MJordan2121
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Typical call with atypical results:
So, I was dispatched to a local nursing home for an 82 y/o female pt who was hypoglycemic, I thought, ok, check glucose, rule out other possibilities, give her some D50 and perk her up - pretty typical call. We get vitals, do a 12-lead, all normal, BG not so good - 44 and dropping. Initial BG by nursing facility was 55, so they nurses there are having a panic attack upon our arrival. She was a bit clammy, would answer our questions to the best of her ability, which wasn't too bad for a hypoglycemic demented patient. She could at least tell us who she was and what city she was in. While my partner was hooking her up to the monitor and getting vitals, I was actively searching for a vein, which was a nightmare. Since nothing was visible or palpable and this lady, I visualized the veins anatomically and attempted a blind stick to the AC - nope! This lady had a good 12 bruises to her left arm alone from previous attempts from a recent hospital visit and her right arm is not accessible due to over 100 stitches and multiple fractures and a recent surgery to fix it up. I look for veins in other areas without success.
Since we were 1 mile from ER, I just gave Glucagon and tx rapidly. Rechecked sugar, another finger stick, now down to 20. Pt is still talking and mumbling, no change in mental status - still answers the same questions appropriately. Surprised at the low glucose reading and her remaining unchanged. We are at the ER in about a minute and nurses recheck they now have a reading of 12. They try sticking her a good 5 times without success , so doctor comes in and attempts an EJ and misses it - guess he doesn't do them very often - anyhow, doctor resorts to placing a femoral line and it was successful and quite interesting to watch. Dr gives D50, Blood glucose unchanged, pushes another, unchanged.
Well, patient was discharged today and we happened to be the crew that was taking her back - read the chart to see history and according to the chart, the patient was probably never hypoglycemic. I know diabetics have poor circulation, but in this case, the circulation was poor and gave a false reading - they did a stick to her earlobe and found out it was 398. Since they already gave her the D50, and the reading was showing 398 on earlobe and 12 on fingertips. Just thought it was an interesting follow up and wanted to share.
:wacko:
So, I was dispatched to a local nursing home for an 82 y/o female pt who was hypoglycemic, I thought, ok, check glucose, rule out other possibilities, give her some D50 and perk her up - pretty typical call. We get vitals, do a 12-lead, all normal, BG not so good - 44 and dropping. Initial BG by nursing facility was 55, so they nurses there are having a panic attack upon our arrival. She was a bit clammy, would answer our questions to the best of her ability, which wasn't too bad for a hypoglycemic demented patient. She could at least tell us who she was and what city she was in. While my partner was hooking her up to the monitor and getting vitals, I was actively searching for a vein, which was a nightmare. Since nothing was visible or palpable and this lady, I visualized the veins anatomically and attempted a blind stick to the AC - nope! This lady had a good 12 bruises to her left arm alone from previous attempts from a recent hospital visit and her right arm is not accessible due to over 100 stitches and multiple fractures and a recent surgery to fix it up. I look for veins in other areas without success.
Since we were 1 mile from ER, I just gave Glucagon and tx rapidly. Rechecked sugar, another finger stick, now down to 20. Pt is still talking and mumbling, no change in mental status - still answers the same questions appropriately. Surprised at the low glucose reading and her remaining unchanged. We are at the ER in about a minute and nurses recheck they now have a reading of 12. They try sticking her a good 5 times without success , so doctor comes in and attempts an EJ and misses it - guess he doesn't do them very often - anyhow, doctor resorts to placing a femoral line and it was successful and quite interesting to watch. Dr gives D50, Blood glucose unchanged, pushes another, unchanged.
Well, patient was discharged today and we happened to be the crew that was taking her back - read the chart to see history and according to the chart, the patient was probably never hypoglycemic. I know diabetics have poor circulation, but in this case, the circulation was poor and gave a false reading - they did a stick to her earlobe and found out it was 398. Since they already gave her the D50, and the reading was showing 398 on earlobe and 12 on fingertips. Just thought it was an interesting follow up and wanted to share.
:wacko:
