Glucometry

I have been told that the strips have a substance on it that can adversely be affected by alcohol, giving false low readings - I have no evidence of this but my service no longer recommends the use of alcohol swaps, We now use water on a gauze swab
 
E tank said:
One common and traditional method of treatment for a ganglion cyst was to strike the lump with a large and heavy book, causing the cyst to rupture and drain into the surrounding tissues. Historically, a Bible was the largest or only book in any given household, and often was employed for this treatment. This led to the former nickname of "Bible bumps" or "Gideon's disease" for these cysts.[2][23]
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Kidding. Paper dictionaries are getting rare these days. I think using an iPad might void the warranty.
 
Pond Life said:
I have been told that the strips have a substance on it that can adversely be affected by alcohol, giving false low readings - I have no evidence of this but my service no longer recommends the use of alcohol swaps, We now use water on a gauze swab
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alcohol is a solvent
you are supposed to let it dry before poking them
 
EpiEMS said:
syrup.gif
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Though I am ecstatic you were able to find this gif (oh the possibilities), alas this was a Colorado tourist town.
 
Unless the finger is visibly dirty then nothing; just do a BGL and put a plaster on it.
 
If you were to ask patients who monitor their own blood sugar, I don't think you would find too many that are cleansing the site with too much if any great care. All, and I mean 100%, of the diabetics I know(5) do not and Ive had this conversation with many patients who scoff at me while I dutifully cleanse the site before the poke. I cant say if this is nationally or internationally representative, but it is representative for me. So, when I cant properly clean the puncture site, I dont feel too bad.

On the topic of where to obtain the blood sample, I too have heard many, many time over that you must use a capillary sample or the result is inaccurate. I have tested this theory at least ten times by having a venous sample taken from me and testing that sample against a capillary sample. Literally every single time, the difference has been negligible(<5 points). Granted, I am not a diabetic and every time I have done this my readings have been well inside the normal range, so perhaps this is totally irrelevant. Maybe when in a hypo or hyper state, that small difference can become clinically relevant. I dont see how, but I'm not wicked smart like some guys here, so maybe somebody can speak to that.
 
Venous samples are fine in most cases but technically the glucometer should be rated for it. Some ask at startup.

Caution Venous samples if infusing D5 based med same limb

Caution capillary sample in high alpha pressor pts, severe pvd, hypothermia
 
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Tigger said:
It isn't? Yea, I definitely don't care about infection in critically ill patients. Seriously, did you go to paramedic school? That's some pretty basic airway management knowledge. Doesn't need to be a sterile procedure but care does need to be taken..
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I didn't say I didn't care, I said it wasn't high on my list of priorities. Seriously, did you go to high school? that's basic reading comprehension.

If you are intubating someone, there is a good chance if you don't, they are going to die in the next few minutes. If they catch an infection, they might still die, but it won't be in the next few minutes.

See where the priorities are? Let me be even clearer for you, just so there is NO misunderstanding: My highest priorities would be securing a patient airway, and making sure they continue to breath.

Preventing infection (especially on a critically ill patient) is important, but if you protect that infection but can't secure a patent airway, what do you have? that's right, a dead body free of infection. See? priorities.
 
How about you try your hardest to consider, if not institute both? VAP is also a very real thing.

What will that yield, well, maybe not always a dead body, but the overall outcome is often not very far behind. And where does this leave said patients family members?

Just some more food for thought. I just think it's one procedure that really isn't considered enough with regard to sterility.
 
DrParasite said:
If you are intubating someone, there is a good chance if you don't, they are going to die in the next few minutes. If they catch an infection, they might still die, but it won't be in the next few minutes.
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In both cases that you presented both have the same outcome which does not mean one is better than the other. The first patient died because you couldn’t secure an airway and the second patient died because you caused an infection that killed them. They both died. Really all you allowed to happen was for this patient to get tens of thousands of dollars in hospital bills that the patients family is now going to have to deal with on top of their loved one being dead.

It’s really not that difficult to keep the procedure somewhat clean. Leave the tube in the sterile wrapping and only manipulate it from the outside such as shaping it or doing a distal cuff test. If you are not able to pass the tube on the first try then place the tube in the packaging. It really does not take much more effort to help reduce the chances of the patient getting VAP.
 
hometownmedic5 said:
On the topic of where to obtain the blood sample, I too have heard many, many time over that you must use a capillary sample or the result is inaccurate. I have tested this theory at least ten times by having a venous sample taken from me and testing that sample against a capillary sample. Literally every single time, the difference has been negligible(<5 points). Granted, I am not a diabetic and every time I have done this my readings have been well inside the normal range, so perhaps this is totally irrelevant. Maybe when in a hypo or hyper state, that small difference can become clinically relevant.
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I take mine off of arterial lines all of the time and whatever difference there may be, it doesn't vary to a degree where my treatment will change. Probably doesn't vary more than the device for sampling error of the same blood tested multiple times. But the conversation has me a little curious so next time I get bored with a case, I'll do a little trial and report back.
 
