Bgl invasive

[DesertMedic66]

There are still places thst don't allow EMTs to measure BGL?

Here we can "measure" the BGL. We just aren't allowed to poke their finger to get it. After the medic gets an IV then I automatically grab the flash blood and measure that. I've seen many EMTs here go "out of their scope" and poke the patients finger.

 

[truetiger]

EMT's should be allowed to check a BGL. While on a basic/basic truck you may not be able to do anything about it, its an important vital sign. On a medic/basic truck, its one more thing I can delegate to my partner to do while I do other things. For example, a BLS pumper beats you to the scene of a possible stroke. They can quickly perform a stroke scale, check the BGL, and determine onset before I arrive. With this information I can go ahead and launch the helicopter to take this patient to the proper facility while I'm still en route. I show up, quickly verify the findings, and won't be spending much time waiting for the helicopter.

 

[rmabrey]

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.

I have been told there can be up to 30 mm/dl difference, possibly more. Of course if we check BGL before the IV nobody really ever checks again so who really knows.

 

[18G]

I have been told there can be up to 30 mm/dl difference, possibly more. Of course if we check BGL before the IV nobody really ever checks again so who really knows.

Correct. Unless the glucometer is made for venous sampling the blood should be capillary from a finger stick.

And I have heard also a difference of 20-30mg/dl difference between venous and capillary samples.

 

[Tigger]

Correct. Unless the glucometer is made for venous sampling the blood should be capillary from a finger stick.

And I have heard also a difference of 20-30mg/dl difference between venous and capillary samples.

Is there any research proving this?

 

[18G]

Capillary blood hasn't been "used" yet. Venous blood has.


Here is one study on the issue...:

http://emj.bmj.com/content/22/3/177.abstract

... and this.

III. Clinical Issues of Blood Glucose Monitoring

Regardless of where a specimen is obtained, be it venous, capillary, or arterial, the integrity of this specimen is crucial for obtaining accurate reliable results. Venous specimens should only be used on meters that are not affected by low oxygen concentrations. Those meters which use the enzyme glucose oxidase, use oxygen to react with the glucose. Therefore, these meters should not be used with venous specimens. Capillary specimens have a high oxygen concentration and a slightly higher glucose than venous specimens. It’s important to remember a number of key concepts when collecting a capillary specimen:

Patient should have adequate circulation and warm hands.
The site should be cleaned with alcohol or warm soapy water.
Be sure to wipe the first drop off the finger before analyzing the second drop for a glucose concentration.
Arterial blood draws also have a high oxygen concentration and will give a slightly higher glucose reading than a venous specimen. Make sure the meter is compatible with heparin if one is using a blood gas specimen.

IV line draws should also be mentioned here. If one must use a line draw, it should be flushed with at least a 5 mL blood draw before collection of the specimen. If one is suspect that any glucose solutions have been administered through the line, using an alternate type specimen is recommended.

 

[DrParasite]

With that said, I do think it is extremely stupid that family calls EMS and the EMT's can't assess blood sugar and they have to ask the family to do it. When I was an EMT in PA I asked the family for the glucometer and did it myself. Technically not supposed to but oh well... slap my wrist.

Yeah I always felt embarrassed that I, as the trained professional could not check a patient's sugar, but her 10 year old was able to. and I had to ask the 10 year old to do with because I was not permitted to.

I actually had a call once for a known diabetic with an altered mental status and CVA like symptoms. by know, i mean, I had personally been to her home when he BGL was 30, IV dextrose was administered, and she RMAs. This time I am thinking she is having a CVA, but I can't rule out hypoglycemia because I don't have a BGL on her. we get there, load her up to carry her to the truck (and apply oxygen, because everyone gets a NRB), and are waiting for ALS to do their full assessment, call the doctor (why the medic did this before checking BGL I still have no idea), when the only thing we needed them to do was check BGL, since everything else needed to be done at the hospital. BGL turned out to be normal, and she was having a CVA. but we could have been off the scene and enroute to the hospital for definitive care 10 minutes sooner if BLS could have checked BGLs...

 

[the_negro_puppy]

BGL/BSL check should be part of every EMTs scope. Really its a tiny p-rick on the finger and if people are so concerned about their health to call 000/911 should they really be concerned about a tiny pin p-rick used to medically assess them? Even if an EMT cant give IV glucose or glucagon they can assist with oral glucose or even have a cause of the ALOC available for when ALS comes so they cant start treatment sooner.

