D50 Orally

As we don't charge by the Rx, I have trouble understanding why one would be fired for an action such as this. Oral glucose is definitely more appropriate, however, here we encouraged to think outside of the box and if someone can defend their treatment plan more power to them.(This is part of our training program where students have to give a capstone defence for one of their complexed calls in front of a panel of three docs and three mentor/preceptors)
Also our protocols are considered guidelines, we rarely call for medical direction and it is almost exclusively at the discretion of the medic.
 
bonedog said:
As we don't charge by the Rx, I have trouble understanding why one would be fired for an action such as this. Oral glucose is definitely more appropriate, however, here we encouraged to think outside of the box and if someone can defend their treatment plan more power to them.(This is part of our training program where students have to give a capstone defence for one of their complexed calls in front of a panel of three docs and three mentor/preceptors)
Also our protocols are considered guidelines, we rarely call for medical direction and it is almost exclusively at the discretion of the medic.
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The reason was simple, we did not have standing orders for p.o. D50w and why administer if the LOC has the ability of swallowing why administer it that way? They were at the scene in the patients house with protein/carbohydrate food; which is much better than rebounding glucose. Also, we carry oral glucose as well that was not administered. Short and simple, improper tx was administered.

Yes, we have the same philosophy but part of the critical thinking is to think about the whole picture. The same would be true in administration of Lasix, etc. Would you give it p.o. as well if you did not start an I.V.?


R/r 911
 
R/r911,if the patient was at risk for iatrogenic aspiration then termination would be the appropriate course of action. This couldnot be considered critical thinking.

If a patient was unconscious IV is the preferred course of administration to limit cerebral damage. I usually only use D50W in cardiac arrest as you get the same effects with D10W without the sclerosis.

Don't use lasix much anymore, CPAP and NTG. Sometimes for renal failure. Cann't say I have ever given it PO though.
 
I personally would not be in favor of giving D50 PO as there are better options for increasing BG level. In Maryland, we have the option of using Glucagon and also IO. If they are conscious enough to swallow I would not even be thinking to give the pt. D50 PO. Concentrated OJ and food along with oral glucose works quite well.

As far as the firing thing goes... I'm a very liberal person and would never fire anyone except as a last resort once all forms of discipline have been implemented. Discipline is not to punish but to serve as a corrective and remedial action. If a provider does something like give D50 PO and no harm was done... why fire them? Explain that its not acceptable practice at your agency and leave it at that.
 
Ridryder911 said:
Personally, I do not understand why one would want to administer medications inappropriately? Why give D50w orally when there is oral glucose for a 1/4 of the price or even having a protocol for allowing such? Why administer D50w rectally when one can administer Glucagon?

If your protocols are not sufficient, can you not make suggestions to your medical director on the inadequacies? Maybe new or revised protocols? Would we allow a continuation of non current medical therapy for cardiac care?

As a diabetic, I personally would not want to have to drink D50w when a slice of pizza would definitely be in my best interest and taste and personally would not like to have my rectal vault necrosing and rotting out.

R/r 911
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True, Rid. I have tasted D50. Cracked a joke to a doctor once while he had it in his hand. He skeeted it across the room and caught my mouth. Tasted like 100+ wedding cakes on one spoon on my tongue. D*mn, that is rrriiiccchhh!

And a "rotting rectal vault"?!? That would have to be a real pain in the arse.

Sorry. The shot was there. I had to take it. ^_^
 
I've given D50 IO (after multiple failed IV attempts, BSL 30 mg/dL). For my patient it was quite a difficult medication to push -- requires a lot of force even if you're trying to do it slowly. I was worried that I might extravasate considering how hard I was pushing.

It was pretty amazing though. I barely got 5 grams into the pre-load when the patient started turning around...wanting to yank the IO out.

Patient came into the ED several weeks later for another episode of hypoglycemia, and apparently was telling the medics (of another department), "Last time this happened the paramedics tried to kill me putting a needle in my bone!". She got out of the ambulance, saw my crew sitting around and promptly started screaming.
 
There was already a thread discussing rectal D50: Here

It is quite informative.
 
Everything is always situational, and no one can really accurately say...


In my experience, I dont know if it was a lack of creativity or what but I've never heard of D50 orally... interesting though. Thats one of those lil tid-bits you put in the back of your 'filing cabinet' for when you are on that once-in-a-lifetime call and NOTHING is goign correctly.... get what I'm saying???
 
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