Insulin

xrsm002 said:
The patients glucometrr said 1000
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Just for your own knowledge, if someone has a high BGL one of the things that is going to be done before giving insulin is making sure they are hydrated (what are some of the symptoms related to hyperglycemia?). Insulin will come later.

Starting IV fluids may be helpful in the pre-hospital environment for hyperglycemia, along with other indicated treatments to get the ball rolling towards bringing the BGL down, but insulin isn't the first step in this process once it gets to be too high.
 
Akulahawk said:
. Usually we just don't suspect K being that bad unless we're looking at extricating a crush patient. Outside of that, I don't think our protocols even touch using albuterol in that manner.
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Do you carry Calcium gluconate? Works wonders for hyperK induced arrhythmias
 
Chase said:
Do you carry Calcium gluconate? Works wonders for hyperK induced arrhythmias
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Last time I was around an ambulance, no. We didn't. I'd be surprised if they did these days. Probably had to do with the idea that patients could be brought to the ED before something bad happens... :blink:
 
Chase said:
Do you carry Calcium gluconate? Works wonders for hyperK induced arrhythmias
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...but doesn't do anything for the serum potassium levels.
 
Akulahawk said:
Last time I was around an ambulance, no. We didn't. I'd be surprised if they did these days. Probably had to do with the idea that patients could be brought to the ED before something bad happens... :blink:
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Please. That sine wave is just artifact.
 
JPINFV said:
...but doesn't do anything for the serum potassium levels.
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I know, but it can prevent cardiac arrest until the K can be treated appropriately.
 
Chase said:
Most providers have a very poor, if any, understanding of anion gap acidosis.
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Before I go chasing down stuff to read on my day off today, do you have any recommendations for a resource for this?
 
JPINFV said:
Please. That sine wave is just artifact.
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It must be... Otherwise it could be a sign of, oh, I don't know, a really high K level? And since it's just artifact, it's nothing to worry about... right? :rolleyes:
 
Are we looking at in vitro or in vivo relevant materials?
I can run your brain on ketones but you'll die. Is this something like that?

:mellow:
 
xrsm002 said:
The patients glucometrr said 1000
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Say what? I'm not familiar with home glucometer brand that will read numbers that high.
 
Aidey said:
Say what? I'm not familiar with home glucometer brand that will read numbers that high.
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Good catch, I didn't noticed the "home glucometer" at first. Most hospital meters do not even read that high. Anything over 500 needs a lab draw to confirm.
 
Chase said:
Good catch, I didn't noticed the "home glucometer" at first. Most hospital meters do not even read that high. Anything over 500 needs a lab draw to confirm.
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I assumed it was figurative hyperbole.
Ours went from "500" immediately to "HI".

("HI" yourself! :angry: )
 
Chase said:
Good catch, I didn't noticed the "home glucometer" at first. Most hospital meters do not even read that high. Anything over 500 needs a lab draw to confirm.
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I was wondering the same.

I am also curious how could a prehospital service carry insulin and store it successfully insulin last I remember must be refridgerated so unless the new buses come out with a reefer unit. I don't see it hitting the streets anytime soon

On top of that theres still the clinical overview. why is the sugar high? is it DKA, or non compliance or new onset diabetes or head injury or recent steroid use? theres too many factors to go into play for me to think about giving a pt. insulin before knowing that it will benefit.

Second part of it reading the thread almost seem liked the OP was chasing a number theres patients out there that have high blood sugars and just stay there hell my wife used to work in a old folks home and she had a woman who if her sugar went below 200mg/dl. she'd look like a normal person with a sugar of 30.
 
Fury: Just to address your comment about the need for refrigeration (too tired to give any kind of thought out response on anything else :P ).

On-board fridges are actually quite common now. Many units are finding use for them with things like cold fluids for induced hypothermia, medication storage for meds like Vec and diltiazem, and even just to have cool/cold water on board for whatever need.

That is all. Hoping to knock out another couple hours of sleep before shift change :D
 
A few of our clinics carry insulin. Some of them are fly in fly out camps and it can take a while to get to the hospital or to the pharmacy if a pt runs out.
 
Regular Insulin should be refrigerated to extend shelf life however once opened it can be stored at room temperature for one month. So technically you could just keep a vial at room temp in the ambulance and replace it monthly. But you would have to look at the long term cost.
 
STXmedic said:
Fury: Just to address your comment about the need for refrigeration (too tired to give any kind of thought out response on anything else :P ).

On-board fridges are actually quite common now. Many units are finding use for them with things like cold fluids for induced hypothermia, medication storage for meds like Vec and diltiazem, and even just to have cool/cold water on board for whatever need.

That is all. Hoping to knock out another couple hours of sleep before shift change :D
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Meh were still in the dark ages, fluid induced hypothermia is done by the whole cold pack trick. While I don't agree with it since its hard to control the temp vs. a chilled fluid via a fridge
 
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