Low RBS WITHOUT catheter.

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falcon-18

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hello, every body. today I listen this information if you are in diabitic pt . ans his RBS is LOW. and you can not open IV line. no catheter or another. you can give D5W by rectal. of course pt unconscious. My Q . Is it true ?
 
There was a similar post not to long ago. I believe it had a lot of replies. You could probably search for it.
 
falcon-18 said:
hello, every body. today I listen this information if you are in diabitic pt . ans his RBS is LOW. and you can not open IV line. no catheter or another. you can give D5W by rectal. of course pt unconscious. My Q . Is it true ?
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I would not give D5W, but have given oral glucose this way. BTW, there is a very interesting case report in the literature of fluid resuscitation in a remote area by rectal administration of crystalloid.
 
usafmedic45 said:
I would not give D5W, but have given oral glucose this way. BTW, there is a very interesting case report in the literature of fluid resuscitation in a remote area by rectal administration of crystalloid.
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If you do not have only D5W . what you will do . I think you will give him that. I will see link from MSDeltaFlt:):)
 
Try a honey bear. A tube of oral glucose followed by a small bolus does work. I've shortened a french cath and done it one time many moons ago.
 
Before you go putting things in someones rectum, what about GLUCAGON IM!!!!
 
rescue99 said:
Try a honey bear. A tube of oral glucose followed by a small bolus does work. I've shortened a french cath and done it one time many moons ago.
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you can not give ;) . pt unconscious . oral glucose lead to aspiration in unconscious :sad:


medic3416 said:
Before you go putting things in someones rectum, what about GLUCAGON IM!!!!
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but, If not available :sad: . what you will do? I mean last choice you will go to this.
 
A honey bear is not administered per (cough) oral :>) I figured you meant you didn't have Glucagon as an option.
 
I was assuming we were talking at the BLS level, so glucagon and D5W would not be available. Also, I am not aware of a state that does not require oral glucose on all ambulances at the BLS level. In my case, I carried a tube of it in my pocket while on duty (the person who was my partner for the longest time was prone to hypoglycemic events) and still keep two in the first aid bag in my car.

Also, you really can't raise someone's glucose level all that effectively with D5W due to the low glucose content. It just takes too long to push the volume of fluid necessary, compared to the effect you'll get from oral or rectal glucose As someone else said, you can always use non-medicinal sources of glucose. I've personally seen cases or seen the documentation on cases where oral glucose (guess it would be rectal glucose in this setting), maple syrup and honey were all administered rectally.

oral glucose lead to aspiration in unconscious
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Not always, but that is one of the reasons why I would favor the rectal route in that setting to avoid the possibility.
 
What about an IO?
 
As an ALS provider, I would hesitate to jump to doing an IO for something that can be effectively treated with a procedure with far lower risk of complications and a lot less pain involved (even after insertion IOs are not supposed to be the most comfortable device). This is a major issue in EMS: the push for advanced procedure when something less aggressive will function just fine. The best example of this is intubation in the setting where the patient can be adequately managed with a BVM and perhaps an OPA. In the case of the scenario presented here, contrary to popular belief a failed IV is not an instant indication for an IO (pretty much the only exception to this is cardiac arrest or the unequivocal need to IMMEDIATELY give medications that have no alternate route).

For the service I worked for, I can guarantee you would have been hauled before our medical director and your peers at audit and review to explain the decision to use an IO in this setting. The first questions would have been: " Why not glucagon? Why not give the glucose rectally?".

As the saying goes, if it's stupid and it works, it's not stupid; if it's ugly and it works, it's thing of beauty. It might not be the most high speed practice out there- I don't know many people who look forward to sticking a tube of glucose up someone's backside- but if it fixes the problems and "saves" the patient without inflicting excessive pain or exposing them to undue risk, that is something that should be the bigger ego boost. We are here for our patients- first, foremost and without question- and sometimes (most of the time?) EMS providers tend to get ahead of themselves in the rush for new skills or to apply the ones they already have.
 
I am confused as to why glucagon "is not available" as some post seem to get at. If I had an unconscious person d/t hypoglycemia you better bet I would go IO if unable to get a PIV. Why not go rectally? Because it's not in my protocols.
 
emtjack02 said:
I am confused as to why glucagon "is not available" as some post seem to get at. If I had an unconscious person d/t hypoglycemia you better bet I would go IO if unable to get a PIV. Why not go rectally? Because it's not in my protocols.
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Ever heard of deviation from protocols? Call in and just ask just like you do for any other order that was not clear or a more simpler effective way of doing it. I treat patients not protocols.


R/r 911
 
Sure I could call in. My experience w/ our Med control is they dont like to stray from the protocols. We also have trouble reaching them sometimes because our truck s**ks. But thank you ry.
 
usafmedic45 said:
I was assuming we were talking at the BLS level, so glucagon and D5W would not be available. Also, I am not aware of a state that does not require oral glucose on all ambulances at the BLS level. In my case, I carried a tube of it in my pocket while on duty (the person who was my partner for the longest time was prone to hypoglycemic events) and still keep two in the first aid bag in my car.

Also, you really can't raise someone's glucose level all that effectively with D5W due to the low glucose content. It just takes too long to push the volume of fluid necessary, compared to the effect you'll get from oral or rectal glucose As someone else said, you can always use non-medicinal sources of glucose. I've personally seen cases or seen the documentation on cases where oral glucose (guess it would be rectal glucose in this setting), maple syrup and honey were all administered rectally.



Not always, but that is one of the reasons why I would favor the rectal route in that setting to avoid the possibility.



yes. I am with you but if not available D50.:sad:

D5W it can elevate,but it will take more time than D50.
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gicts said:
What about an IO?
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IO. not available.

But if IO available I will use it or rectal ? I will give rectaly.
 
Ridryder911 said:
Ever heard of deviation from protocols? Call in and just ask just like you do for any other order that was not clear or a more simpler effective way of doing it. I treat patients not protocols.


R/r 911





Exactly. we are treat pt not protocol.
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emtjack02 said:
Sure I could call in. My experience w/ our Med control is they dont like to stray from the protocols. We also have trouble reaching them sometimes because our truck s**ks. But thank you ry.
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If I will safe pt. I will not look protocol. :):)
 
The same as in a seizing patient. Would you rather I/O a seizing patient or give Diastat Gel rectally? Which is the best and most appropriate for the patient?

R/r 911
 
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