Did you read the OP? Sugar was checked, but it was unanimously agreed upon (after the fact) that the reading was false for whatever reason. It should definitely have been re-checked, but I wasn't running the show.
Called for 40ish/M Unresponsive...
- Thread starter NBfire841
- Start date
Did you read the OP? Sugar was checked, but it was unanimously agreed upon (after the fact) that the reading was false for whatever reason. It should definitely have been re-checked, but I wasn't running the show.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
It was checked.. "CBG = 413"
With any abnormal results one should always double check though..... Blood pressure, FSBS, etc...
R/r 911
Last edited by a moderator:
Indeed. It is almost humorous that the medic was so lazy he wouldn't even have me check it again. Almost.
traumamama
Forum Crew Member
- 56
- 0
- 0
Not the pt's blood sugar. The medic's blood sugar:excl: That would have been his only good excuse for not doing what he was supposed to do. Someone should have checked it. If it was ok then he should have had a full lobotomy!
ooooooh lol. Yes, yes. He is quite an altered individual.
Tiberius
Forum Crew Member
- 60
- 0
- 0
Exactly! I've seen some shoddy pt. care, but that is interesting.
As bad as it was to run with someone that holds a paramedic certification, as opposed to a running with a PARAMEDIC-if you get my drift, this can be a good learning experience. You'll learn from the card-holders what NOT to do, as well as acquiring some valuable knowledge with some good medics.
hmm, I see your point. I try to learn something on every call, even IFTs. I definitely learned from this call.
Normally I try to just lurk 'round here, but IMHO, that was a pretty harsh statement that EMTs should not take blood glucose measurements. Our protocols allow them to not only obtain the measurement, but treat with Glutose (PO) or Glucogen (IM), depending on the patient's presentation. ALS or MICU intervention is highly recommended when possible, but can be delayed out here in the "sticks" with nothing but cotton fields for as far as you can see. Prior to any treatment though, any low reading must be confirmed with a second sample at a different site (another finger, whatever).
Please be aware that there are several brands of glucometers that are specifically labeled for use with capillary or venous blood. The Accu-Chek Inform System comes to mind in the hospital setting, and the city 9-1-1 EMS system I work for also uses a glucometer specifically intended for both blood types (and includes umbilical and arterial blood, but I'm hoping not to play with either
)Now, you are correct that the manual and strip bottle should be checked first before assuming that glucometer is set up for multiple blood sources. My personal glucometer (yeah, I'm a diabetic) takes only five or so seconds to give me a reading, and it is labeled only for capillary blood. The glucometer on my ambulance takes forever to provide a reading, costs a heck of a lot more, and since this is hospital-based EMS service, obtained through the hospital inventory. It's quality and functionality is very different to my own cheapo pocket meter.
While there are differences in the glucose readings of venous and capillary blood samples, it is in the order of about 10%, from my understanding with the lab folks. If using a capillary blood only meter, the venous sample is going to probably read on that order higher.
Even with that difference in mind...
Let's say your protocols indicate that you should treat for hypoglycemia if the patient is symptomatic and the blood glucose measurement is 70 mg/dL or below (keeping this simple, I'm going to disregard patients taking beta-blockers, etc.). If you obtain a capillary sample that reads 60 mg/dL, you would probably treat with dextrose (oral), D50W, or glucagen (IM)... whatever is most appropriate if the patient was symptomatic, correct?
Now, if the same patient's blood sample is obtained through the venous blood, your BGL reading could instead show as 66 mg/dL. You'll probably still treat if the patient was symptomatic, correct? It all falls under 70 mg/dL, so your butt is covered in the protocols. Right??? Ummm.
If you are looking for that magic line of 70 mg/dL to determine if you will treat your symptomatic patient, then you are treating your monitor, not your patient. For example, my own afternoon BGL is normally 150 mg/dL. If I drop to 80 mg/dL, my glucose is low for me, and I am going to present as someone symptomatic for hypoglycemia even though it's above the protocol's magic line. Drop it any lower, then I'm a hellava fighter at 60 mg/dL. Should you wait that long, even when you can clearly see my DM necklace and multiple brown dots on my fingertips? In that case, good luck holding me down for a line, and it'll be quite a ride until the IM shot of Glucagen finally works.
The first thing I ask any diabetic patient who is conscious (and may be symptomatic) is what their average or normal BGL should be... what is expected for them. I continue my assessment and decisions with that in mind.Just my humble opinion and experience.
Last edited by a moderator:
Hossifelter
Forum Ride Along
- 1
- 0
- 0
I must say this is one of the easiest and smartest things I've heard in a long time. I'll have to remember this one. You are correct. Good friend of mine was near-comatose @ 90. He normally ran, he found out after this, in the mid-upper 200's, though. Prime example of pt. over machine treatment. Again, very good way to find a baseline normal. I do this with all my hypertensive pt's. Easy way to find out if it's something to worry about or just keep in mind.