Most patients of mine get a BSL check. You would be surprised how many abnormal levels you can find i.e the pt said they checked theirs 4 hours ago and it was ok, you do a check at its 20.0 mmol/L. I've even caught hypoglycaemic pts after MVAs by checking out their BSL once a hx of DM is obtained.

 

[CAOX3]

At the BLS level here EMTs can check BGLs administer oral glucose and glucagon.

 

[joeshmoe]

I know when volunteering for my local MFRs I cant take BG on a call. I always assumed it was considered a liability because of a possible needle stick, since the lancet has to be disposed of, and if someone did get stuck, who is gonna pay for testing? What the reason would be for not letting basics do it on a rig I have no idea.

 

[attnondeck]

hey. the word "assisted" comes in handy here. have the pt hold the lancet and push there finger into it(after you clean with a prep). then you have the blood droplet.

our ems captain states that we(as basics) are allowed to test blood glucose levels. he states out medical director has given us permission. this makes me nervous because its not in our protocols.... but if need be, an assisted d-stick works. just document that!

 

[Jay]

EmergencyJunkie, a few points from a fellow Pennsylvanian:

First, I got good news, AEMT is coming to PA after the new year. I have access to a lot of training resources in the state due to the nature of the program that I am involved in. For example, literally within a few months of the EMR-EMT Bridge rollout, our entire crew who happened to be EMR's got to take the course and become EMT's, this was one of the first in the state. Now, here is the bad news, AEMT is a loooooooong course, I heard over 400 hours but that is just an estimate. It is also a fairly tough course and you will really need to put time in to study so if you are working a full time job and in school it will suck but like anything else in EMS it will pay off in the end All I know for certain is that AEMT is just around the corner for us, so please hang in there!

Next, BGL vs. EPI-Pen in PA is relatively simple. The core purpose of BLS in PA [and elsewhere] is to provide care to stabilize the Pt using immediate lifesaving measures. For example, using a pseudo-ALS analogy, which is going to be more effective in saving your Pt's life CPR or pushing salt-water through their veins? Anaphylaxis is an immediate life threat and needs to be tended to as such, for testing purposes in PA for EMT-B certification one mut go through Vitals, SAMPLE, at least QRS to compare to after the EPI is administered but the state also knows that on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it. See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go straight to the oral glucose to once again resolve the immediate life threat. That's all it boils down to is rapidly making an attempt to stabilize immediate life threats, in the BGL case it is by skipping the reading (since the Pt can also deteriorate over that time, this can make oral administration a contraindication) and go for the administration of both oral glucose and O2 (not necessarily in that order, everyone usually gets O2 first).

I hope that clears things up a bit!

I am also interested in any thoughts on the above. This was pretty much the consensus that I heard through our EMS-I chain near Philly. This is a fairly common question though.

 

[emergancyjunkie]

EmergencyJunkie, a few points from a fellow Pennsylvanian:

First, I got good news, AEMT is coming to PA after the new year. I have access to a lot of training resources in the state due to the nature of the program that I am involved in. For example, literally within a few months of the EMR-EMT Bridge rollout, our entire crew who happened to be EMR's got to take the course and become EMT's, this was one of the first in the state. Now, here is the bad news, AEMT is a loooooooong course, I heard over 400 hours but that is just an estimate. It is also a fairly tough course and you will really need to put time in to study so if you are working a full time job and in school it will suck but like anything else in EMS it will pay off in the end All I know for certain is that AEMT is just around the corner for us, so please hang in there!

Next, BGL vs. EPI-Pen in PA is relatively simple. The core purpose of BLS in PA [and elsewhere] is to provide care to stabilize the Pt using immediate lifesaving measures. For example, using a pseudo-ALS analogy, which is going to be more effective in saving your Pt's life CPR or pushing salt-water through their veins? Anaphylaxis is an immediate life threat and needs to be tended to as such, for testing purposes in PA for EMT-B certification one mut go through Vitals, SAMPLE, at least QRS to compare to after the EPI is administered but the state also knows that on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it. See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go straight to the oral glucose to once again resolve the immediate life threat. That's all it boils down to is rapidly making an attempt to stabilize immediate life threats, in the BGL case it is by skipping the reading (since the Pt can also deteriorate over that time, this can make oral administration a contraindication) and go for the administration of both oral glucose and O2 (not necessarily in that order, everyone usually gets O2 first).

