D50

[Ridryder911]

That's what I presumed that it was a med injector. If that is the case, a couple of things, they should be reviewed and possibly reprimanded, and certification and license reviewed for possible removal. If this is the case, this person is an idiot and should be removed form EMS.

Using device not used as designed for use, second the med probably did not reach muscular area, rather into sub-q tissue.

R/r 911

 

[FFEMT1764]

Rid,
I think she will be caught once the report makes its way through our QA process, but that could take a week or two since we are paperless and it take 5-10 minutes just to open a call for review by the QA Lt. I hope that she gets busted, she is the laughing stock of the service and to think she just got her medic in the past 6 months!

 

[Guardian]

That's what I presumed that it was a med injector. If that is the case, a couple of things, they should be reviewed and possibly reprimanded, and certification and license reviewed for possible removal. If this is the case, this person is an idiot and should be removed form EMS.

Using device not used as designed for use, second the med probably did not reach muscular area, rather into sub-q tissue.

R/r 911

yep, no nice way around this, that person is an idiot.

 

[Guardian]

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.

Note to everyone...I'm trying to be nice and post within the rules, but when people post like this, it's hard.


First you say anyone who cannot sign a refusal cannot protect his/her airway enough for OG...that is just wrong and I feel sad there are people like this in ems. Then you say treat your pt, not the numbers...I agree but doesn't this contradict what you just wrote? I need a strong drink...

 

[Fedmedic]

First you say anyone who cannot sign a refusal cannot protect his/her airway enough for OG...that is just wrong

I think it is a matter of where you come from and what you were taught. I was taught not to put anything, including oral glucose, in the mouth of a patient that was less than A/O x 4. Why take the chance on airway compromise. There are too many ways to increase the blood glucose levels without having too take a chance. Even if you're a BLS provider, someone on here mentioned rectal oral glucose(now that's an oxymoron) anyway, I'm not above trying it, if that is all I can do. It makes perfectly good sense, medications cross the rectal membranes almost as fast as IV meds. No chance of aspiration then. Of course they may wake up a "sore azz."

 

[Stevo]

I suppose Glucagon helps these situations...

~S~

 

[Ridryder911]

I think it is a matter of where you come from and what you were taught. I was taught not to put anything, including oral glucose, in the mouth of a patient that was less than A/O x 4. Why take the chance on airway compromise. There are too many ways to increase the blood glucose levels without having too take a chance. Even if you're a BLS provider, someone on here mentioned rectal oral glucose(now that's an oxymoron) anyway, I'm not above trying it, if that is all I can do. It makes perfectly good sense, medications cross the rectal membranes almost as fast as IV meds. No chance of aspiration then. Of course they may wake up a "sore azz."

According to NHTSA/DOT Basic EMT curriculum the Basic EMT can administer oral glucose, if one monitors the airway for aspiration. ..." it is recommended to place a small amount on a tongue blade"... Not to be picky, but they have to be "total alert" to person, place, time and event?.. Then why the need to even treat them? They could eat a high carbohydrate and the need to ever give oral glucose would never be needed, unless one just didn't have food.

I'll give glucose gel rectal if that means to keep my patient from dying or preventing no cerebral damage, (just like Diastat rectal for seizures)... (also remember glucose is needed to transport oxygen through the cerebral cell wall) but; IV D50W is too toxic for such, (remember what it does to skin tissue?, although I have seen safe to administer to drink).

I do understand your perception and respect it, but to place a small amount on the mucosa and keep suction on hand and placing the patient in a lateral recumbent position, so aspiration would be near impossible, is safe. Yes, extremely cautious....but can be considered safe. I too do not like patients that aspirate, but as well do not like hypoglycemic patients with cerebral hypoxia......

R/r 911

 

[Stevo]

..." it is recommended to place a small amount on a tongue blade"...

poppycock, guffaw & boulderdash!

get a good dab of OG on your finger, then swipe it bettween the patients cheek and gum. spreading it out well will prevent aspiration, and speed absorbtion

~S~

 

[Fedmedic]

I understand what you're saying and I also respect your take on it and in theory it makes sense. But to me oral glucose is given when you have a patient who is hypoglycemic, but awake and alert, who needs glucose replacement. Oral glucose has 5 grams glucose per tube, that is quicker than fixing a high carb meal and easier. Enough to either get it up until ALS arrives or you feel comfortable leaving them to fix a meal for themselves.

This is taken directly from our protocols:

BLS
If patient can protect airway, administer oral glucose:

1. Squeeze small portions of glucose between cheek and gum.
DO NOT use large portions(airway hazard)

To me,"can protect airway" means awake and alert.

I mean, I have nasotracheally intubated patients that were extemely lethargic(borderline unresponsive) just to protect their airway.

I wouldn't think oral glucose would be necrotic to rectal membranes. I'm not talking about administering D50 via rectum.

