Bgl invasive

[Handsome Robb]

Our protocol states for any unconscious pt with the reason being hypoglycemia we are to give oral glucose buccally.

And before I start putting a sticky substance in an unconscious persons mouth...I want to know that it is actually their bgl that is the problem.

Everyone's gonna hate you for that one! haha

but.........

No reason you can't put them in left lateral and use some suction unless they are on a mask.

 

[Anjel]

Everyone's gonna hate you for that one! haha

but.........

No reason you can't put them in left lateral and use some suction unless they are on a mask.

I don't agree with that protocol. And depending on how low the bgl was and how close I was to an ER which is never more than 10 minutes away. I probably would never do it.

I am just pointing out that it is protocol and I want a BGL before I do it.

 

[Handsome Robb]

I like the D50 I can give as an Intermediate much better, just saying that's how I'd do it if I was stuck in a bad spot.

 

[Anjel]

I like the D50 I can give as an Intermediate much better, just saying that's how I'd do it if I was stuck in a bad spot.

Yea I agree.

 

[Anjel]

EMT/SPECIALIST
3. If the patient is alert but demonstrating signs of hypoglycemia, measure blood
glucose level, if available.
A. If less than 60 mg/dl administer oral high caloric fluid.
4. If patient is not alert or vital signs are unstable:
A. Evaluate and maintain airway, provide oxygenation and support ventilation as needed.
B. If no suspected spinal injury, place the patient on either side.
C. Administer small amounts of oral glucose paste, buccal or sublingual.

So we have to have it.

I don't understand what the big deal is. It is p ricking a finger.

 

[emergancyjunkie]

Ok knowing protocal. If I were to respond to a patient and they state they have diabetes can we ask them if they have a glucometer and if they do can I have them do the bgl on themself. It's technically not me doing it. That way I have a bgl on them and know if I should give them oral glucose... Man I wish pa had AEMT as one of the levels. Al we have is emt-b paramedic and PHRN



Sent from my Desire HD

 

[rmabrey]

Ok knowing protocal. If I were to respond to a patient and they state they have diabetes can we ask them if they have a glucometer and if they do can I have them do the bgl on themself. It's technically not me doing it. That way I have a bgl on them and know if I should give them oral glucose... Man I wish pa had AEMT as one of the levels. Al we have is emt-b paramedic and PHRN



Sent from my Desire HD

yes.

 

[Handsome Robb]

A lawyer could say you gave the pt medical advice and have it come back to bite you.. just playing the devils advocate. 95% of the time if their sugar is low enough to make you pucker they wont be capable of doing it themselves, in my experience at least.

 

[emergancyjunkie]

yes.

Ok so if that is done how would it be documented so I can save myself from a lawsuit or in the future my cert

Sent from my Desire HD

 

[ArcticKat]

This right here is what I find very odd, you can give oral glucose yet you cannot check the patient's BGL ?

Why is that odd? Even basic first aid training says when in doubt, give sugar. If a patient is hypoglycemic at 2 mmol/L and is given oral glucose he might come up to 5 mmol/L and you'd have saved a few million brain cells. If he's hyperglycemic at 15mmol/L and you give suger you're not going to cause any further harm by bumping it up a few more points.

 

[JPINFV]

Ok so if that is done how would it be documented so I can save myself from a lawsuit or in the future my cert

Sent from my Desire HD

Pt's BGL ____ per ____ @ [time].

Helpful for SpO2 as well at SNFs.

 

[rmabrey]

Ok so if that is done how would it be documented so I can save myself from a lawsuit or in the future my cert

Sent from my Desire HD

Never had to do it, but "BGL per Pt 107 @ whatever time" should be sufficient. Your a basic and cant check it anyway, so i see this being no different then asking when the last time they checked their sugar was and what it was.

 

[Yarbo]

Agreed, "basic" EMS is just a lower form of advanced in most cases.

Our PCPs are able to insert King tubes, administer nitrous oxide, BGL, insert a Foley, 12 Leads, and CPAP. SubQ Epi, and several other meds.

I enjoy this!, as much as I wish I was trained to do IVs instead of foleys!

 

[ArcticKat]

I enjoy this!, as much as I wish I was trained to do IVs instead of foleys!