E tank said:
I take mine off of arterial lines all of the time and whatever difference there may be, it doesn't vary to a degree where my treatment will change. Probably doesn't vary more than the device for sampling error of the same blood tested multiple times. But the conversation has me a little curious so next time I get bored with a case, I'll do a little trial and report back.
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I would be very interested to hear the results of your test.
 
I'm not saying VAP isn't a real thing, nor am I saying that you should spit on the tip of the ET tube for extra lube nor should you drag it through the dirt. Keep it clean, try not to get it dirty, but at the end of the day, do what you need to do to secure the airway. That needs to be your priority or else the patient WILL die, and there is nothing anyone can do to reverse it.
DesertMedic66 said:
In both cases that you presented both have the same outcome which does not mean one is better than the other. The first patient died because you couldn’t secure an airway and the second patient died because you caused an infection that killed them. They both died. Really all you allowed to happen was for this patient to get tens of thousands of dollars in hospital bills that the patients family is now going to have to deal with on top of their loved one being dead.
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no.... in one case, the patient will die, in the other the patient might die.

one is a definite, one is a might. Again, reading comprehension.... I don't understand why this is so difficult....
 
DrParasite said:
I'm not saying VAP isn't a real thing, nor am I saying that you should spit on the tip of the ET tube for extra lube nor should you drag it through the dirt. Keep it clean, try not to get it dirty, but at the end of the day, do what you need to do to secure the airway. That needs to be your priority or else the patient WILL die, and there is nothing anyone can do to reverse it.
no.... in one case, the patient will die, in the other the patient might die.

one is a definite, one is a might. Again, reading comprehension.... I don't understand why this is so difficult....
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Not being able to place an ET is not a definite dead patient by any means....

You simply said that it is not high on your list of priorities which leaves a lot to be imagined. To at least 3 people on here we all took it as "I don't really care about infections as long as I got the tube". It's not an issue with reading comprehension if several posters are understanding it the same way, it's an issue with what you posted or at least the way you posted it.

In my history class the final is still a decent amount of time away so it's not high on my list of priorities... but if I don't pass the final then I don't pass the class.
 
So, 2 things:

1. @EpiEMS, sorry for the brief derail, but it's still sort of thread topic relevant.

2. I kind of do take issue with the "this patient needs a tube now or they will die" mindset. Many times, they're already dead; many others they will die regardless of the means to the end.

My issue with it is that it's often (incorrectly) taught this way to new EMT's and paramedics. If they're taught to think "this patient will die if I don't perform this 'life-saving' procedure" then they're most likely doing more harm than good. This to me screams "emergent", which is often followed by rush to judgment behaviors as well as many deleterious mistakes, and sentinel events to be had.

As it stands now, prehospital providers on the whole continue to do a piss poor job at securing an advanced airway. If they're being taught to rush through such a procedure such as this so much that they don't really have time to worry about it's long-term effects on the patients outcome should they indeed survive their initial insult, why do it at all?

Again, for me it's the beginning and end points of airway management. I also can't help but think if providers are still practicing with this mindset that they're taking enough time to properly preoxygenate, let alone understand its importance, and how many minutes they have until they actually reach the drop off point and are behind the proverbial eightball.

@DrParasite I get what you are saying, but I am saying that we should equally emphasize the importance of a proper aseptic technique with this procedure more so than say, a blood sugar. It's a tried and true killer even if in the long run. What's worse is it becomes an agonizingly painful killer with the latter.

If we're not teaching the basics properly (we=generally all EMS instructors/ trainers), then we're not teaching proper oxygenation and ventilation. And if that is in fact the case, we don't even need to worry about proper sanitary techniques, let alone "getting the tube".

A failed airway has nothing to do with any sort of tube making its way into the patients airway. I think we need to start there with basic EMT and paramedic education.
 
Venous samples are reliably a few points off, if the meter is calibrated for capillary samples. A lot of meters can be set for either. Capillary samples can be off by much more than that in the critically ill, so I personally believe in using venous (or arterial) samples when possible, even in a meter set up for capillary blood.
 
EpiEMS said:
What kind of method do you typically use to sanitize a site prior to obtaining a capillary blood sample for glucometry? Alcohol swab?
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Alcohol swab is the standard of care in this region.
 
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