And yeah, I have had patients standing on the side of the road after being involved in minor MVA's that were hypoglycemic, drinking D50 also. Because no other source of glucose was available and they didn't need an IV or transporting. Amazing at the things you will do to get a refusal...

I guess just different ways of thinking, experience and education. But then that is what makes EMS what it is. The diversity of the treatment options, as long as the outcome is favorable for the patient...everything is OK.

 

[Ridryder911]

poppycock, guffaw & boulderdash!

get a good dab of OG on your finger, then swipe it bettween the patients cheek and gum. spreading it out well will prevent aspiration, and speed absorbtion

~S~

I agree, I never have used the tongue blade method & actually prefer to "rub" into the mucosa slightly, and prefer s.l... but, I believe they are trying to keep people maintaining all 5 digits.... for legal purposes.

R/r 911

 

[Stevo]

sometimes we have to cross that protocall line to help people Ryder, i came into this trade very protocall oriented, yet as a mentor once said 'what works works' echoed by FedMedic here...

The diversity of the treatment options, as long as the outcome is favorable for the patient...everything is OK.

~S~

 

[jeepmedic]

Note to everyone...I'm trying to be nice and post within the rules, but when people post like this, it's hard.


First you say anyone who cannot sign a refusal cannot protect his/her airway enough for OG...that is just wrong and I feel sad there are people like this in ems. Then you say treat your pt, not the numbers...I agree but doesn't this contradict what you just wrote? I need a strong drink...

#1 I don't care about being Nice.


Now I wrote and still write that if a Pt is Hypoglycemic and not A&O x4 They will get D-50 instead of oral glucose. If a Hypoglycemic pt. has a altered LOC then They can not protect there airway and there is no one here that will change my mind. I have worked on the streets and inside of a prison with too many diabetics and treated them. I will not give Oral Glucose to a Pt. with an altered mental status. If you do, you are wrong and have had too many drinks.

Now if you feel sad there are people like me in EMS, you need to get another Hobby. And another drink. I have been trained by the best and I will stand by what I have been taught. I do what I feel is in the best intest of my Pt.

 

[trauma1534]

Note to everyone...I'm trying to be nice and post within the rules, but when people post like this, it's hard.


First you say anyone who cannot sign a refusal cannot protect his/her airway enough for OG...that is just wrong and I feel sad there are people like this in ems. Then you say treat your pt, not the numbers...I agree but doesn't this contradict what you just wrote? I need a strong drink...

Guardian, again, I respectfully ask you... how long have you been in EMS and what level of training are you? There is a reason I ask.

 

[Guardian]

Guardian, again, I respectfully ask you... how long have you been in EMS and what level of training are you? There is a reason I ask.

3 months, I'm a certified first responder. Now, why do you care what level of training I have and how long I have been in ems. Do you judge people based on their certification level? I judge people based on their ideas, not what a piece of paper says.

 

[trauma1534]

3 months, I'm a certified first responder. Now, why do you care what level of training I have and how long I have been in ems. Do you judge people based on their certification level? I judge people based on their ideas, not what a piece of paper says.

Well... it is just interesting to me that you are a first responder, a level in which I happen to know alot about seeing as how I am one of the instructors for a class going on right now. I think it is great that you are interested in EMS to the point that you are taking part in discussions of all training levels. I hope that you continue with your training and can run with the best of us.

Now, with that said, I find it unfair that we ridicule you for your positon on your ideas of treatment. First responder level is a very entry level certification. It is a 40 hour class. You only have one practicle at state boards here.

First Responders are only taught to recognize red flags so that they can know what to tell the incomming unit. They are not certified to transport or ride in the back with a patient even on a granny tote. They are taught very basic things such as there is only one dosage for oxygen, that is 15 lpm, NRB. They are not even certified to give instant glucose, or in most areas around here, even touch a glucose monitor. They are not required to back board a patient, as it is an OMD option here. They don't have to back board, because they can't transport. The curriculim is very vague, and in my opinion it is hard to teach, as there is so much vital core information that we must leave out at that level.

First responders are great, and I feel we really need them to help us load a patient, they are great for going streight to the scene and letting us know what we are comming into. They offer a great extra set of hands and back strength for lifting and moving patients.

This is a great place for you to learn your place in EMS. You see everything posted here. As I tell all the new rookie's who come into my agency and ride with me, this is the time to learn, listen, and watch. Not a good time to argue treatment higher certified providers give. You can't argue something if you don't know enough about it to support that arguement. As far as you giving D-50, don't worry about the drugs that you can't give right now. You have only been in the field for 3 months. Learn to perfect your skills at your level. It is good that you are interested and are hungry to learn all you can, but pretending to know when you don't, will get you in alot of trouble. If you don't know something, say you don't know. That is the very best way to learn. When you are afraid to admit when you don't understand something, that makes you very very very dangerous!!! That goes for and provider at any level.

