blood glucose levels...

[ksrrvfd]

Below 50 with s/s is how our protocols are written. But like it was said earlier post treat the patient not the numbers.

 

[Jochempeiper]

With the Western Virginia EMS, we can use Oral Glucose on a patient as long as they do NOT have a Altered LOC. I've saw some patients who have a Glucose of 56 and still be able to eat and drink(they were eating when we got there), his only complaint was being a little dizzy. After 1 tube of Glucose and a half of cup of pop he was back up to 76 and he refused care.

 

[snaketooth10k]

Our policy calls for oral glucose when a patient has an altered level of consciousness that is possibly due to hypoglycemia and the pt has no signs of stroke.

Our state guidelines say that oral glucose should not be administered unless the patient is still AOx3 due to the fact that oral glucose can create an airway problem in patients who are not in full control of their mouth/airway. This is ridiculous because it means our only alternative once they have an AMS is to put it in their eyes, and that is not allowed. We've not had a call like that where medics didn't show up in time, but it's been close.

 

[Topher38]

Nope. In PA, gulcometers are reserved for ALS.

Same for here in CT

 

[EMT007]

Our state guidelines say that oral glucose should not be administered unless the patient is still AOx3 due to the fact that oral glucose can create an airway problem in patients who are not in full control of their mouth/airway. This is ridiculous because it means our only alternative once they have an AMS is to put it in their eyes, and that is not allowed. We've not had a call like that where medics didn't show up in time, but it's been close.

hmm, yeah that is interesting. Another part of our policy is that they must be able to control their airway and swallow the medication, so if they are so altered that they can't take the medication, we have to call ALS out to administer D50. Otherwise, our medical director is very clear that only patients with an altered mental status should receive oral glucose.

 

[Shaggy]

Hello,

Here in Austria normal for a non-diabetic is 60 - 110 mg/dl and for a diabetic is 80 - 110 mg/dl.
But it is right, treat the patient, I saw a pt with 34 with no symptoms at all (in hospital) then there where several calls with 35 - 40 and the pt´s where unconscious.

By the way: Is D50 Glucose 50%? The highest we have here is 33% in an 100ml infusion.

Shaggy

 

[marineman]

D50 is 50% dextrose solution.

Glucometer's are a basic skill in my area. For those of you that don't have glucometers do you carry glucagon at the basic level? For us if the patient is alert and able to manage their own airway anything under 60 gets oral glucose. If a patient is not alert and/or can't manage their own airway and is sub 50 we as basics give glucagon after consulting med direction.

 

[Ridryder911]

D50W, is approximately (dependent upon the brand) 25gms of 50% Dextrose suspended in water solution.

R/r 911

 

[EMTWintz]

Omars.... are you intending this to be a BLS level discussion or ALS discussion?


Amen.

If the patient is CAOx4, trying OJ and food (if available) is probably in the patient's best intrest. Patients usually prefer food to glucose paste and the paramedic's IV's.

If the patient has a decreased LOC and is unable to swallow and maintain their airway, then oral glucose is contraindicated.

Being a BLS service, we don't carry or use glucometers.

Wow it is interesting to see that there is so much difference in the BLS squads. I think there needs to be some sort of standard level of practice.

 

[mikie]

Wow it is interesting to see that there is so much difference in the BLS squads. I think there needs to be some sort of standard level of practice.

Ha! If only everyone could come to an agreement, that would be great...but this is EMS! What do you expect?!

 

[Airwaygoddess]

No truer words were ever spoken............ ^^^^^^^^^*

 

[EMTWintz]

At least here in Small town IL. We are able to use our own judgement as to whether a pt needs oral glucose. We use the meter most everytime there is a DM pt. or pt that is presenting with DM type s/s. Usually when ALS arrives they want to know that number along with all the other usual stats. As for the 12 lead vs. standard AED, really what is the use? Yes a 12 lead is going to show more, but what BLS squad has someone knowledgable enough to interpret? I am also a Mobile Medical Examiner and part of my job is hitching up 12leads, half of the members on my squad have no clue how to do them. The standard 3 patch AED is sometimes hard enough on them.

 

[Jeremy89]

..... The standard 3 patch AED is sometimes hard enough on them.

wait, 3 patch? Which kind do you use?

 

[EMTWintz]

wait, 3 patch? Which kind do you use?

Sorry not patch, 3 lead. I can't remember which kind it is, but its one of those dummy proof kind. You know turn this way to monitor, turn that way if your gona need to shock.

 

[Jeremy89]

Sorry not patch, 3 lead. I can't remember which kind it is, but its one of those dummy proof kind. You know turn this way to monitor, turn that way if your gona need to shock.

So it's a 3 lead capable of shocking? Usually AED's, (and monitors such as the LifePak 12) have the 2 patches used for shocking/analyzing.

 

[EMTWintz]

So it's a 3 lead capable of shocking? Usually AED's, (and monitors such as the LifePak 12) have the 2 patches used for shocking/analyzing.

This one has the 3leads (white, black n red) to monitor, now if you have a feeling or know your gona have to shock then you take out and hitch up the 2 larger pads and turn dial to shock and analyze mode.

 

[Jeremy89]

This one has the 3leads (white, black n red) to monitor, now if you have a feeling or know your gona have to shock then you take out and hitch up the 2 larger pads and turn dial to shock and analyze mode.

Ah, gotcha.

 

[JPINFV]

This one has the 3leads (white, black n red) to monitor, now if you have a feeling or know your gona have to shock then you take out and hitch up the 2 larger pads and turn dial to shock and analyze mode.

Of course, the million dollar question is if you're able to monitor (educated, trained, and equipt), why do you need an AED to defibrillate?

 

[Jon]

Of course, the million dollar question is if you're able to monitor (educated, trained, and equipt), why do you need an AED to defibrillate?

EMTWintz - I'm confused. You seem to be telling us some parts of the story, assuming we know how your local system operates... can you clarify some questions?

Are you with a BLS squad in a BLS/ALS tiered response system, or something else?

You keep saying AED. Are you really talking about an AED, or a cardiac monitor/defibrillator?

Is the monitor/defibrillator on the BLS rig or the ALS rig?

If it is on the BLS rig, are you trained to use it as a monitor? When do you attach it, before or after ALS arrivial? Do your state protocols allow you to do this?

 

[EMTWintz]

EMTWintz - I'm confused. You seem to be telling us some parts of the story, assuming we know how your local system operates... can you clarify some questions?

Are you with a BLS squad in a BLS/ALS tiered response system, or something else?

You keep saying AED. Are you really talking about an AED, or a cardiac monitor/defibrillator?

Is the monitor/defibrillator on the BLS rig or the ALS rig?

If it is on the BLS rig, are you trained to use it as a monitor? When do you attach it, before or after ALS arrivial? Do your state protocols allow you to do this?

ok will try to clarify. When we get paged LCPA (paramedics) get paged also. They come from 7 miles away. If its a call for "chest pain" we hitch them up to I guess you would say monitor/defib. Most are trained to identify common irregularities (throwing PVC's and the like) When LCPA arrives we of course hand over the strip. They will then load pt to transport and hitch them up to their onboard 12 lead monitor