# blood glucose levels...



## Explorer127 (May 1, 2008)

how low should someone's blood glucose level be before you adminster glucose?


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## EMTgurl911 (May 1, 2008)

*I heard anything below 65 
The regular is 80 to 120 I believe, but that's what I heard.*


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## Ridryder911 (May 1, 2008)

It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl. 

Remember, we treat the patient not the numbers. 

R/r 911


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## EMT007 (May 2, 2008)

Our policy calls for oral glucose when a patient has an altered level of consciousness that is possibly due to hypoglycemia and the pt has no signs of stroke. 

Thats it - we dont' carry a glucometer yet, but thats in the planning stages. Once we get that, I assume we will set a numerical standard as well as the current ALOC indication.


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## Jon (May 2, 2008)

Omars.... are you intending this to be a BLS level discussion or ALS discussion?



Ridryder911 said:


> It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl.
> 
> Remember, we treat the patient not the numbers.
> 
> R/r 911


Amen.

If the patient is CAOx4, trying OJ and food (if available) is probably in the patient's best intrest. Patients usually prefer food to glucose paste and the paramedic's IV's.

If the patient has a decreased LOC and is unable to swallow and maintain their airway, then oral glucose is contraindicated.

Being a BLS service, we don't carry or use glucometers.


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## emtwacker710 (May 2, 2008)

Ridryder911 said:


> It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl.
> 
> Remember, we treat the patient not the numbers.
> 
> R/r 911



I couldn't agree more, always check to see what the number is but if they are presenting signs of hypoglycemia then administer glucose, in accordance with your local protocols of course.


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## Katie (May 2, 2008)

our protocol is 70 mg/dl for adults, 30 mg/dl for children under 2 months


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## hitechredneckemt (May 2, 2008)

jon im a little confused are glucometers not used by bls personal in your area 
In Ohio it is a bls skill. Our protocals say under 70 and the patient be able to swallow


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## Jon (May 2, 2008)

hitechredneckemt said:


> jon im a little confused are glucometers not used by bls personal in your area
> In Ohio it is a bls skill. Our protocals say under 70 and the patient be able to swallow


Nope. In PA, gulcometers are reserved for ALS.


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## hitechredneckemt (May 2, 2008)

Thats interesting ,I did not think what other states protocols where. Im not far from PA never thought that much difference so close. Glad to have learned that


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## Katie (May 2, 2008)

here an emt-b can use a glucometer but it is not required.  it's up to the stations if they want to carry them on their units and many do not.  for the most part it is an als skill, which is sad because it is quite easy to use.


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## emtd29 (May 3, 2008)

Glucometers in New York are an ALS ONLY thing. 

In order for your service to have and use them a "Limited Laboratory License " is required from the state.


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## paramedix (May 3, 2008)

It completely depends on the patient itself. You may for instance have a patient with a BGL that is 5.0mmol/L and present with some signs of hypoglycemia. Then like Rid said (treat your patient not the numbers), if you treat the numbers not your patient, why would he have those symptoms, because that falls in the normal range.

What I'm trying to get across is that every patient differs from each other. The given values are only guidelines and whats high for the one patient, might be low for the other.

Treat the patient and not the monitor...


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## emtwacker710 (May 3, 2008)

emtd29 said:


> Glucometers in New York are an ALS ONLY thing.



not anymore, it is becoming BLS, my agency just got approval to use them for BLS, we of course had to put every member through an "in service" training of it and submit the proper paperwork to the state but we should have them in the rig for BLS use by the end of this month.


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## ERnurse17 (May 14, 2008)

Treat the pt not the number.  if the sugar is 50 and they are alert times 4 why bother with their sugar.  but if they are 65 and not alert then i would administer glucose.


