Oral Glucouse

[musicislife]

A few questions:

My friend (1st Responder as well) gave a woman some OG because she was not feeling right while running a biathalon (i did not find out signs and symptms, but she was not a diabetic). Can this happen? Would I look for the same signs of hypoglycmia in a non diabetic person?

If I administer it to a patient (lets say he fainted) because he is a diabetic and I suspect hypoglycemia, but I suspected wrong...would that do any damage?

An emt said to me the stuff is one of those things that can do no harm, only good. Is that true?

 

[Epi-do]

Actually, they have found that large spikes in blood sugar can and do have consequences. In fact, if your blood sugar spikes to over 140, you can have inflammation of your blood vessels and organs. The longer and higher the spike, the greater the effects upon your body. Over time, repeated spikes can have long term damage on your body.

This is why, at least in my area, we no longer give a full amp of D-50 to a patient, but rather, dose them according to their actual blood sugar at the time we test it.

Just like anything else we give, there are very real consequences to giving oral glucose (or D-50) to any patient. Nothing we do is benign, despite what you may be told.

 

[workworkwork]

too much of anything is never a good thing.

even oxygen can be harmful to nasopharynx and oropharynx as it can dry out the passages and become uncomfortable if it is prolonged and not humidified. granted its not as bad as shocking someone when you shouldn't etc.

another contraindication to glucose is suspected stroke. if someone was experiencing a TIA/CVA is would be a bad move to administer glucose. i'm going to go ahead and assume her speech wasn't slurred and her face wasn't drooping.

in that situation, i would have thought dehydration or heat exhaustion / heat stroke. visualize if there's sweat, their temperature etc. rest, fluids, rescue blanket and/or maybe a few minutes in the back with A/C would have been the options I'd go through.

 

[Hunter]

too much of anything is never a good thing.

even oxygen can be harmful to nasopharynx and oropharynx as it can dry out the passages and become uncomfortable if it is prolonged and not humidified. granted its not as bad as shocking someone when you shouldn't etc.

another contraindication to glucose is suspected stroke. if someone was experiencing a TIA/CVA is would be a bad move to administer glucose. i'm going to go ahead and assume her speech wasn't slurred and her face wasn't drooping.

in that situation, i would have thought dehydration or heat exhaustion / heat stroke. visualize if there's sweat, their temperature etc. rest, fluids, rescue blanket and/or maybe a few minutes in the back with A/C would have been the options I'd go through.

why is tia\cva a contra indication for glucose. I know it is for D50 but never heard the glucose thing before.

 

[medichopeful]

An emt said to me the stuff is one of those things that can do no harm, only good. Is that true?

Absolutely not. Although oral glucose is readily available in many other, non-medication places, it's a drug, and needs to be treated as such.

 

[medichopeful]

too much of anything is never a good thing.

even oxygen can be harmful to nasopharynx and oropharynx as it can dry out the passages and become uncomfortable if it is prolonged and not humidified. granted its not as bad as shocking someone when you shouldn't etc.

There's also other issues that can come about from oxygen, but I like how patient comfort is one of the first things you wrote about

 

[Hunter]

There's also other issues that can come about from oxygen, but I like how patient comfort is one of the first things you wrote about

Increases icp in high concentrations no?

 

[workworkwork]

There's also other issues that can come about from oxygen, but I like how patient comfort is one of the first things you wrote about

i try!

why is tia\cva a contra indication for glucose. I know it is for D50 but never heard the glucose thing before.

i actually had to lookup what D50 is, as we don't have that in MA, at least not at my company. we just have glutose. on my pharm table from my cert class its marked off as a contraindication, my first thought would be because you don't know what kind of stroke it is, raising blood sugar levels for a hemorrhagic stroke doesn't sound right to me. this is my first scrape in the medical field so i'm still learning on the origins of inner workings of our protocols (only been at it 6 months)

Increases icp in high concentrations no?

i know you're supposed to induce hyperventilation via BVM to avoid herniation via the foramen magnum, but that reduces CO2 levels i believe?.. am i wrong?

 

[medichopeful]

Increases icp in high concentrations no?

I've never heard this that I can recall, but that doesn't mean it's not true!

