D50

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Guardian

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I just want to bring up an issue I've been seeing a lot lately. In paramedic class, I learned D50 can cause tissue necrosis (death) if the IV is infiltrated (which you can't always see). I also learned that whenever you give a med (or whatever else for that matter), you always assess the risks verses the benefits of giving that med. They never went into any more detail but common sense told me to never give D50 unless you have no other choice. Why then am I seeing ALS providers giving D50 to hypoglycemic pts who are awake. I ran a decreased BGL call last week where the glucometer read 20 and the pt was awake, not quite oriented, slurring speech, slightly lethargic, all the normal stuff. I was riding double ALS and my paramedic partner wanted to give D50. I wanted to give a little oral glucose and have the pt eat breakfast. Apparently my partner didn't like that because that might take 10-20 mins instead of 20 seconds with the D50. Here is my question to ems educators--why don't these paramedics know any better? Could I be wrong? Is there some reason why we should give D50 to people who are awake and not in immediate danger?
 
I like D50, it is quick and to the point. As long as you check your line before you give it, in the middle of giving it and after you give it, by pulling back for blood. There are risks associated with alot of things we do in the EMS field.
 
you can't always tell by looking or drawing blood back and who does that anyway.
 
If they were still concious with a sugar of 20, I would have given D50 as well but only maybe half an amp. Give just enough to get them oriented and then make sure they eat. No sense in jacking their sugar sky high when a half dose will suffice and get them to the point where they can eat some complex carbs which is what they truly need.

But I have no hesitation using oral glucose when indicated.

As for drawing back on the line during D50 administration, who has ever done that??!!

Its hard enough to push it yet you are going to draw back 3 times??

After you start pushing it, you wouldnt see blood anyways, you would be aspirating the D50 back.
 
akflightmedic said:
If they were still concious with a sugar of 20, I would have given D50 as well but only maybe half an amp. Give just enough to get them oriented and then make sure they eat. No sense in jacking their sugar sky high when a half dose will suffice and get them to the point where they can eat some complex carbs which is what they truly need.

But I have no hesitation using oral glucose when indicated.

As for drawing back on the line during D50 administration, who has ever done that??!!

Its hard enough to push it yet you are going to draw back 3 times??

After you start pushing it, you wouldnt see blood anyways, you would be aspirating the D50 back.
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I do the pull back, not always 3 times, but I do pull back on the line. Sorry, think what you want about it, but that is how I was taught from the book and in the field. Everyone I've worked with who gave it did the pull back on the line to check.
 
akflightmedic said:
As for drawing back on the line during D50 administration, who has ever done that??!!

Its hard enough to push it yet you are going to draw back 3 times??

After you start pushing it, you wouldnt see blood anyways, you would be aspirating the D50 back.
Click to expand...

I do it everytime I give D50(blood aspiration before, middle and end) and have been doing in that way since I started giving D50. All you do is pinch the line off, if you have a patent IV you will draw back blood very easily. All you do is draw back enough to see it come back in the syringe, then start administering again. It is a good habit to get into and to document accordingly, in case something does come up down the road. And that goes back to the EXPERIENCE vs. EDUCATION thing. That is not something your taught in class, just something I picked up over the years.
 
I always give D50 if to patient who are hypoglycemic IF I think for half a second that they might not be able to maintain their airway. If they can maintain, then I give the oral glucose time to work, and then I also use OJ with 2-3 tablespoons of sugar in it too. If they are conscious then I will spend 30-45 minutes on scene with them. If they are out then the D50 comes out too.
 
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Guardian said:
you can't always tell by looking or drawing blood back and who does that anyway.
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This is the way I was taught to give D-50. D-50 is a very dangrous drug to the tissue if not given right. I was taught by an old medic and procepted by more old Medics. Why would you not aspirate for blood on a given drug that is caustic to the tissue. To me this is common sense. It is just like starting an IV and not checking for aspiration. DUH:wacko:
 
Now if a Pt. with a BGL of 20 can not sign a refusal then he can not protect his airway good enough to receive oral glucose so yes D-50 would be indicated. I have seen diabetics with blood glucose levels of 100 that were unresponsive. You treat your pt. not your numbers on your equipment.
 
I was never taught to aspirate D50, and have never seen it done in the field. I have, however, aspirated the line with NS to check for blood return prior to drug administration. I also wont give D50 in anything smaller than an 18 gauge catheter and I prefer to use AC veins to aminister it unless the are a younger diabetic and the hand viens are well developed. I have seen someone who didnt check the patency of their IV before D50 and saw the necrosis begin to occur in a very, very short time. NOT A PRETTY SIGHT!:angry:
 
jeepmedic said:
Now if a Pt. with a BGL of 20 can not sign a refusal then he can not protect his airway good enough to receive oral glucose so yes D-50 would be indicated. I have seen diabetics with blood glucose levels of 100 that were unresponsive. You treat your pt. not your numbers on your equipment.
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You dang skippy!
 
jeepmedic said:
I have seen diabetics with blood glucose levels of 100 that were unresponsive. You treat your pt. not your numbers on your equipment.
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Makes me wonder when the glucometer was last calibrated, but I have seen people at 100 altered because their normal ranger is 160-240...thats why its always important to check your equipment daily!
 
I have given D50 to patients that were awake and had a low blood sugar(usually less than 40) just because we could clear the scene in 15 minutes as opposed to an hour. When you have calls holding because all of your ambulances are tied up, then you have to get 10-8 as soon as possible. I don't see a problem with it as long as YOU KNOW YOUR IV IS PATENT, you won't have any problems. D50 is a safe drug. Its all about the provider being competent.
 
Fedmedic said:
I Its all about the provider being competent.
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That is the truth...and we have a few here who are unfortunately not very competent. Example, someone gave Ativan IM with a BLUNT cannula. This was done without consulting med control, and the only Ativan we have on orders is IV for adult SZ...and this person is bragging about giving it IM with the blunt cannula. As in a plastic blunt cannula at that!!!!<_<
 
Yeah, and this medic thinks she is the stuff too, until the stuff hits the fans then from what I hear she hides in the corner of the box and starts spazing outB)
 
Bet she is in the front looking back asking if you are ready to transport yet. We have one like that at the Fire Dept. He is all talk until you have a bad call then he is in the drivers seat ready to drive. (He can't do that eather)
 
What the heck is a "blunt cannula"?

R/r 911
 
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