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## Jeremy89 (May 14, 2008)

Last week my sister passed out at a fast food restaurant.  The FD that responded was BLS and didn't have a medic (that I saw).  They took her BS and it was about 65.  She was A&O, at times joking with the FF's.  We denied transport, got our food and drove to the ER, just to get her checked out (which worked out well because I got a chance to talk to a tech about getting a job there...)



ERnurse17 said:


> ...but if they are 65 and not alert then i would administer glucose.



Correct me if I'm wrong, but I was aware that the pt had to be alert in order to administer oral glucose.  Unless there is another form IM or IV or something.


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## ERnurse17 (May 14, 2008)

I didnt mean oral glucose i meant another form like glucogon for D50.  Sorry for the misunderstanding


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## JPINFV (May 14, 2008)

Katie said:


> here an emt-b can use a glucometer but it is not required.  it's up to the stations if they want to carry them on their units and many do not.  for the most part it is an als skill, *which is sad because it is quite easy to use.*



Well, 12 leads are easy to use (especially under the California model of using the machine interpretation to determine AMI), why don't we allow basics to do a 3 hour course and use 12 leads as well?


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## Ridryder911 (May 14, 2008)

JPINFV said:


> Well, 12 leads are easy to use (especially under the California model of using the machine interpretation to determine AMI), why don't we allow basics to do a 3 hour course and use 12 leads as well?




I realize you were being sarcastic.... Dummy boxes are for just that..... dummies. I have seen them interpret a SR to be V-tach and I don't know how many inferior AMI, BBB that are truly ST elevation. Anyone using such is a fool and dangerously practicing medicine. I realize LA uses them as a interpretation guide and hence why they have a poor reputation. 

It is not the skill, but rather the knowledge behind the whole process and the skills accompanied them. Too many emphasize the skills portion which is the easiest to obtain, repeated practice and stamina anyone can do them... obviously. 

R/r 911


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## JPINFV (May 14, 2008)

Ridryder911 said:


> I realize you were being sarcastic....



I'm not going for sarcastic, but rhetorical since there are systems out there that rely on machine interpretations (yes, Los Angeles and Orange County, CA). Since this essentially waters down 12 leads to "attach wires, press a button, read top right corner," it's no different than the standard argument for Basics using pulse oximetry or blood glucose monitoring since it's "easy to use." I do agree, how ever, that the knowledge of physiology that should be required to use diagnostic instruments is generally lacking from the Basic curriculum.


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## Kimmy Schaub (May 15, 2008)

Normal glucose levels usually fall between 70 and 150 mg.


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## R-Katt (May 17, 2008)

Our protocols call below 60. But then I have had a pt. in the back who was  acting a little sluggish, not really complaining much,with no altered mental and I was kinda at a standstill (wishing I was a medic  :saduntil I checked his BGL level and it was 27:unsure:

Uh....can you say "uh-oh"?

Of course I checked it again to make sure it was correct and sure enough it was the same.After a little oral glucose paste he was right as rain on a summer night!A lot more alert and feeling better!!

Glucometers are very unpredictable and love to give you a hard time!

You have to be aware and use your good judgement.

 If yours says 20 but your pt. is fine with no symptoms then you might want to ? your Glucometer.
Always treat the pt!! (which is the best advice!!)


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## Ridryder911 (May 17, 2008)

Part of the problem of glucometers is most do not calibrate them daily. Otherwise their pretty accurate. 

R/r 911


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## piranah (May 22, 2008)

my protocol is under 60 administer oral glucose and if contraindicated. admin
glucagon 1mg/dose IM per med control


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## Epi-do (May 23, 2008)

Our protocols state that BLS can administer oral glucose for a "patient showing signs of hypoglycemia, and is in control of his/her own airway."

At the ALS level it states "if blood glucose suggests hypoglycemia" so the medic can still use his/her own judgement as to whether or not D-50 is the right route to go.

We actually do not have a diabetic protocol.  It is actually an altered level of consciousness protocol and includes when narcan would be indicated to use as well.


