# glucagon as a smooth muscle relaxant?



## Emt512 (Apr 19, 2011)

okay I was told by a healthcare professional (ER RN )that the administering of glucagon can be used to a smooth muscle relaxant for the esophagus, for situations of something stuck in there like a fish bone or a food impaction. Can we utilize drugs that we carry in such a diverse ways? of course with no contraindications but why wouldnt we utilize these drugs we carry to the fullest, expanding our situational management outside of the over populated ER rooms?


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## Medic785 (Apr 19, 2011)

This is a relatively common usage for Glucagon, as well as for beta blocker overdose.  Nobody is doing themselves a favor when they fail to realize the many alternative usages of the most common medications.


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## GirevikMedic (Apr 19, 2011)

Glucagon isn't a one-trick pony. I know many folks tend to think of it as merely a back up to D50 in BG issues but it has other effects. (Not to mention it's effectiveness for BG issues is questionable. I've given it once for hypoglycemia, didn't see any significant change. I know of others who hate the idea of glucagon usage for hypoglycemia). 

The smooth muscle relaxation is one of the effects of the drug. It's pretty common for ERs to give it for chokings or partial FBAOs. I've seen it used as such in the past. Can it be used in the field for the same reason? Sure, depending on local protocols. In my area it's not a designated SOP (it's not flat out excluded either) but a quick physician request could solve that. 

It's also used in the treatment of beta-blocker OD. 

Using medications for multiple purposes is not that radical. Sometimes medications simply fall into multiple categories. A good example is Benadryl. 

antihistamine --> allergy/anaphylaxis

antiemetic  --> nausea

sedative --> crying babies at home who won't sleep (I've not done this personally, but I know parents who love over-the-counter diphenhydramine for this reason alone. The kids are sick with allergies at the same time too but you get the picture ^_^).

anticholinergic --> Our local protocols allow for Benadryl in narcotic OD with hypotension persisting after Narcan administration


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## AnthonyM83 (Apr 19, 2011)

It's up to your EMS system. Some places, as long as you're trained in the drug, you can use it for different purposes, for some you might have to get clearance from online medical control, yet for others medical control isn't even allowed to use it for an unapproved indication, even if it's appropriate.


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## 18G (Apr 19, 2011)

To the OP.... Steakhouse Syndrome is what the ED nurse was probably talking about. It's an obstruction in the esophagus due to a food bolus and of which glucagon is used quite commonly for. 

I think glucagon is a very interesting drug with many cool uses that many aren't aware of. Primarily, it is a back-up agent to D50 when we can't get IV access but it also plays a role in beta / calcium channel blocker OD, and anaphylaxis. 

A patient in anaphylaxis that is refractory to standard first-line treatments of epinephrine, benedryl, albuterol, and IV fluids, and who may also be on beta-blockers, can show significant improvement with glucagon. 

Even if a drug use is not in the protocols it doesn't mean we can't call for orders for it. In fact, if we feel the patient will benefit from a drug use not outlined in protocol we have a professional obligation as clinicians and advocates for our patients to call MC and try for the orders.


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## NomadicMedic (Apr 19, 2011)

I recently took the protocol test for Thurston County, Washington. (That was a hell of a test!) While pouring over their standing orders, I found they have several indications for the use of Glucagon, including FBAO and refractory asthma.

Great article about Glucagon here. http://paramedicine101.blogspot.com/2010/02/common-and-uncommon-usages-of-glucagon.html


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## 18G (Apr 19, 2011)

I had read some stuff on its use for asthma but it wasn't conclusive on how well it worked. It does make perfect sense though how it would work in the case of asthma. 

Very cool to see that use in your protocols.


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## systemet (Apr 19, 2011)

There's a real lack of evidence that glucagon is effective for relieving esophageal obstruction.  There's case reports of it being used, but a general lack of good evidence to support the practice (Aurora, 2008).  Of course, the absence of evidence, is not evidence of the absence of effect -- it may just mean that more studies need to be done.  But it doesn't seem like the ambulance is the place to be trying to fish things out of the esophagus.  My limited understanding is that this generally requires endoscopy.

Obviously glucagon is useful in treating combative / unresponsive diabetics that have adequate glycogen stores, especially if IV access appears problematic.  

It has a role in the management of beta-blocker OD.  However, most of us aren't carrying enough on our ambulances to see a decent therapeutic effect.  

I love pharmacology, and I'm all for more education -- but I think that sometimes just because we can do something, doesn't mean we should.  I think in most of the situations where glucagon is potentially useful to combat the effects of a patient's po beta-blocker, there are other therapies that are going to be more urgent.  

Arora S, Galich P.  Myth: Glucagon is an effective first line therapy for esophageal foreign body impaction.  CJEM 2009 Mar 11(2):169-171.


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