Does your BLS protocal incl. glucose monitor finger-stick?

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Freddy_NYC

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Does your BLS protocal include glucose monitoring finger-stick? New York City doesn't have one. I'm trying to understand why? If your BLS protocols include glucose finger-sticks do you find it to be necessary and accurate?
 
Yes we have it, and yes it's necessary. Accuracy depends on how you maintain it and how often you calibrate it. The methods we use in the field are obviously less accurate and quite limited in comparison to the lab tests done at the hospital but for our uses as long as you keep on top of it, it's accurate enough. Do you have oral glucose and/or glucagon in your BLS protocols? Why would you carry a medication without being able to test to see if it's indicated or not? Above and beyond administering those two meds the BGL can be useful in determining or ruling out other problems. A BGL is another vital sign required on every report that we write.
 
We carry a glucometer on my ambulance. It is nice to have, and is one more thing we can do prior to ALS arrival if it is that kind of call.

Is it necessary? No.

Is it accurate? Only as accurate as the meters you get at WalMart, though I'm not sure how good or bad that is.
 
Yes we have it. Yes it is necessary.
As a BLS provider I carry oral glucose and glucagon.
I also have two years of college education in order to practice.
I do not advocate increasing scope without the requisite education.
 
WolfmanHarris said:
Yes we have it. Yes it is necessary.
As a BLS provider I carry oral glucose and glucagon.
I also have two years of college education in order to practice.
I do not advocate increasing scope without the requisite education.
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I'm assuming you're not from the U.S. with a 2 year education to be a BLS provider?
 
In Texas, yes.


It's one of those gray areas. Yes, it's "invasive", but the TexDSHS basically whistles and walks away when asked if basics can do it.

So as such, basics do BGL readings in Texas.
 
WolfmanHarris said:
Yes we have it. Yes it is necessary.
As a BLS provider I carry oral glucose and glucagon.
I also have two years of college education in order to practice.
I do not advocate increasing scope without the requisite education.
Click to expand...

I think some disagree that it's necessary as they are not always accurate and too many providers will rely on the magic 80-120 numbers. In some areas giving oral glucose depends on th EMT's ability to assess for and recognize the signs and symptoms of hypoglycemia without depending on a finger stick.
 
Sasha said:
I think some disagree that it's necessary as they are not always accurate and too many providers will rely on the magic 80-120 numbers. In some areas giving oral glucose depends on th EMT's ability to assess for and recognize the signs and symptoms of hypoglycemia without depending on a finger stick.
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It's necessary for glucagon as well a building a good differential. Any decreased LOA/LOC gets glucometry with me.

How much does proper maintenance correct for inaccuracy? We do a high/lo test on the glucometers to calibrate them twice a week. I wasn't aware of issues with accuracy.
 
Sasha said:
In some areas giving oral glucose depends on th EMT's ability to assess for and recognize the signs and symptoms of hypoglycemia without depending on a finger stick.
Click to expand...

Which is why the two years of education can be a good argument for extending the scope. There is knowledge to go along with the "skill".

One could also compare this to the OPALS study of ALS vs BLS. Americans who took this argument to be a support of EMT-Bs didn't realize that "BLS" where this study was done meant 1- 2 years of education and not 120 hours.
 
I am all for expanding skill sets and allowing more when proper training follows but BLS using glucometers is something I have always viewed as non-essential and a skill that will not alter the treatment plan of your patient.

As an EMT, what are you really gonna be able to do any differently having a numerical value of the patient's BG level? With a good assessment of the patient and their medical history and current meds, along with talking to family, 9 out of 10 times you can be sure a patient is having a hypoglycemic emergency without the glucometer.

I know in my many years as a BLS provider on a BLS ambulance coming out of a fire station and ALS coming from the hospital as chase, a glucometer would not have affected my care of the many diabetic patients I cared for.
 
Handy but not nessisary.

Glucojel can be given based on "known diabetic with ALOC". MOST of the time you can tell by the S+S and the way they present.
 
I think it can be helpful when determining care plans in pts that are maybe not fully symptomatic, or have an atypical presentation (ie the pt with a CC of hand weakness with no hx and a sugar of 54). It can also be very helpful in areas with BLS first response. I love it when I get on scene of the ALOC pt, or probably intoxicated pt, or postictal pt and the crew has already done a blood sugar. It allows me to formulate my differential diagnosis more efficently, and eliminate a possible potential issue.
 
Most medics will always repeat their own glucose check prior to ne treatment ne way.
 
Aidey said:
I think it can be helpful when determining care plans in pts that are maybe not fully symptomatic, or have an atypical presentation (ie the pt with a CC of hand weakness with no hx and a sugar of 54). It can also be very helpful in areas with BLS first response. I love it when I get on scene of the ALOC pt, or probably intoxicated pt, or postictal pt and the crew has already done a blood sugar. It allows me to formulate my differential diagnosis more efficently, and eliminate a possible potential issue.
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But you also have to remember that the glucometer may not always be correct and that patients may have different norms that don't fit into the 80-120 number and to not let the numerical number side track you.
 
Yes. NM has a more broad scope than some other states for their basics, so we do have a few invasive skills (IM/SQ, MLA, LMA)
 
Not allowed to do it where I'm at, although I think that's a load of toss. I don't think a finger :censored::censored::censored::censored::censored: should be considered "invasive", it's certainly less invasive than cramming an NPA in someone's nose! "Wake up sleepy!"

As far as giving oral glucose is concerned, as long as the pt can swallow I don't think giving it will hurt much, even if the pt is hyperglycemic as opposed to hypo. The amount that a tube of oral glucose will raise a BG level isn't really a whole lot in the scheme of things so a person with a BG of 400 or up really won't be hurting because of it. Besides, hyperglycemic emergencies tend to have a longer onset, whereas hypo is acute so getting a good history if possible is key, and getting some sugar into someone who you suspect may be running low can make a big difference in a hurry. If a tube doesn't change their status then don't give 'em any more and quit standing around, bring their bum in.
 
MendoEMT said:
Not allowed to do it where I'm at, although I think that's a load of toss. I don't think a finger :censored::censored::censored::censored::censored: should be considered "invasive", it's certainly less invasive than cramming an NPA in someone's nose! "Wake up sleepy!"

As far as giving oral glucose is concerned, as long as the pt can swallow I don't think giving it will hurt much, even if the pt is hyperglycemic as opposed to hypo. The amount that a tube of oral glucose will raise a BG level isn't really a whole lot in the scheme of things so a person with a BG of 400 or up really won't be hurting because of it. Besides, hyperglycemic emergencies tend to have a longer onset, whereas hypo is acute so getting a good history if possible is key, and getting some sugar into someone who you suspect may be running low can make a big difference in a hurry. If a tube doesn't change their status then don't give 'em any more and quit standing around, bring their bum in.
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All that depends on the patients weight, body structure, metabolism and other things. I would not trust any basic giving a diabetic glucose unless they can do some kind of glucose testing in the field. I've seen a hyperactive basic give glucose to someone they thought was 'a little low' (close to 90) and just that tube shot up the BGL to well past 350. Brittle diabetics can have very unpredictable results.
 
We have a glucometer, and as someone said, while we don't rely 100% on it, we still have it as a back up to the diagnostic

But evaluating px. History, Medical Condition, Medications, Last Meal and Vitals, you can get the diagnosis
 
Yes it does.
 
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