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## mikeylikesit (May 23, 2008)

Well remeber as diabetics are all different where they keep their BGL at the number varies. what is too low for one patient say 50 is ok for another. i go with 50 being a diabetic myself. some people are completely coherant at 35, so it all veries but a safe number is always 50 that way no harm done.


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## JPINFV (May 23, 2008)

I just wanted to point this out since it seems to be a subtle piece of information. There are conditions besides DM that cause hypoglycemia. They may be a lot rarer than DM, but they do exist.


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## mikeylikesit (May 23, 2008)

well for instance drinking alcohol dramatically raises the blood sugar before slamming it down acting as a synthetic insulin. also sleep deprivation and stress after the exhaustion stage and the depletion of the glycogen reserves.


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## Raf (May 26, 2008)

In MA it is required that all basic ambulances carry oral glucose (paste or tablets). However it is not mandatory that we have glucometers, but services can opt to have them available. I have never seen a basic use a glucometer, probably because of money and maintanence.

Same thing with pulse oximetry, optional for basic units, but I have never seen a basic use one. We just grab the pulse ox for the paper work when we get to the ER at the triage station.


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## sabbymedic (May 26, 2008)

I do not have U.S. Value's but I can give Canadian values and we will administer glucose if the BG is < 4.0 mmol or equal to it depending on the pt's state of GCS. As a primary care medic I can give Glucagon at the above mentioned values if the pt is not responding well. If the pt is responding ok and I can get them to eat or drink I do that instead it is less invasive.


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## PapaBear434 (May 28, 2008)

Just thought I'd chime in and say that here in Virginia, BSL are able to use glucometers, though it's not necessary.  If the patient shows signs of hypoglycemia and is able control the airway, hook them up with some pink goo.

But every rig is equipped with a meter, and they see quite regular use by Basics.  Just seems like a Basic skill, though diabetes runs high in my family so maybe it's just simple because of my familiarity.


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## philfry (Jun 5, 2008)

Kentucky required additional training for BLS providers to utilize glucometers.  Most services here have these protocols in place.  Our local protocol is to administer oral glucose if below 80 and patient is conscious and able to swallow the med.  Otherwise, it would move to the ALS procedures for hypoglycemia (D-50, Glucogen).


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## PapaBear434 (Jun 5, 2008)

philfry said:


> Kentucky required additional training for BLS providers to utilize glucometers.  Most services here have these protocols in place.  Our local protocol is to administer oral glucose if below 80 and patient is conscious and able to swallow the med.  Otherwise, it would move to the ALS procedures for hypoglycemia (D-50, Glucogen).



Ah, the good ol' D-50.  I am doing my ALS intro clinical right now, and saw my classmate blow an IV and push D-50.  Of course, we didn't know he infiltrated until after the skin got all red, irritated, and of course eventually necrotic.  

It wasn't bad, though, as our proctor caught it before it could get real bad.  Just some irritation as far as the patient is concerned, and she was really nice to a couple of nubs like us.


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## BossyCow (Jun 5, 2008)

We had an unconscious pt. Bystanders said he had heart surgery a month prior. Before losing consciousness, he clutched his chest and said he had the worst pain he'd ever had in his life, then passed out. His buddies called 911. 

We arrive to a scene where there are 4 guys, 1 of them passed out in a chair and the thick smell of wacky tobaccy in the air. Pt is alert only to verbal, ABCs intact. Skin grey, sweaty, no medic alert bracelet. We called for ALS support immediately upon hearing 'unconscious pt', but ALS is 15 - 20 minutes away. As we start our assessment, give the guy some O2, he starts coming around, sits up, is able to talk to us, but is slightly combative, only complaint is chest pain 10:10.  Our protocols insist on a glucose stick and turns out our guy has a blood sugar of 33. By the time we met up with ALS, his blood sugar was up to 60 somthing and was no longer combative. 