I hope that clears things up a bit!

I am also interested in any thoughts on the above. This was pretty much the consensus that I heard through our EMS-I chain near Philly. This is a fairly common question though.

It makes sense now. Now that I know AEMT is coming to pa I'm going to put off starting paramedic and go for that

Sent from my Desire HD

 

[Tigger]

EmergencyJunkie, a few points from a fellow Pennsylvanian:

First, I got good news, AEMT is coming to PA after the new year. I have access to a lot of training resources in the state due to the nature of the program that I am involved in. For example, literally within a few months of the EMR-EMT Bridge rollout, our entire crew who happened to be EMR's got to take the course and become EMT's, this was one of the first in the state. Now, here is the bad news, AEMT is a loooooooong course, I heard over 400 hours but that is just an estimate. It is also a fairly tough course and you will really need to put time in to study so if you are working a full time job and in school it will suck but like anything else in EMS it will pay off in the end All I know for certain is that AEMT is just around the corner for us, so please hang in there!

Gasp! A mid-level provider course that actually requires time to be spent on it! 400 hours is not all that long given the expected scope of any level above basic, and I am going to bet it doesn't include any sort of A&P requirement either.

Next, BGL vs. EPI-Pen in PA is relatively simple. The core purpose of BLS in PA [and elsewhere] is to provide care to stabilize the Pt using immediate lifesaving measures. For example, using a pseudo-ALS analogy, which is going to be more effective in saving your Pt's life CPR or pushing salt-water through their veins? Anaphylaxis is an immediate life threat and needs to be tended to as such, for testing purposes in PA for EMT-B certification one mut go through Vitals, SAMPLE, at least QRS to compare to after the EPI is administered but the state also knows that on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it. See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go straight to the oral glucose to once again resolve the immediate life threat. That's all it boils down to is rapidly making an attempt to stabilize immediate life threats, in the BGL case it is by skipping the reading (since the Pt can also deteriorate over that time, this can make oral administration a contraindication) and go for the administration of both oral glucose and O2 (not necessarily in that order, everyone usually gets O2 first).

I hope that clears things up a bit!

I am also interested in any thoughts on the above. This was pretty much the consensus that I heard through our EMS-I chain near Philly. This is a fairly common question though.

Not everyone needs to get 02 first even if they are having a diabetic emergency. Diabetic emergency =/= respiratory emergency.

How long does it really take to get a BLG? Maybe thirty seconds if the two drops of blood are slow in coming. Nothing wrong with multi-taking, it is fairly easy to get the BGL during a stroke test. The "seconds" saved in skipping getting the measurement are not going to be clinically significant, and I'd rather have a better understanding of my patients condition than save fifteen seconds.

 

[JPINFV]

on the street seconds count, the above scenario is generic across all drugs and is used to make sure that one has rote memorization and that's pretty much it.

Except "the street" doesn't hold any special properties that makes seconds count. Sorry, in the vast majority of cases, including emergencies, seconds don't count. If seconds count in a hypoglycemia case, then a paramedic would be needed as IV dextrose solutions are infinitely faster than buccal or oral glucose administration.

See, if you can assume that one is suffering from some kind of blood sugar abnormality it is taught to give glucose [orally] at the BLS level, since we can quickly rule out it is not a stroke during initial Pt contact then we go straight to the oral glucose to once again resolve the immediate life threat.

Since hypoglycemia can mimic a stroke, how are you ruling out hypoglycemia with out a blood glucose test?

everyone usually gets O2 first).

Only because the powers that be believe that EMS providers are too stupid to determine if a patient is hypoxic and EMS providers are too impotent to prove them otherwise.

 

[Jay]

Gasp! A mid-level provider course that actually requires time to be spent on it! 400 hours is not all that long given the expected scope of any level above basic, and I am going to bet it doesn't include any sort of A&P requirement either.

Tigger, I am [G-d willing] planning on taking this course when it becomes available next year, I agree that in the grand scheme 400 hours is not long compared to EMT-P and other vocations however, I am talking from a married guy's perspective with a family and a full time job which sort of makes medic school out of the question [at least at this particular juncture]. Having such obligations means that AEMT is an option but having so many responsibilities does make time a huge factor. I also own and run a small business so I didn't realize until fairly recently how precious time really is and how easy it is to burn out for taking an extra hour to finish everything.

