or a nurse? Just curious as to how you guys do it as opposed to us.


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## DesertMedic66 (Jul 12, 2014)

MonkeyArrow said:


> Do you guys also prescribe meds (narcos in particular) from triage too? Is it staffed with a mid-level or a nurse? Just curious as to how you guys do it as opposed to us.



It's staffed with nurses and either a PA or NP. The doc may float by if needed. And yes they will prescribe pretty much anything up there.


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## rabidrider (Jul 12, 2014)

I got a kind of stupid question that really dont matter but its something I have been wanting to know for ever. 

Back in EMT school I did a couple scenarios (more than a couple but these 2 stood out). I dont remember the scenarios anymore just the first was with my main instructor and he asked why I didnt check the BGL of a patient with a altered mental status. Ok he got me I should have.

A few days later I did a similar scenario with a different instructor and this time I did check the BGL and he nearly took my head off saying it was a ALS skill.

So which is it? Is it ALS or BLS? I know on clinical rides it would depend on the medic. Some would pretty much let me do anything I felt ok doing. Others not so much lol. 

I am in Medic school now so it really no longer matters but it has always had me wondering if it is a ALS skill why? I can see pulling blood from the IV cath but sticking the finger really?


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## TransportJockey (Jul 12, 2014)

rabidrider said:


> I got a kind of stupid question that really dont matter but its something I have been wanting to know for ever.
> 
> Back in EMT school I did a couple scenarios (more than a couple but these 2 stood out). I dont remember the scenarios anymore just the first was with my main instructor and he asked why I didnt check the BGL of a patient with a altered mental status. Ok he got me I should have.
> 
> ...


Some states it's an als skill. Never understood that, but part of that is becaise here in nm its a bls skiLl all around


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## DesertMedic66 (Jul 12, 2014)

rabidrider said:


> I got a kind of stupid question that really dont matter but its something I have been wanting to know for ever.
> 
> Back in EMT school I did a couple scenarios (more than a couple but these 2 stood out). I dont remember the scenarios anymore just the first was with my main instructor and he asked why I didnt check the BGL of a patient with a altered mental status. Ok he got me I should have.
> 
> ...



In some areas it's a BLS skill and in other areas it's an ALS skill. It all depends on your local and state protocols. For my area it is a BLS skill only after a medic or AEMT asks the EMT to check the sugar.


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## rabidrider (Jul 12, 2014)

I guess that makes some sense. I will have to do some more digging for here in florida. It just didnt make sense to me as the instructor that almost took my head off told me that as an EMT-B if you suspect hypoglycemia to just call medical control to administer oral glucose because the benefits outweigh the risks. To me that make no logical sense. I get the benefits would outweigh the risks but if I was to call medical control the first thing they are going to ask is what is the BGL. If I say I dont know I just want to give him some :censored::censored::censored::censored: for hypoglycemia they would be looking like this guy on the other end :rofl:


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## ABQmedic (Jul 29, 2014)

jwk said:


> I'm playing devils advocate as much as anything, but this is something that's hard to teach, especially when I have new anesthetists and docs straight out of training jumping into my private practice.  If you don't charge extra for it, that's fine, and since it's not invasive if you're doing it with an IV start, it's pretty much no harm, no foul.
> 
> In the hospital, we need an indication for everything, which is quite different than the way it used to be.  35 years ago, every patient that was admitted to the hospital got an admission chest X-ray, EKG, CBC, UA, and what is now called a BMET.  That applied to the healthy 18 yr old male and the 96 year old female and everything in between.  Sure, we occasionally found something important, and something that changed our management of the patient.  Most of the time we didn't.  When they started adding up the cost of all these "routine tests", the totals were astronomical.
> 
> ...



Fortunately, most BGL's that I check are benign.  It follows most other "vitals" in my experience.  Most abnormal BGL's are a result of diabetes and require the usual management. I have had one coincidence of BGL > 200 and AMI, though.  Honestly, I considered it a "gee whiz" finding, until the receiving cardiologist commended me for checking the BGL.  At that point, I approached my medical director and received some great education on the relationship with stress/inflammation response and blood glucose elevation.


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## drjekyl75 (Aug 14, 2014)

It used to be part of our protocols to draw labs, this was until a mix up happened. On a MVA with multiple patients, 4 ended up going to the same trauma center. The medic drew blood and in haste taped the wrong tubes to the wrong patient. This happened a few times and we lost the field blood draw from the protocol.


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## Brandon O (Aug 21, 2014)

Aprz said:


> It depends if the glucometer is calibrated for venous blood samples, capillary blood samples, or both. I would say most modern ones are now calibrated for both.
> 
> I think I've read before that if distal circulation is poor, venous blood may be more accurate to use, however, I read that from a blog rather than from a study or something super legit so I am not sure how true that is.


 
That may have been me. Not sure I've see anybody else recommend that.



> So I am guessing overall the glucometer that is calibrated for only capilary blood samples would think there is less glucose than there really is? Right?


 
Right. More glucose has been used when you sample from the veins (it's already given up its glucose), so using a meter calibrated for capillary blood (i.e. the one you have) on venous blood will result in a falsely low reading. But only by, oh, maybe 5-10 mg/dl, which is a small and predictable difference... whereas in sick people, capillary samples can be dramatically, significantly wrong in unpredictable ways. I say use venous blood if you has access.


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## Aprz (Aug 21, 2014)

Well, I know which blog is associated with you , and found it quickly with "emsbasics blood glucose" on Google, haha.



> In sick people, circulation is often impaired; this is particularly true in situations like shock, sepsis, and the mother of all shock states, cardiac arrest. When perfusion is poor, the first thing we lose is the peripheral circulation, and it doesn’t get more peripheral than the capillaries of the fingertips. What does this mean? It means that in many acute patients, when it’s important to have accurate diagnostics, capillary blood sugars can be utterly, totally inaccurate. Since blood is no longer moving actively through the periphery, it tends to “pool” there stagnantly, letting the tissues chew through its glucose supply without resupplying it. This results in a falsely depressed capillary BGL even when the venous BGL is normal. Conversely, it’s also possible that in poor circulation, the distal capillaries are the “last to hear” about a drop in sugar, resulting in a falsely elevated BGL. But high or low — usually low — it’s not reliable. Anybody with impaired circulation should get a venous glucose if there’s a chance of it affecting care. (And if there’s no chance of it affecting care, then why do it?) By the way, this includes impaired _local_ circulation, such as patients with PVD. Not that a diabetic would ever have PVD…


http://emsbasics.com/2012/05/04/glucometry-how-to-do-it/


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## Brandon O (Aug 21, 2014)

That's the one. Not gonna lie, I had to check it myself to remember some of the details. (Perk of educational writing: when you forget something, your "notes" are indexed by Google.)


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