Didn't your PCP education include IV initiation? Don't be surprised to see it coming down the pipe in the not too distant future.

 

[Yarbo]

Didn't your PCP education include IV initiation? Don't be surprised to see it coming down the pipe in the not too distant future.

Well, we learned about securing, managing, and discontinuing the line just not introducing it. Now that the ICP/EMT-A program is gone out of popular locations Saskatoon/Regina I hope someone steps up and adds PCP IV insertion into a protocol.

 

[ArcticKat]

Well, we learned about securing, managing, and discontinuing the line just not introducing it. Now that the ICP/EMT-A program is gone out of popular locations Saskatoon/Regina I hope someone steps up and adds PCP IV insertion into a protocol.

Hmm, I thought SIAST included initiation in the training. Give it a couple of years, it's coming, I guess there's just a more significant education module to develop.

 

[Tigger]

A lawyer could say you gave the pt medical advice and have it come back to bite you.. just playing the devils advocate. 95% of the time if their sugar is low enough to make you pucker they wont be capable of doing it themselves, in my experience at least.

Agreed. While asking the patient to check is BGL works and is nice to have on arrival at the ED, if you're thinking "damn I wonder what this guy's sugar is?" you are not going to be getting him to check it for you. Maybe if you're lucky he can speak coherently.

For the record, both CO and MA allow for basics to check BGL, I honestly see no issue with this as it should be unlikely to delay treatment or transport if done correctly. And as another poster mentioned, it's great on P/B trucks to help divide the patient load (if appropriate). having the basic be able to use the glucometer is also useful during IV initiation, the medic can finish the IV while the basic checks the sugar quickly.

Incidentally, I've heard that BLG monitors need to be calibrated differently to use blood from an IV. Is this true? And is there such a difference between the numbers that it would make any difference clinically? Despite hearing this, not once have I ever been on a truck (ALS or BLS) that carried anything beyond your standard OneTouch meter.

 

[Yarbo]

Agreed. While asking the patient to check is BGL works and is nice to have on arrival at the ED, if you're thinking "damn I wonder what this guy's sugar is?" you are not going to be getting him to check it for you. Maybe if you're lucky he can speak coherently.

For the record, both CO and MA allow for basics to check BGL, I honestly see no issue with this as it should be unlikely to delay treatment or transport if done correctly. And as another poster mentioned, it's great on P/B trucks to help divide the patient load (if appropriate). having the basic be able to use the glucometer is also useful during IV initiation, the medic can finish the IV while the basic checks the sugar quickly.

Incidentally, I've heard that BLG monitors need to be calibrated differently to use blood from an IV. Is this true? And is there such a difference between the numbers that it would make any difference clinically? Despite hearing this, not once have I ever been on a truck (ALS or BLS) that carried anything beyond your standard OneTouch meter.

Hope not. lol

 

[JPINFV]

Incidentally, I've heard that BLG monitors need to be calibrated differently to use blood from an IV. Is this true? And is there such a difference between the numbers that it would make any difference clinically?

Technically yes, as capillary blood is going to have different properties than venous blood. I, however, don't think it's enough of a difference to be concerned about if you know it's present, but I'm sure someone will jump on the chance to prove me wrong.

 

[Yarbo]

Technically yes, as capillary blood is going to have different properties than venous blood. I, however, don't think it's enough of a difference to be concerned about if you know it's present, but I'm sure someone will jump on the chance to prove me wrong.

Good news! lol

Random sources from other forums; I'd take these posts with a grain of salt though.

Our medical control has us do a capillary blood glucose (CBG) aka finger stick. I know it's a common practice to use blood from the IV site for a D-Stick. Our medical control says that there is a difference in glucose readings between serum glucose from the IV and a finger stick (CBG). They want us to do finger sticks for the reading. So, instead of one stick for everything, the patient has pain twice. The hospitals go by serum glucose readings. Of course their methods of reading serum glucose are more sophisticated than a glucometer.

Thought I'd throw my nickels worth in here.

"

As for those of you using IV flash or venous blood syringes to take your glucose readings from, you MUST make sure that your glucometer can recognize and read venous blood, which is much different from capillary blood. If not, this will give you false readings.

You are right. There is a difference between venous and capillary blood. Many machines now days are calibrated for either.