How long does it really take to get a BLG? Maybe thirty seconds if the two drops of blood are slow in coming. Nothing wrong with multi-taking, it is fairly easy to get the BGL during a stroke test. The "seconds" saved in skipping getting the measurement are not going to be clinically significant, and I'd rather have a better understanding of my patients condition than save fifteen seconds.

Again, not my view, this is coming from the state directly, our group was involved in some talks on a regional level not too long ago and this exact question came up. Perhaps the state feels that a BLS provider doesn't have the training to manage the Pt if things go South over those 30 seconds? I sort of agree with them and also kind of don't. I think it should be an option and the EMT-B should be able to take a BGL on the stable Pt but it should be out for a "Priority" Pt.

In PA even SpO2 is not generally allowed for a BLS provider and what does that take... 10 seconds... If that? The state does recognize the ACLS-B course and does allow BLS providers to take an SpO2 after having their ACLS-B certificate (8 hours) but they can very well yank your numbers for doing this without the ACLS-B training. I know it is sort of stupid but you probably know that there are some EMT-B's out there that can barely do their current scope of practice and anything else will confuse them, well guess what, the state of PA [and a ton of other ones out there] will hold off these *simple* procedures for what, maybe 5% of the certified population of Basics. It does suck, I agree with you but everything here is coming from information that I either heard or read on the state level!

 

[Jay]

Since hypoglycemia can mimic a stroke, how are you ruling out hypoglycemia with out a blood glucose test?

Just the opposite, a Basic would rule out stroke, e.g. with a quick Cincinnati stroke scale; since you can rule out many of the other issues and can get a good to fair educated guess that hypoglycemia is the issue than a little sugar probably wont hurt them even if it was something else. I know that there are rare issues that upping the glucose can interfere but the majority of the time, perhaps over 99% of the time this is not an issue and would be out of the scope of an EMT-B anyhow.

Only because the powers that be believe that EMS providers are too stupid to determine if a patient is hypoxic and EMS providers are too impotent to prove them otherwise.

I agree with you and that was what I was trying to explain to Tigger is that in Pennsylvania ALL priority Pt's get high flow O2. You and I both know that the AHA says that is not the case but this is on the books for the EMT-B protocol.

Now I have noticed that in Philly the medics and up (ED staff) will listen to you if your a Basic and you have proven yourself. I don't know if this goes for other places as well?

The one big thing here is that your in CA and PA is mostly rural so their BLS protocols play the rule of averages and assume that medics are over 30 minutes away in most cases and the EMT-B has to act with a sense of urgancy. This doesn't really apply to me since I am in Philly. Pittsburgh and for a lesser degree Scranton are the same way but the remainder of this huge state is mainly utilizing a Basic EMS system using QRS and the like for its First Responders... Is Cali similar in that respect, I know that there is a lot of more city area so I would think that they have EMT-P's factored higher into their protocols in general? Tell me if this is so I am real curious to know.

 

[Jay]

It makes sense now. Now that I know AEMT is coming to pa I'm going to put off starting paramedic and go for that

Sent from my Desire HD

One more quick point for you, the AEMT curriculum will be on the books soon enough however it doesn't mean that the schools will be ready to teach them that quickly. When the EMR-EMT Bridge came about it took maybe 8 months before I was able to take it and that was a special pilot program at that. I would guess that at best the AEMT program will be rolled out for schools to teach in 2013... Does this change your mind any?

 

[emergancyjunkie]

One more quick point for you, the AEMT curriculum will be on the books soon enough however it doesn't mean that the schools will be ready to teach them that quickly. When the EMR-EMT Bridge came about it took maybe 8 months before I was able to take it and that was a special pilot program at that. I would guess that at best the AEMT program will be rolled out for schools to teach in 2013... Does this change your mind any?

good point. but i still would like to get some field experiance in after the state test before i just jump straight into medic school or for that Matter AEMT school

 

[Jay]

Are you certified yet as either an EMR or an EMT?

Also, you may want to get some good con-ed such as ACLS-B and maybe train to become an instructor because it will really help you know the topics in a whole new way. There is a lot of training out there and yes, hands on is highly recommended