Yes he still needed ALS, but my point is that ALS got a much more stable pt due to BLS intervention. Without the glucometer and our MPDs standing orders to check sugar, we probably would have thought cardiac on this one and not given sugar causing the pt to deteriorate further.


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## scottmcleod (Jun 5, 2008)

sabbymedic said:


> I do not have U.S. Value's but I can give Canadian values and we will administer glucose if the BG is < 4.0 mmol or equal to it depending on the pt's state of GCS. As a primary care medic I can give Glucagon at the above mentioned values if the pt is not responding well. If the pt is responding ok and I can get them to eat or drink I do that instead it is less invasive.



"4 to 8, feelin' great" ;-)

Google's cache has a chart 

http://72.14.205.104/search?q=cache...+dl&hl=en&ct=clnk&cd=1&gl=ca&client=firefox-a


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## alex71 (Jul 11, 2008)

80 to 120 is normal


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## JPINFV (Jul 11, 2008)

alex71 said:


> 80 to 120 is normal



It all depends on the units, otherwise just about any unit less number could be considered "normal" or "abnormal."


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## daedalus (Jul 11, 2008)

Ridryder911 said:


> I realize you were being sarcastic.... Dummy boxes are for just that..... dummies. I have seen them interpret a SR to be V-tach and I don't know how many inferior AMI, BBB that are truly ST elevation. Anyone using such is a fool and dangerously practicing medicine. I realize LA uses them as a interpretation guide and hence why they have a poor reputation.
> 
> It is not the skill, but rather the knowledge behind the whole process and the skills accompanied them. Too many emphasize the skills portion which is the easiest to obtain, repeated practice and stamina anyone can do them... obviously.
> 
> R/r 911


I work in an ALS 911 system in LA right now as transport for Fire. I can't stand the fire medics here if you can even call them medics. I am better at 12 lead interpretation than they are. I once pointed out A Fib and was promptly told that if the machine doesn't see it than it doesn't exist. But than again these medics go to a six month Paramedic Program run by the county of LA. I have only taken a formal college class on ECG interpretation through the local RN program...


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## sabbymedic (Jul 15, 2008)

Well see there is a difference some medics practice clinitian based medicine while others go stricktly by the standing orders and what the machine says. The level of training and how far an individual is willing to take it says a lot to your dedication to this field.

I am a Primary Care Medic in Ottawa Canada and I interpret 12 Leads in order to DX STEMI's so we can bipass ER's and go straight to the heart institute. We have been trained and practice our training ever year twice a year in Base Hospital CME's to make sure we are up on the interpretation.

I think the heart is a cool vital organ and love to practice studying it.


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## skyemt (Jul 15, 2008)

emtwacker710 said:


> not anymore, it is becoming BLS, my agency just got approval to use them for BLS, we of course had to put every member through an "in service" training of it and submit the proper paperwork to the state but we should have them in the rig for BLS use by the end of this month.



this is not accurate... in many areas of NY, it is not becoming BLS at all.
it has been allowed in NY for some time, but it is the county level that decides whether or not it will be a BLS skill for their EMT's , and most have decided that it is not.


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## ksrrvfd (Jul 16, 2008)

Below 50 with s/s is how our protocols are written. But like it was said earlier post treat the patient not the numbers.


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## Jochempeiper (Aug 26, 2008)

With the Western Virginia EMS, we can use Oral Glucose on a patient as long as they do NOT have a Altered LOC. I've saw some patients who have a Glucose of 56 and still be able to eat and drink(they were eating when we got there), his only complaint was being a little dizzy. After 1 tube of Glucose and a half of cup of pop he was back up to 76 and he refused care.


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## snaketooth10k (Aug 26, 2008)

EMT007 said:


> Our policy calls for oral glucose when a patient has an altered level of consciousness that is possibly due to hypoglycemia and the pt has no signs of stroke.



