blood glucose levels...

[BossyCow]

We carry both an AED and a Monitor. The AED is carried on the rescue rig and the ff are all trained in its use. It was a grant/gift and is used at big events in the district and on fire scenes.

 

[thatrescueguy]

We don't use a blood glucose reading to determine when to administer Glutose - its based on pt. behavior/ AMS.

 

[TNemt975]

Our protocols are as follows: Pt aaox3 and patent airway w/ BS <70 administor oral glucose. If pt is AMS <70, initiate IV and 1 amp D50. This is standing orders for everyone EMT or Medic. Of course in TN IVs and D50 are not medic skills.

 

[wxduff]

not anymore, it is becoming BLS, my agency just got approval to use them for BLS, we of course had to put every member through an "in service" training of it and submit the proper paperwork to the state but we should have them in the rig for BLS use by the end of this month.

Same here. Once all the EMT's pass a test were putting one on our rig.

 

[mbcwgrl]

I agree to treat the pt not the numbers! If you have an unconscious pt you should do a bsl anyways. If its lower than say 80 or so... (really lower than 90) then push some D-50... Wont hurt and it could be the cause for the unresponsiveness... :wacko:

 

[sethking]

in california protocol is:

<or=65 bgl with symptoms
<or=55 bgl without symptoms

 

[JPINFV]

in california protocol is:

<or=65 bgl with symptoms
<or=55 bgl without symptoms

There is no state wide treatment protocol in California. Orange County and Los Angeles County has it listed at 60 mg/dL if the patient has an ALOC whereas Riverside's protocol is set at 80 mg/dL

 

[EMTinNEPA]

Nope. In PA, gulcometers are reserved for ALS.

According to the rumor mill, there is talk of making glucomters a BLS skill here in PA. Which, imo, it should be already. Admittedly, I do run on a MICU, but dextrose sticks are easy-peasy.

 

[Mercy4Angels]

how low should someone's blood glucose level be before you adminster glucose?

depends on the patient. a good rule of thumb is if you think they need it give it. worst that will happen is a nice sugar rush. as BLS you wont know the number cause you cant take the glucose level unless the patient does it him or herself. 80-120 is fine but look at your patient everyones different.

 

[stephenrb81]

According to the rumor mill, there is talk of making glucomters a BLS skill here in PA. Which, imo, it should be already. Admittedly, I do run on a MICU, but dextrose sticks are easy-peasy.

Basics are allowed to use glucometers here in MO. But rumor is BLS will lose it once the rehash of the scope of practice takes place

 

[FLAEMT22]

It depends on the patient's presentation and symptoms. Some patients that are Type I IDDM can withstand low blood sugar levels, and don't experience drastic symptoms, while others do. Anything under 70 we treat, the level of treatment can be ALS or BLS (i.e., D50 IV vs. Oral Glucose) depending on how low the sugar is. I've seen people CAO x 3 w/ a BS of 30, and others CAO x 1 with a sugar of 65.

 

[PapaBear434]

I thought I'd chime in and say this: We just had a guy last night with a glucose level of 14. No, he wasn't exactly conscious.

 

[FLAEMT22]

I had a young guy last night with a BGL of 25 and he was totally out of it, blank stare, diaphoretic, and pale. Had to give him 2 doses of D50 before we got his sugar up. Has anyone used glucagon. Have you found patients respond to differently to that?

 

[Ridryder911]

I question any glucose reading < 30-40 on FSBS. Since most glucometers are not even made to read so low of reading as well unless it is from a qualified lab I doubt the credibility. Again, treatment of the clinical symptoms and of course within reason of glcuose reading.

 

[FF-EMT Diver]

Flaemt, We use Glucagon if we are not able to obtain an I.V. for D50,

Then glucagon is given IM but usually takes 15-20 to take effect where D50 is almost instant,

While I'm posting this let me ask some of the more experienced ones here I've heard that if you are unable to obtain an IV for whatever reason and you have GOT to have one for whatever reason that you can hit a Pt. with Glucagon and their veins will (stand up) for about 30 sec. any truth to this?

 

[Ridryder911]

While I'm posting this let me ask some of the more experienced ones here I've heard that if you are unable to obtain an IV for whatever reason and you have GOT to have one for whatever reason that you can hit a Pt. with Glucagon and their veins will (stand up) for about 30 sec. any truth to this?

Don't know what you mean "hit" as it is administered IM or IV. If you administer it to get a "vein up" then you will have to account it for the glucose to raise. There is an old trick of using NTG spray and "raising" a vein, the problem is it might lower the BP and if it the patient is not having chest pain, you administered for the wrong reason.

R/r 911

 

[FF-EMT Diver]

Thanks r/r, I was saying "hit" meaning administer so have you heard of this working? I know you would have to account for BG raise.

Not saying to try just asking ever since I've heard that I've never really known whether to call BC or believe it, thought I would ask.

 

[Ridryder911]

I guess in theory it would. It is also a smooth muscle relaxer as well. For example one of the common use is for foreign body or large food in the esophagus.

R/r 911

 

[ryanbg]

I remember last year we had a lady who had 3 kids, and an 11 year old "baby sitter" who appeared to be trying to locate her baby on the bottom of a kiddie pool, with her baby in her arms. My buddy thought she was intoxicated, but after she was close to going UC, we figured it out in a minute. She didn't have a med alert or anything, and she was too out of it to drink or eat anything. After the medics came, they said her blood sugar was 20, and by that time we had her on a spine board which we used to backboard her out. She barely responded to a sternum rub. We don't have glucose which is stupid with all the diabetics we get that come in and have diabetic emergencies. I think they gave her an IV and she came to and we released her. Her young children who were screaming and crying was another story, including her "baby sitter". Good times.

 

[daedalus]

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.

I never got this. If a patient is eating and trying "food and juice" why the helll was EMS even called? An AOx4 patient does not call 911 and say "Hey, I am perfectly fine right now but I feel like I should eat some food to keep my blood sugar up, can you send the ambulance so they can respond and watch me eat and decide not to intervene with their equipment, and than after I eat they can leave"

Makes not a drop of sense to me. Not a single drop.

Now, if they are altered, than someone is going to call 911. Food wont be an option.