How about that

ChrisMed1

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Tones drop for a headache and general unwell.
HR 116 BP 117/69 O2 95% RR 14 BGL...... Well yikes. Patient is a diabetic with heart failure as well.

Afebrile, hemodynamics pretty stable, chest auscultation normal, nothing else on history. Exam did reveal also patient had some light sensitivity.


Opened patient her sweet tea bottle load and go went code 3 pretty standard. But look at that dexcom wow looks like my bank account.





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Akulahawk

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ChrisMed1 said:
Tones drop for a headache and general unwell.
HR 116 BP 117/69 O2 95% RR 14 BGL...... Well yikes. Patient is a diabetic with heart failure as well.

Afebrile, hemodynamics pretty stable, chest auscultation normal, nothing else on history. Exam did reveal also patient had some light sensitivity.


Opened patient her sweet tea bottle load and go went code 3 pretty standard. But look at that dexcom wow looks like my bank account.





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Was the patient alert/oriented or was the patient acutely altered? Was the BG level verified by a separate fingerstick reading? If the patient is acutely altered and can't take PO dextrose (or perhaps that very sweet tea), I can see/rationalize load & go with a code 3 transport if the crew is BLS only. If the patient is not acutely altered and can take PO dextrose / drinks that very sweet tea... RLS transport isn't indicated. Continue monitoring the blood glucose level and level of consciousness, transport Code 2 and upgrade to Code 3 if the patient becomes acutely altered.

If the crew is ALS, they have more options...
 
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ChrisMed1

ChrisMed1

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Akulahawk said:
Was the patient alert/oriented or was the patient acutely altered? Was the BG level verified by a separate fingerstick reading? If the patient is acutely altered and can't take PO dextrose (or perhaps that very sweet tea), I can see/rationalize load & go with a code 3 transport if the crew is BLS only. If the patient is not acutely altered and can take PO dextrose / drinks that very sweet tea... RLS transport isn't indicated. Continue monitoring the blood glucose level and level of consciousness, transport Code 2 and upgrade to Code 3 if the patient becomes acutely altered.

If the crew is ALS, they have more options...
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A&O x 3 so a little altered unknown acuity (patient states, "I don't give a f**k who the president is") we did do a fingerstick en route patient already started drinking her tea it was 61. We did go code 3 probably could have gone code 2 but that's up to the driver and medic I ride as the aid.
 
Akulahawk

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Slightly altered (maybe), following commands, and treating with the sweet tea and improvement in BG level? I wouldn't take that one Code 3 to the hospital. Your medic and driver should have made a safer decision unless protocol by their EMS agency requires Code 3 travel for patients who are/were hypoglycemic regardless of orientation status or response to treatment.
 
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ChrisMed1

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Akulahawk said:
Slightly altered (maybe), following commands, and treating with the sweet tea and improvement in BG level? I wouldn't take that one Code 3 to the hospital. Your medic and driver should have made a safer decision unless protocol by their EMS agency requires Code 3 travel for patients who are/were hypoglycemic regardless of orientation status or response to treatment.
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Yeah I would have to review protocols to know for certain but I started volunteering like 2 months ago and haven't seen any code 2 transports. It's always been either code 1 routine or code 3 emergent.
 
Akulahawk

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ChrisMed1 said:
Yeah I would have to review protocols to know for certain but I started volunteering like 2 months ago and haven't seen any code 2 transports. It's always been either code 1 routine or code 3 emergent.
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Code 1 is "routine"
Code 2 is urgent but no lights/sirens. Obey all traffic laws.
Code 3 is lights/sirens, drive with due regard for safety of others and don't throw the people in the back around...

Code 1 is basically that you're doing round-trips to/from medical appointments, dialysis, etc. It's basically a gurney run.
Code 2/3 are going to end up in the ER, or for interfacility trips, end up at another in-patient facility. Medical monitoring REQUIRED.
 
DrParasite

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Is her BGL coming up following some sweet tea? She's mostly AOx3 (doesn't care about the president fine, but she's answering appropriately).... You know what the issue is, and have the tools to both assess and reverse her condition.

stay on scene, give her some more tea, and then have her take a nice easy ride to the ER.
 
Tigger

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An ALS provider took a hypoglycemic patient back emergent and did nothing but have them drink tea? Am I missing something?
 
Akulahawk

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Tigger said:
An ALS provider took a hypoglycemic patient back emergent and did nothing but have them drink tea? Am I missing something?
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Apparently we all are... I've rarely heard of such a patient brought emergently to the ED outside of a system-level order requiring ALL ambulance movements (dispatch, transports, post move-ups) being done emergently.
 
NomadicMedic

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Tigger said:
An ALS provider took a hypoglycemic patient back emergent and did nothing but have them drink tea? Am I missing something?
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I don’t belive this was an ALS crew. Sounds like an inexperienced provider with little frame of reference regarding appropriate transport priority, coupled with a “check out this cool thing” they posted on the internet.

I just shake my head and move on when I read these. Not my circus, not my monkeys.
 
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EpiEMS

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This patient was ripe for treat and release. Needs a QA review, because this is an inappropriate use L&S.
 
NomadicMedic

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EpiEMS said:
This patient was ripe for treat and release. Needs a QA review, because this is an inappropriate use L&S.
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Sadly, most places just say “hey, try not to do that again” and they just move on.