Our state guidelines say that oral glucose should not be administered unless the patient is still AOx3 due to the fact that oral glucose can create an airway problem in patients who are not in full control of their mouth/airway. This is ridiculous because it means our only alternative once they have an AMS is to put it in their eyes, and that is not allowed. We've not had a call like that where medics didn't show up in time, but it's been close.


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## Topher38 (Aug 26, 2008)

Jon said:


> Nope. In PA, gulcometers are reserved for ALS.



Same for here in CT


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## EMT007 (Aug 27, 2008)

snaketooth10k said:


> Our state guidelines say that oral glucose should not be administered unless the patient is still AOx3 due to the fact that oral glucose can create an airway problem in patients who are not in full control of their mouth/airway. This is ridiculous because it means our only alternative once they have an AMS is to put it in their eyes, and that is not allowed. We've not had a call like that where medics didn't show up in time, but it's been close.



hmm, yeah that is interesting. Another part of our policy is that they must be able to control their airway and swallow the medication, so if they are so altered that they can't take the medication, we have to call ALS out to administer D50. Otherwise, our medical director is very clear that only patients with an altered mental status should receive oral glucose.


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## Shaggy (Aug 28, 2008)

Hello,

Here in Austria normal for a non-diabetic is 60 - 110 mg/dl and for a diabetic is 80 - 110 mg/dl.
But it is right, treat the patient, I saw a pt with 34 with no symptoms at all (in hospital) then there where several calls with 35 - 40 and the pt´s where unconscious.

By the way: Is D50 Glucose 50%? The highest we have here is 33% in an 100ml infusion.

Shaggy


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## marineman (Sep 9, 2008)

D50 is 50% dextrose solution. 

Glucometer's are a basic skill in my area. For those of you that don't have glucometers do you carry glucagon at the basic level? For us if the patient is alert and able to manage their own airway anything under 60 gets oral glucose. If a patient is not alert and/or can't manage their own airway and is sub 50 we as basics give glucagon after consulting med direction.


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## Ridryder911 (Sep 9, 2008)

D50W, is approximately (dependent upon the brand) 25gms of 50% Dextrose suspended in water solution. 

R/r 911


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## EMTWintz (Sep 10, 2008)

Jon said:


> Omars.... are you intending this to be a BLS level discussion or ALS discussion?
> 
> 
> Amen.
> ...



Wow it is interesting to see that there is so much difference in the BLS squads. I think there needs to be some sort of standard level of practice.


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## mikie (Sep 10, 2008)

EMTWintz said:


> Wow it is interesting to see that there is so much difference in the BLS squads. I think there needs to be some sort of standard level of practice.



Ha!  If only everyone could come to an agreement, that would be great...but this is EMS!  What do you expect?!


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## Airwaygoddess (Sep 10, 2008)

No truer words were ever spoken............ ^^^^^^^^^*


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## EMTWintz (Sep 11, 2008)

At least here in Small town IL. We are able to use our own judgement as to whether a pt needs oral glucose. We use the meter most everytime there is a DM pt. or pt that is presenting with DM type s/s. Usually when ALS arrives they want to know that number along with all the other usual stats. As for the 12 lead vs. standard AED, really what is the use? Yes a 12 lead is going to show more, but what BLS squad has someone knowledgable enough to interpret? I am also a Mobile Medical Examiner and part of my job is hitching up 12leads, half of the members on my squad have no clue how to do them. The standard 3 patch AED is sometimes hard enough on them.


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## Jeremy89 (Sep 11, 2008)

EMTWintz said:


> ..... The standard 3 patch AED is sometimes hard enough on them.



wait, 3 patch? Which kind do you use?


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## EMTWintz (Sep 11, 2008)

Jeremy89 said:


> wait, 3 patch? Which kind do you use?


Sorry not patch, 3 lead. I can't remember which kind it is, but its one of those dummy proof kind. You know turn this way to monitor, turn that way if your gona need to shock.


