Bgl invasive

[pa132399]

i agree i need a new source and im not implying that i would put it in the patients hand to administer an epi pen it was just how my emt class was taught it doesnt mean that i would do it that way. technically even if you do it you are assisting the patient in taking there own medication so i understand what you are getting at and yes the drugs i agree we do need to know. but i sat with one of my medic partners and she went through the pile of drug card and narrowed them down to what we carry and also what i definately need to know. so in turn i am also taking a pharmocology class next semester and i do hope to learn as much as i can possibly implant in my nuerons.

 

[18G]

Cool. I'm not trying to oppose everything ya say but almost everything you relayed was heresy and I don't want you believing stuff that isn't true.

Your Paramedic partner should know that even though the drug cards you have aren't for drugs in the drug box at the station, they are still drugs on the National Registry exam and you still need to know them since you may have to answer test questions that deal with them. Disregard that advice she gave you and study all of your drug cards.

 

[MedicJon88]

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.

We didn't measure anything technically, same as the poking part its above our "supposed understanding"- we did it under the medics supervision- its stupid but its still not in our scope of pratice... and it common pratice for them to hand us the glucometer along with the lancet... you are going to get a look if you tell them "its out of my scope"- same as setting up a flush,spike the NS/LR/D5, administering SL nitro,and a 4 lead... sometimes when they are feeling kind- EMTs get to set up nebulizer and CPAP get a 12lead... but its always under the supervision of the P-medic...

I heard they are thinking about adding BGL and Pulse Ox to the EMTb scope of pratice... bt 2014...

 

[usalsfyre]

Doing a mix of IFT and 911 I carried meds that weren't in my drug box daily. Just knowing what's in your protocols is a good sign of a technician skill monkey...

 

[CAOX3]

Is anyone using glucagon at the BLS level?

 

[emergancyjunkie]

Is anyone using glucagon at the BLS level?

I think in pa that is an als assist skill

Sent from my Desire HD

 

[MassEMT-B]

Is anyone using glucagon at the BLS level?

Rhode Island is.

 

[CAOX3]

I think in pa that is an als assist skill

Sent from my Desire HD

So your allowed to a administer it under the supervision of a paramedic?

 

[18G]

No, glucagon IS NOT a BLS primary or assist skill in Pennsylvania.

 

[emergancyjunkie]

No, glucagon IS NOT a BLS primary or assist skill in Pennsylvania.

Yeah another skill that's considered invasive. Just read that portion of the BLS protocal.

Sent from my Desire HD

 

[18G]

Yeah another skill that's considered invasive. Just read that portion of the BLS protocal.

Sent from my Desire HD

Glucagon is an injection so yes, invasive. More importantly it has positive chronotropic and inotropic effects (ie increases heart rate and force of hearts contraction).

Patient's receiving glucagon should be on a cardiac monitor preferably.

 

[JPINFV]

The following is in regards to California's scope of practice for EMTs.

same as setting up a flush,spike the NS/LR/D5, administering SL nitro,and a 4 lead...

One of these things is not like the others. One of these things just doesn't belong.

Also, "Setting up for ALS procedures" is very much a part of the scope of practice for EMTs. CCR Title 22, Div. 9, Ch. 2, § 100063 (a)(12)

I heard they are thinking about adding BGL and Pulse Ox to the EMTb scope of pratice... bt 2014...

If you wanted to play amature lawyer, you could argue that, especially with the pulse ox, that they could fall under (a)(3) "Obtain diagnostic signs to include, but not be limited to." I believe this is how Orange County is justifying allowing EMTs to utilize pulse oximetry.

Additionally, there are optional scope of practice packages for the following:

• Perilarygeal airways
• Naloxone
• Epinephrine autoinjectors (not patient assist)
• Atropine and Pralidoxime Chloride

 

[emergancyjunkie]

Glucagon is an injection so yes, invasive. More importantly it has positive chronotropic and inotropic effects (ie increases heart rate and force of hearts contraction).

Patient's receiving glucagon should be on a cardiac monitor preferably.