There’s so little operational education given to most EMS providers, it’s sad.

I teach a class on how to appropriately process refusals and assess medical decision making capacity. Even after I cite cases and research, I still get push back on refusals for “lift assists” and car accidents with “no patient found.”

And we wonder why nobody takes EMS seriously.
 
DrParasite

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Akulahawk said:
(post move-ups) being done emergently.
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really? so they go lights and sirens from one street corner to sit on another street corner? or from one station to another station?
 
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ChrisMed1

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Tigger said:
An ALS provider took a hypoglycemic patient back emergent and did nothing but have them drink tea? Am I missing something?
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Went code 3 because there sugars weren't stable if you look at the pattern the sugar has been non stop climbing and dropping

Medic did what the patient asked for just tea and no IVs. Patient declined IV placement. Stables were still unstable they were still tachycardic.

Not a medic so bare with me but tachycardia is response to something the body is not happy with like hypoglycemia. Increased heart rate increases metabolism so with increased metabolism and unstable brittle type 1 we were still very concerned of it continuing to drop. The down arrow on a dexcom referring to dropping they have a straight arrow for stable so if its 40 and dropping and then it comes up but we still know it's been doing that the whole time up and down it's still just as concerning.
 
NomadicMedic

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That’s a dexcom. Notoriously unreliable. Do a finger stick. If she’s low, either have her continue to drink tea or start a line and give some dextrose. Here’s a protip: If she’s conscious enough to drink sweet tea, there’s no reason to go lights and sirens.

I really mean no disrespect here, but you have no idea what you’re talking about. Tachycardia is nothing without some correlation, and you haven’t provided any clinical indication that has anything to do with anything and absolutely nothing that shows a lights and sirens transport is indicated.

This is the kind of stuff that just makes EMS providers look like chuckleheads. Congratulations. You’ve achieved the EMS version of HIHFTY.
 
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ChrisMed1 said:
Went code 3 because there sugars weren't stable if you look at the pattern the sugar has been non stop climbing and dropping

Medic did what the patient asked for just tea and no IVs. Patient declined IV placement. Stables were still unstable they were still tachycardic.

Not a medic so bear with me but tachycardia is response to something the body is not happy with like hypoglycemia. Increased heart rate increases metabolism so with increased metabolism and unstable brittle type 1 we were still very concerned of it continuing to drop. The down arrow on a dexcom referring to dropping they have a straight arrow for stable so if its 40 and dropping and then it comes up but we still know it's been doing that the whole time up and down it's still just as concerning.
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Have a low or high blood sugar isn’t usually a good reason to transport someone lights and sirens.

People with low sugar and a history of diabetes typically like for us to just get their sugar up and then leave them at home.

People’s blood sugar normally have swings so on a continuous monitor, swings of high and low are to be expected. Continuous monitors are not usually trusted for what they are reading and anyone in the medical field should be doing a finger stick blood glucose check using their institution supplied devices. You shouldn’t be treating anyone based on the continuous ones.

Tachycardia can be from a huge amount of causes. Tachycardia does not mean a patient is unstable. Tachycardia does not mean the body is compensating for anything serious. I become tachycardic anytime my girlfriend is driving but that doesn’t mean I am unstable or that my body is compensating for anything.

Please correct peoples blood glucose levels before transporting them and forcing them to be stuck with an unnecessary ambulance bill and an unnecessary hospital bill.
 
EpiEMS

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DrParasite said:
really? so they go lights and sirens from one street corner to sit on another street corner? or from one station to another station?
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This can’t be, right? Gotta be some sort of infraction.
 
DrParasite

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EpiEMS said:
This can’t be, right? Gotta be some sort of infraction.
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I know FDNY used to do that... but I had hoped they stopped... it's the epitome of rush / rush / rush / lights / sirens just to back into someone else's station...

I can see if they were responding to a call in another area, but how do you justify your actions if a crash occurs?
 
DrParasite

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ChrisMed1 said:
Went code 3 because there sugars weren't stable if you look at the pattern the sugar has been non stop climbing and dropping

Medic did what the patient asked for just tea and no IVs. Patient declined IV placement. Stables were still unstable they were still tachycardic.
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Let me see if I have this right... your medic considered the patient so unstable that they warranted an emergent transport, but not stable enough to push for an IV? do you think if the patient's sugar was so low, that an IV could have provided an intervention that would have stabilized the patient?
ChrisMed1 said:
Not a medic so bare with me but tachycardia is response to something the body is not happy with like hypoglycemia. Increased heart rate increases metabolism so with increased metabolism and unstable brittle type 1 we were still very concerned of it continuing to drop. The down arrow on a dexcom referring to dropping they have a straight arrow for stable so if its 40 and dropping and then it comes up but we still know it's been doing that the whole time up and down it's still just as concerning.
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if it's 40 and dropping (assuming the dexcom is accurate, when was it last calibrated? have you confirmed that it has been calibrated in accordance with the manufacturers directions? have you validated that it was reporting correctly based on objective testing?), what are you going to do while going L&S to the hospital without an IV? What do yo think the ER will do?

I'm not saying you need to force an IV against her will, but if she's stable enough to refuse IV intervention, than I question how unstable she is that she warrants an emergent transport.
 
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