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## Jeremy89 (Sep 11, 2008)

EMTWintz said:


> Sorry not patch, 3 lead. I can't remember which kind it is, but its one of those dummy proof kind. You know turn this way to monitor, turn that way if your gona need to shock.



So it's a 3 lead capable of shocking?  Usually AED's, (and monitors such as the LifePak 12) have the 2 patches used for shocking/analyzing.


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## EMTWintz (Sep 11, 2008)

Jeremy89 said:


> So it's a 3 lead capable of shocking?  Usually AED's, (and monitors such as the LifePak 12) have the 2 patches used for shocking/analyzing.


This one has the 3leads (white, black n red) to monitor, now if you have a feeling or know your gona have to shock then you take out and hitch up the 2 larger pads and turn dial to shock and analyze mode.


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## Jeremy89 (Sep 11, 2008)

EMTWintz said:


> This one has the 3leads (white, black n red) to monitor, now if you have a feeling or know your gona have to shock then you take out and hitch up the 2 larger pads and turn dial to shock and analyze mode.



Ah, gotcha.


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## JPINFV (Sep 11, 2008)

EMTWintz said:


> This one has the 3leads (white, black n red) to monitor, now if you have a feeling or know your gona have to shock then you take out and hitch up the 2 larger pads and turn dial to shock and analyze mode.



Of course, the million dollar question is if you're able to monitor (educated, trained, and equipt), why do you need an AED to defibrillate?


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## Jon (Sep 12, 2008)

JPINFV said:


> Of course, the million dollar question is if you're able to monitor (educated, trained, and equipt), why do you need an AED to defibrillate?


EMTWintz - I'm confused. You seem to be telling us some parts of the story, assuming we know how your local system operates... can you clarify some questions?

Are you with a BLS squad in a BLS/ALS tiered response system, or something else?

You keep saying AED. Are you really talking about an AED, or a cardiac monitor/defibrillator?

Is the monitor/defibrillator on the BLS rig or the ALS rig?

If it is on the BLS rig, are you trained to use it as a monitor? When do you attach it, before or after ALS arrivial? Do your state protocols allow you to do this?


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## EMTWintz (Sep 12, 2008)

Jon said:


> EMTWintz - I'm confused. You seem to be telling us some parts of the story, assuming we know how your local system operates... can you clarify some questions?
> 
> Are you with a BLS squad in a BLS/ALS tiered response system, or something else?
> 
> ...



ok will try to clarify. When we get paged LCPA (paramedics) get paged also. They come from 7 miles away. If its a call for "chest pain" we hitch them up to I guess you would say monitor/defib. Most are trained to identify common irregularities (throwing PVC's and the like) When LCPA arrives we of course hand over the strip. They will then load pt to transport and hitch them up to their onboard 12 lead monitor


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## BossyCow (Sep 12, 2008)

We carry both an AED and a Monitor. The AED is carried on the rescue rig and the ff are all trained in its use. It was a grant/gift and is used at big events in the district and on fire scenes.


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## thatrescueguy (Oct 6, 2008)

We don't use a blood glucose reading to determine when to administer Glutose - its based on pt. behavior/ AMS.


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## TNemt975 (Oct 15, 2008)

Our protocols are as follows: Pt aaox3 and patent airway w/ BS <70 administor oral glucose.  If pt is AMS <70, initiate IV and 1 amp D50.  This is standing orders for everyone EMT or Medic.  Of course in TN IVs and D50 are not medic skills.


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## wxduff (Oct 15, 2008)

emtwacker710 said:


> not anymore, it is becoming BLS, my agency just got approval to use them for BLS, we of course had to put every member through an "in service" training of it and submit the proper paperwork to the state but we should have them in the rig for BLS use by the end of this month.



Same here. Once all the EMT's pass a test were putting one on our rig.