I was more focused on respiratory issues when I said this (for example, absorption atelectasis, etc)

 

[Hunter]

I've never heard this that I can recall, but that doesn't mean it's not true!

I was more focused on respiratory issues when I said this (for example, absorption atelectasis, etc)

Well I know that o2 causes vasoconstriction. I don't have the research on hand but I'll look it up.

 

[medichopeful]

i know you're supposed to induce hyperventilation via BVM to avoid herniation via the foramen magnum, but that reduces CO2 levels i believe?.. am i wrong?

Hyperventilation does reduce CO2 levels, which causes vasoconstriction. As far as using it for reduction of ICP, it is in the MA State Protocols, though a paramedic friend of mine says it's not suggested anymore (though I haven't come up with a definitive answer for whether he misspoke or not! I'll add it to my list of things to research more in-depth)

 

[medichopeful]

Well I know that o2 causes vasoconstriction. I don't have the research on hand but I'll look it up.

I'd love to see it! I know lack of O2 causes vasodilation, so going the other way I could potentially see that.

 

[workworkwork]

Hyperventilation does reduce CO2 levels, which causes vasoconstriction. As far as using it for reduction of ICP, it is in the MA State Protocols, though a paramedic friend of mine says it's not suggested anymore (though I haven't come up with a definitive answer for whether he misspoke or not! I'll add it to my list of things to research more in-depth)

hmm, i'll check up on that too, though i've had several protocol update emails, maybe i missed it. my class was in 2011 if that makes a difference.

 

[medichopeful]

hmm, i'll check up on that too, though i've had several protocol update emails, maybe i missed it. my class was in 2011 if that makes a difference.

There's definitely a chance he just didn't speak correctly, it happens. I did a bit of searching a while back, but can't really remember what I found! Though I do seem to recall him stating an AHA article that I wasn't able to find...

 

[TheGodfather]

Respiratory alkalosis will cause increases of ICP. With that said, oxygen in and of itself may or may not always cause ICP spikes.... it really is most determined on the patients pH; specifically PaCO2.

Also, in the head injured patient, this causes a "robin hood effect"...

Example:

A head-injured patient has brain tissue that is both ischemic and non-ischemic --> Healthy areas of brain vasoconstricts and push oxygenated blood to injured areas of the brain. --> leads to further ischemia and "oxygen steal" from the non-affected areas.

Mild vasoconstriction, though, is beneficial to the patient with increased ICP to prevent herniation for ways that I'm sure you already understand...

That's why it is now recognized as standard of care to maintain ETCO2 as nearest to 35mmHg (or, some might agree between about 32-35mmHg) in these situations (but you must be verrrrrrry cautious).

 

[medichopeful]

Respiratory alkalosis will cause increases of ICP.

Am I reading this wrong or was this misstated? Did you mean to say respiratory alkalosis will cause decreased ICP?

 

[TheGodfather]

Am I reading this wrong or was this misstated? Did you mean to say respiratory alkalosis will cause decreased ICP?

sorry, yes my mistake.. i was too far on the topic of decreased cerebral perfusion that i confused myself in the process...

correction: respiratory alkalosis will result in decreases of ICP at the cost of cerebral perfusion, and respiratory acidosis (or physiologic "norms") = ICP increased due to underlying TBI and/or vasodilation

 

[medichopeful]

sorry, yes my mistake.. i was too far on the topic of decreased cerebral perfusion that i confused myself in the process...

correction: respiratory alkalosis will result in decreases of ICP at the cost of cerebral perfusion, and respiratory acidosis (or physiologic "norms") = ICP increased due to underlying TBI and/or vasodilation

I thought it might be a mistake, but I was all sorts of confused for a second!

 

[TheGodfather]

I thought it might be a mistake, but I was all sorts of confused for a second!

I know the feeling... I have the habit of confusing myself quite regularly! :blush:

I guess that's what I deserve for getting distracted from my studies to check back on here... Brain mush!

 

[Hunter]

I know the feeling... I have the habit of confusing myself quite regularly! :blush:

I guess that's what I deserve for getting distracted from my studies to check back on here... Brain mush!

Lol... I'm studying for my state medics, this place keeps me from going crazy. o.o