D50 io

[EMT B]

73 yo F unresponsive with BGL of 10. Hx of diabetes. You are running at the AEMT level no medic responded to your request. Can't get a line on the pt. vitals pulse 220 BP 90/60.
I was told in this situation that you would not give them D50, but instead a bolus of D5W or glucagon IM. What is the reasoning behind this? Is there something wrong with giving d50 via IO

 

[TransportJockey]

D50 is completely cleared for use in an IO. I might dilute it to D25 just to make it easier to push though

I did it several times as an intermediate, as well as PR oral glucose.

 

[Jambi]

Yup. IO is good to go for D50.

 

[Akulahawk]

If your protocols allow you to establish an IO and you're allowed to push D50, you should know if your protocols allow you to push D50 through the IO. Personally, I'd much rather dilute the D50 so that it's easier to use or push it slowly through a wide-open line. In an emergent situation, the IO is basically an uncollapsible IV line. Of the drugs normally carried on an ambulance, I can't think of one that I wouldn't give through an IO. Now there might be reasons to attempt an IV and not an IO, but that's a whole different thought process from what drugs I can push through a functional IO line.

 

[rwik123]

We don't have IOs yet. Glucagon it would be unfortunately.

 

[Aidey]

I would give glucagon IM and call for orders for a second dose before I give someone D50 (or any variation of it) IO. Yes, you can do it, but that doesn't mean it is the best option.

 

[NomadicMedic]

I probably want to have an IO anyway. Sure, her blood sugar may be 10, but her heart rate is 220 and she's borderline hypotensive. What else is going on there?

 

[Aidey]

He's an AEMT, aside from a fluid bonus there is nothing he can do. Plus $5 says that HR is what the pulse ox said.

If I anticipate the pt needing treatment in addition to dextrose, IO may be justified. I'm not convinced it is justified simply for dextrose administration. At the AEMT level I would be calling for a paramedic before I IO. Everywhere I've worked has disallowed EJs by AEMTs, but allowed them for medics.

 

[NomadicMedic]

Agreed. I don't think I would drill a simple diabetic wake up. Glucagon is so much easier.

 

[xrsm002]

He's an AEMT, aside from a fluid bonus there is nothing he can do. Plus $5 says that HR is what the pulse ox said.

If I anticipate the pt needing treatment in addition to dextrose, IO may be justified. I'm not convinced it is justified simply for dextrose administration. At the AEMT level I would be calling for a paramedic before I IO. Everywhere I've worked has disallowed EJs by AEMTs, but allowed them for medics.

Not true I'm an intermediate/85 and our medical director where I am allows is to push D50, thiamine, Benadryl, Narcan and epi 1:1, and give glucagon IM along with starting IOs.

 

[xrsm002]

We can also start EJs

 

[VFlutter]

Not true I'm an intermediate/85 and our medical director where I am allows is to push D50, thiamine, Benadryl, Narcan and epi 1:1, and give glucagon IM along with starting IOs.

How is any of that, aside from the D50/Glucagon, going to help in this situation?

 

[TheLocalMedic]

How is any of that, aside from the D50/Glucagon, going to help in this situation?

Because why treat the problem when you can treat EVERYTHING? Lol. I routinely give one of everything that I carry in our drug bag just because I can. :glare:

 

[Carlos Danger]

Because why treat the problem when you can treat EVERYTHING? Lol. I routinely give one of everything that I carry in our drug bag just because I can. :glare:

How is any of that, aside from the D50/Glucagon, going to help in this situation?

Actually, I think he just listed those things to relate his scope in response to someone else's comment about his level of certification.

 

[xrsm002]

How is any of that, aside from the D50/Glucagon, going to help in this situation?

I was replying to Aidey's quote of saying all AEMTs can do is start an IV. Texas still calls new NR AEMTs certs Intermediates. Basically I was saying intermediates/AEMTs in Texas can do more than just fluid bolus.

 

[Aidey]

I probably want to have an IO anyway. Sure, her blood sugar may be 10, but her heart rate is 220 and she's borderline hypotensive. What else is going on there?

Not true I'm an intermediate/85 and our medical director where I am allows is to push D50, thiamine, Benadryl, Narcan and epi 1:1, and give glucagon IM along with starting IOs.

And what, exactly, is any of that going to do for the aforementioned patient besides fix her blood sugar?

I'm not knocking AEMTs, but there is nothing you can do for this patient besides fixing her sugar and fluids.

 

[xrsm002]

I wasn't talking about the patient in these comments.

 

[Rialaigh]

I'm pretty sure Im drilling if the first IV attempt is shot, Fixing the blood sugar may correct some of the HR, depending on what you can do for an airway as an AEMT as well may change the decision. if the patients sugar is that low and has been for some time, I'm betting they are breathing about 6 times a minute, I want them awake now, not in 10 minutes...

This patient is a code waiting to happen (and very shortly at that). Drill, push, no one will fault you for that.

you will get faulted for hitting them with glucagon IM and watching them code when it doesn't work fast enough...

 

[Handsome Robb]

I was replying to Aidey's quote of saying all AEMTs can do is start an IV. Texas still calls new NR AEMTs certs Intermediates. Basically I was saying intermediates/AEMTs in Texas can do more than just fluid bolus.

Same with our I's.

Besides fluid for the HR and BP and glucagon IM or IO dextrose there's not much you have to fix this problem. What of you fix the mentation and BGL and she's still in unstable SVT that isn't responding to fluids? What now?

In this patient I'd drill them. There's something else going on here. Hypoglycemia doesn't generally cause supraventricular tachycardia although one could argue diabetics are predisposed to arryhthmias.