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## mbcwgrl (Oct 16, 2008)

I agree to treat the pt not the numbers!  If you have an unconscious pt you should do a bsl anyways. If its lower than say 80 or so... (really lower than 90) then push some D-50... Wont hurt and it could be the cause for the unresponsiveness... :wacko:


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## sethking (Oct 22, 2008)

in california protocol is:

<or=65 bgl with symptoms
<or=55 bgl without symptoms


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## JPINFV (Oct 22, 2008)

sethking said:


> in california protocol is:
> 
> <or=65 bgl with symptoms
> <or=55 bgl without symptoms



There is no state wide treatment protocol in California. Orange County and Los Angeles County has it listed at 60 mg/dL if the patient has an ALOC whereas Riverside's protocol is set at 80 mg/dL


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## EMTinNEPA (Oct 26, 2008)

Jon said:


> Nope. In PA, gulcometers are reserved for ALS.



According to the rumor mill, there is talk of making glucomters a BLS skill here in PA.  Which, imo, it should be already.  Admittedly, I do run on a MICU, but dextrose sticks are easy-peasy.


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## Mercy4Angels (Nov 2, 2008)

omarsobh said:


> how low should someone's blood glucose level be before you adminster glucose?



depends on the patient. a good rule of thumb is if you think they need it give it. worst that will happen is a nice sugar rush. as BLS you wont know the number cause you cant take the glucose level unless the patient does it him or herself. 80-120 is fine but look at your patient everyones different.


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## stephenrb81 (Nov 2, 2008)

EMTinNEPA said:


> According to the rumor mill, there is talk of making glucomters a BLS skill here in PA.  Which, imo, it should be already.  Admittedly, I do run on a MICU, but dextrose sticks are easy-peasy.



Basics are allowed to use glucometers here in MO. But rumor is BLS will lose it once the rehash of the scope of practice takes place


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## FLAEMT22 (Nov 8, 2008)

It depends on the patient's presentation and symptoms. Some patients that are Type I IDDM can withstand low blood sugar levels, and don't experience drastic symptoms, while others do. Anything under 70 we treat, the level of treatment can be ALS or BLS (i.e., D50 IV vs. Oral Glucose) depending on how low the sugar is. I've seen people CAO x 3 w/ a BS of 30, and others CAO x 1 with a sugar of 65.


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## PapaBear434 (Nov 8, 2008)

I thought I'd chime in and say this:  We just had a guy last night with a glucose level of 14.  No, he wasn't exactly conscious.


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## FLAEMT22 (Nov 8, 2008)

I had a young guy last night with a BGL of 25 and he was totally out of it, blank stare, diaphoretic, and pale. Had to give him 2 doses of D50 before we got his sugar up. Has anyone used glucagon. Have you found patients respond to differently to that?


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## Ridryder911 (Nov 8, 2008)

I question any glucose reading < 30-40 on FSBS. Since most glucometers are not even made to read so low of reading as well unless it is from a qualified lab I doubt the credibility. Again, treatment of the clinical symptoms and of course within reason of glcuose reading.


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## FF-EMT Diver (Nov 10, 2008)

Flaemt, We use Glucagon if we are not able to obtain an I.V. for D50,

Then glucagon is given IM but usually takes 15-20 to take effect where D50 is almost instant,

While I'm posting this let me ask some of the more experienced ones here I've heard that if you are unable to obtain an IV for whatever reason and you have GOT to have one for whatever reason that you can hit a Pt. with Glucagon and their veins will (stand up) for about 30 sec. any truth to this?


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## Ridryder911 (Nov 10, 2008)

FF-EMT Diver said:


> While I'm posting this let me ask some of the more experienced ones here I've heard that if you are unable to obtain an IV for whatever reason and you have GOT to have one for whatever reason that you can hit a Pt. with Glucagon and their veins will (stand up) for about 30 sec. any truth to this?