Can't an emt-b prepare the glucagon for the paramedic. From what my instructor has showed the class it comes in such a matter that it has to be mixed

Sent from my Desire HD

 

[18G]

Can't an emt-b prepare the glucagon for the paramedic. From what my instructor has showed the class it comes in such a matter that it has to be mixed

Sent from my Desire HD

You are right. Glucagon has to be reconstituted (mixed) prior to giving since it comes in powder form. I would not allow an EMT to prepare the glucagon when they are not used to handling a syringe, needle, and withdrawing the med. It's far from a difficult task but most EMT's aren't aware of how to draw up the medication, handle sharps, prevent contamination, etc, etc.

Plus, Pennsylvania does not allow EMT's to draw up medication.

 

[Akulahawk]

Can't an emt-b prepare the glucagon for the paramedic. From what my instructor has showed the class it comes in such a matter that it has to be mixed

Sent from my Desire HD

If the EMT is setting up a line, pulling out and assembling a preload, or grabbing a vial and syringe... I'm OK with that. If the EMT is actually drawing or mixing/preparing meds, that I'm not OK with because it's my License on the line. In the case of glucagon, if I ask for it, I expect to be handed the whole package so that I can reconstitute it. Preloads and stuff like that, I'll look for it to be assembled correctly and check (more than once) that the Epi I asked for is exactly the Epi that I asked for and not a different med altogether.

 

[MedicJon88]

--

Also, "Setting up for ALS procedures" is very much a part of the scope of practice for EMTs. CCR Title 22, Div. 9, Ch. 2, § 100063 (a)(12)

Thanks, I know my scope of practice- I'm just saying that we wouldn't be able to do these things without paramedic resources- their box and Monitor. Its always with just "Assists"- We don't carry AEDs in our rigs- They are not Required for EMT level Ambulances- you can have them but its not required. Same with oral glucose, We don't carry those either... We're basically reduced to 1st responders- with ALS assist skills. LA County is A**backwards.

With regards to Local-Expanded Scope of Practice... At one time LA County EMS was progressive- then the Firefighters drop the collective competence of EMTs in LA... now everything is restricted or removed. Riverside, Kern, San Bernadino, even Orange County's scope is better than ours.

Regarding our neighbor OC County's Scope:

2-Pam and Atropine in Duodote or Mark I kit would only be use for organophosphate poisoning.

They added Pulse ox- good for them

Didn't see Narcan and PLA yet but:

Narcan- although very useful, should not be given to BLS providers- There is something to be said about maintaining a patent airway and provide rescue breathing- instead of waking up a junkie that will be very VERY VERY angry with you for ruining his narcotic stupor. Plus the patient should be on cardiac monitor after the administration of Narcan; Benzos would be good to have incase they start to seize...

LMA- or PLA in my opinion is the same thing as King LT... and just the same restricted to ALS only in LA county... god-its time to move.

Our County's justification for limiting our scope of practice is that- Hospitals or ALS resources are plentiful and transport times are short enough that EMTs don't need to implement these skills- Although Hospitals and ALS resources are certainly there- I just don't see the wisdom of dumbing down the provider- the decision of whether or not to do a full assessment and stablizing on scene or initiating trapid transport should be weighted inregards to transport time by the provider, oh wait that would require clinical judgement- but thats unnecessary in LA... I've seen enough times where the medics fail to intubate a patient x3 that had patent airways with OPAs...delaying transport- and they wonder why they want to remove intubation in LA County... too many bad apples in the bunch around here... well with the amount of Apples that are in LA that wants to be oranges but are force to be apples... its no wonder.... Some of them Government Oranges that are forced in Apple rigs can't even do CPR properly... and i'm not just talking about the recent update...

 

[CAOX3]

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.

 

[MedicJon88]

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.

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...

 

[HMartinho]

So, the bgl is considered an invasive procedure ... Are they afraid that the patient will bleed to death with just an little needle bite?

 

[MrBrown]

So when the medic starts the IV, take the catheter from him/her and use the bit of blood on it to get the glucose.

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)

Q: Is it acceptable to use blood on the end of the needle just used for IV cannula insertion for the purposes of measuring blood glucose?

A: No – it is not. It has come to our attention that this is common practice in some areas and it must stop.

Firstly, it is dangerous and increases the risk of needle stick injury.
Secondly, there is some evidence that glucose measurements from venous blood do not correlate well with glucose measurements from capillary blood (to which the glucose meters are calibrated) and false readings have been reported.