As far as pay for EMS providers, no, it is not the highest paying job in the field, but I've been doing this for 12 years now. I do not qualify for food stamps, I make too much! I have not gone hungry, my kids still have clothes, my electricity is still on, and I have a roof over my head. Most of all, I find this career a nice rewarding field that I happen to enjoy. It has landed me a very good job. As a career provider, I started out at a very basic, non-emergency EMS transport agancy. We did granny totes, wheelchair vans, and innerfacility ALS and BLS transports. Once in a blue moon, we would have our code, or we would respond for rescue when they were tied up, but that is where I started my career at. I went from there to a very busy city agancy. We ran non-emergency transports with 80% 911 calls, along with innerfacilty transports. We worked 24 hour shifts and my truck alone would average between 15 and 20 calls per shift, if we didn't get sent out of town on a trip. I went from there to a laid back county agancy where I can get the ashes out of my pants leg where I was suffering from burn-out syndrome, and enjoy my job for what it is. I also, thanks to my years of experience in EMS and as an ALS provider, landed a job at one of Virginia's finest level one trauma centers this past year. So now I work for that agancy in the county part time, just because I like it and enjoy it, and it keeps my truck skills up, and I work full time at the trauma center. The pay is not that bad. It is very good actually. I don't starve!

So, Guardian, my advise to you my friend is stick with it if you are likeing it. IT can take you as far as you will allow it to. Don't get side tracked by wanting to pose as something you are not. Don't ever try to think you know all. I am seeing a paramedic right now who has that attitide that no one is going to be as good as him, and he is under investigation as we speak for a judgement call he made on something, trying to look big and act like he knew it all. So, just be carefull how you portray yourself, and stay humble. Learn all can can from good providers and be the best you can be. Don't try to be something you are not. Good luck with your EMS adventure! If we can ever help you with anything, since you are still new to EMS, feel free at anytime to ask. I am all about helping new providers!

 

[Guardian]

lol, I love this forum.

 

[Guardian]

Thomas Jefferson, third President of the United States and Governor of Virginia, preferred to be called Mr. Jefferson. He did not like being called President Jefferson or Governor Jefferson. Later, he founded the University of Virginia and all of the Professors at that University were to be addressed as Mr or Ms, never by a title such as Dr, Gen, etc. He believed ideas should be judged equally and that a person’s rank or title should not be considered when forming an opinion about their ideas. I think you could learn a thing or two from him.

What makes this so funny is the fact that I was accused of being anti-emt when in fact it is now clear who rushes to judge people based on a silly little piece of paper.

 

[trauma1534]

Thomas Jefferson, third President of the United States and Governor of Virginia, preferred to be called Mr. Jefferson. He did not like being called President Jefferson or Governor Jefferson. Later, he founded the University of Virginia and all of the Professors at that University were to be addressed as Mr or Ms, never by a title such as Dr, Gen, etc. He believed ideas should be judged equally and that a person’s rank or title should not be considered when forming an opinion about their ideas. I think you could learn a thing or two from him.

What makes this so funny is the fact that I was accused of being anti-emt when in fact it is now clear who rushes to judge people based on a silly little piece of paper.

Well, Guardian, no one is judging you. As I said in my post, I am very happy that you are with us in the forum. I am glad that you are interested enough in this field to hang out on here. But I will say this. I am not judging you... but I think 3 mo. experience, and a FR certification does not warrent your comments on some of these posts. You are trying to start posts on D50 and tell why we shouldn't use it, when you are not even certified to give it. Have not even been trained to start an IV. I am not against first responders or EMT's at any level. I am one of the instructors for a first responder class right now. I just know what you are taught as a first responder, and I understand that you are not in a position by education or experience to argue an EMT-B, or an ALS provider. You certainly are not in a position to have an educated opinion either way on drugs, intubations, even ALS laws and protocols. You can't even form an educated opinion on riding in a truck at what levels, and what you would do in the back of a truck on calls. You are not certified to ride in the back of the truck with a patient alone. If you do anything in the back of the truck other than observe, it is at the provider's descresion. So, just be careful when you try to attack other providers who have been in this business probably longer than you've been out of grade school. When you become certified to carry my bag, then we can argue anything, any subject. Until then, you should consider setting back, and trying to learn from the discussions, and the calls that you get to assist on.

 

[Guardian]

This is a forum to discuss issues. John Kerry doesn’t have to be a military General to argue military tactics with General Abizaid. I don’t have to be a paramedic to discuss ems issues with you.

 

[jeepmedic]

This is a forum to discuss issues. John Kerry doesn’t have to be a military General to argue military tactics with General Abizaid. I don’t have to be a paramedic to discuss ems issues with you.

John Kerry is a :censored: and a fake.