Don't know what you mean "hit" as it is administered IM or IV. If you administer it to get a "vein up" then you will have to account it for the glucose to raise. There is an old trick of using NTG spray and "raising" a vein, the problem is it might lower the BP and if it the patient is not having chest pain, you administered for the wrong reason. 

R/r 911


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## FF-EMT Diver (Nov 10, 2008)

Thanks r/r, I was saying "hit" meaning administer so have you heard of this working? I know you would have to account for BG raise.

Not saying to try just asking ever since I've heard that I've never really known whether to call BC or believe it, thought I would ask.


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## Ridryder911 (Nov 10, 2008)

I guess in theory it would. It is also a smooth muscle relaxer as well. For example one of the common use is for foreign body or large food in the esophagus. 

R/r 911


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## ryanbg (Nov 13, 2008)

I remember last year we had a lady who had 3 kids, and an 11 year old "baby sitter" who appeared to be trying to locate her baby on the bottom of a kiddie pool, with her baby in her arms. My buddy thought she was intoxicated, but after she was close to going UC, we figured it out in a minute. She didn't have a med alert or anything, and she was too out of it to drink or eat anything. After the medics came, they said her blood sugar was 20, and by that time we had her on a spine board which we used to backboard her out. She barely responded to a sternum rub. We don't have glucose which is stupid with all the diabetics we get that come in and have diabetic emergencies. I think they gave her an IV and she came to and we released her. Her young children who were screaming and crying was another story, including her "baby sitter". Good times.


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## daedalus (Nov 14, 2008)

Jon said:


> Omars.... are you intending this to be a BLS level discussion or ALS discussion?
> 
> 
> Amen.
> ...


I never got this. If a patient is eating and trying "food and juice" why the helll was EMS even called? An AOx4 patient does not call 911 and say "Hey, I am perfectly fine right now but I feel like I should eat some food to keep my blood sugar up, can you send the ambulance so they can respond and watch me eat and decide not to intervene with their equipment, and than after I eat they can leave"

Makes not a drop of sense to me. Not a single drop.

Now, if they are altered, than someone is going to call 911. Food wont be an option.


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## EMTinNEPA (Nov 14, 2008)

daedalus said:


> I never got this. If a patient is eating and trying "food and juice" why the helll was EMS even called? An AOx4 patient does not call 911 and say "Hey, I am perfectly fine right now but I feel like I should eat some food to keep my blood sugar up, can you send the ambulance so they can respond and watch me eat and decide not to intervene with their equipment, and than after I eat they can leave"
> 
> Makes not a drop of sense to me. Not a single drop.
> 
> Now, if they are altered, than someone is going to call 911. Food wont be an option.



I've seen a diabetic with AMS crash a car into a pool, waddle inside his house, start eating, and then sign off.  The medic got released by medical command and everything.


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## Ridryder911 (Nov 14, 2008)

I routinely see someone with altered LOC (not unconscious but confused) that the family is either confused on what to do or basically is aware that something is wrong but still does not know what to do (new onset of hypoglycemia). After obtaining FSBS then I will be able to get the patient to have some oral glucose enough to raise mentation level. After it has been absorbed, give high protein with glucose to sustain the sugar. 

If they are know diabetic with instructions of to repeat FSBS in one hour and then every other hour and to contact PCP for f/u. No reason to transport those with a hx. of Diabetes and history of sliding glucose level, but the do need to evaluated. 

The problem is many attempt to feed and leave patient alone. Sometimes patient glucose will plummet even after rapid glucose administration, hence the reason for protein not just carbohydrates. As well, although the patient has the right to refuse if given the proper information and understanding of the consequences and risks. 

R/r 911


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## tydek07 (Nov 15, 2008)

Ridryder911 said:


> It varies.. usually or hopefully protocols are based not just on numbers but the patients symptoms. I have seen variances from 50 mg/dl to 90 mg/dl.
> 
> Remember, we treat the patient not the numbers.
> 
> R/r 911



100% agree. I have nothing else to say


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