Bgl invasive

[CAOX3]

We can never cancel the medic especially when medication has been administered... I know just how easy it is for narcan to work- which is the problem... titrate to effect but not bring the person all the way back... or if they are opioid dependent you can cause other problems with narcan...

Why?

Why would you tie up another ambulance, especially a medic truck with a patient who's problem has been corrected?

And what other problems are you going to cause? A combative patient, not if your administering it correctly, vomiting, occluded airway? I can address those issues just as well if need be.

The problem is the latter generation of EMT with their compressed training and education has come to rely completely on paramedics, independent thought has been removed, replaced with call a paramedic even if the patient doesn't need one.

When I went to school there wasnt a medic truck on every corner and our education reflected that, we were educated/trained as sole providers able to care for patients, I simply don't drop back and punt if the complaint is in my grasp, we are are able to administer multiple medications, use advanced airways and such. I don't have to call a medic everytime I administer a medication, if it had the desired effect I take them to the hospital if it doesn't I contact some who can address it further.

 

[MrBrown]

Why would you tie up another ambulance, especially a medic truck with a patient who's problem has been corrected?

Now now stop talking logical sense, we can't be having any of that!

And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.

 

[CAOX3]

Now now stop talking logical sense, we can't be having any of that!

And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.

I've have only given narcan with obvious respiratory complications, I'm not of the belief of ruining someones high just because I can.

We don't tube them, we take the edge off, hopefully return some sort of respiratory function and take them to the hospital, I would be more apt to leave them home if I believed for a second they wouldn't cop again and start the whole vicious cycle all over again.

 

[Akulahawk]

Please don't do this, it makes me want to smash my head on the wall

I was having this discussion the other day with one of the guys I am mentoring for his Paramedic (ICO) assignments. As JP rightly said, venous blood is different from capillary blood and although the difference is small the glucometer is not calibrated for venous blood.

It also increases the risk of a needlestick injury.

This was covered in the Ambulance clinical newsletter Clinical Matters (Issue 6, December 2009)

If the glucometer is also calibrated for venous blood, you're OK on that end of things. There aren't many needle systems that I know of that you can easily get a venous sample from, after safing the introducer needle. If I'm working with a system that you can easily get a sample, it's a trivial matter to do it. Any other system and I'll just set the glucometer up before the start and get my drop right out of the catheter itself.

Now if my glucometer is NOT calibrated for venous blood and if I need something to base Tx on, I'll get it the "correct" way.

 

[18G]

We use IM and IN narcan at the BLS level here, you simply want to return spontaneous respirations, which can be achieved quite easily.

If I can achieve that before the medics arrive then we cancel them.

Never had an issue, if I cant return respirations to an acceptable level then the medics can transport.

I am not a fan at all with cancelling ALS or at least transporting BLS on a drug overdose where Narcan had to be given for a few reasons.

One, if you give just enough to return respiratory drive and are successful in doing that, chances are some alteration is still going to be present and possibly some negative hemodynamic effects as well from the opiate.

Two, some narcotics effects will outlast that of Narcan. We never really know how much of a illicit substance was taken.

Three, what if it is a polypharmacy overdose? Say a narcotic was taken along with some stimulants and now since you blocked the opposing narcotic, we now have the stimulant causing tachycardia, agitation, and hypertension?

Four, who is going to be with these OD patients that just received Narcan? Their junkie friends? By allowing the patient to refuse are we possibly instilling a false sense of confidence that if something bad happens they can just call EMS who will do a quick fix and everything is back to normal?

Five, it is our job to advocate for our patient and determine their needs when they are not in a condition to do so themselves. By transporting to the hospital at least the patient is in an environment where intervention services are available and can be offered. Granted quite a few of these patient types will refuse hospital services and just want to leave, but what about the few who maybe do want help but never knew where to turn or was afraid to ask for help? At least we can get the patient to the people who can get them the help they really need.

A patient who overdosed on heroin or whatever has problems that run much deeper than one single episode. We need to be getting these patients to the hospital.

 

[18G]

Now now stop talking logical sense, we can't be having any of that!

And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.

I believe the pre-hospital environment has a need for Narcan. Yes, we can manage their airway and ventilate them but why subject the patient to all that when you can give the Narcan and reduce some of the risks associated with assisted ventilations, airway control, vomiting, aspiration, hypotension, etc, during the trip to the hospital especially if it's a 20-30min transport?

 

[Handsome Robb]

I believe the pre-hospital environment has a need for Narcan. Yes, we can manage their airway and ventilate them but why subject the patient to all that when you can give the Narcan and reduce some of the risks associated with assisted ventilations, airway control, vomiting, aspiration, hypotension, etc, during the trip to the hospital especially if it's a 20-30min transport?

Seconded. Narcan is a pretty benign med when it comes down to it. Yes you can cause seizures or vomiting if you slam it but other than that? I'd rather be stuck with a needle than have a plastic tube jammed down my throat and into my trachea assisted by a giant metal blade that can chip teeth or cause oral trauma that could threaten my airway if the provider is unable to secure the tube.

Why not give narcan prehospitally, Brown?

 

[JPINFV]

Now now stop talking logical sense, we can't be having any of that!

And is there really a need to be giving people naloxone in the pre-hospital setting? I argue no except in the obviously-accidental safe to be left at home with appropriate care and follow up situation, just like there's no role for giving people frusemide.

The argument against furosemide and an argument against naloxone are two completely different arguments.

 

[Calichic]

Does anyone know why an emt-b in pa can give an epi-pen but can not check a bgl

Sent from my Desire HD

We have the same protocol in CA as well

 

[DesertMedic66]

We have the same protocol in CA as well

It's slowly changing in Cali depending on your county. As of next year we can start doing BGL and they are probably gonna put a BG meter on all BLS rigs in my county along with pulse ox and AED.

 

[emergancyjunkie]

We have the same protocol in CA as well

It is a bad idea to not let emt-b check bgl. It's been said in this thread why tie up a medic unit just to see if they have low or high blood sugar

Sent from my Desire HD

 

[JPINFV]

It is a bad idea to not let emt-b check bgl. It's been said in this thread why tie up a medic unit just to see if they have low or high blood sugar

Sent from my Desire HD

Because the things that can cause an altered mental status can often benefit from the education, intervention, or the safety net (in case the patient significantly deteriorates) that the paramedic brings to the patient.

Additionally, if the patient is hypoglycemic to the point that they can't be administered oral glucose, then you're going to need paramedics anyways to administer IV dextrose.