New Scenario

[Fedmedic]

I've never heard of the rectal valium either, but it makes sense. I'll have to research it a little further to give an educated answer about it. It makes sense because the rectal administration route is about the fastest route after IV. I have given rectal valium to actively seizing patients that I could not obtain IV access and it worked just about as fast as IV valium, although I will have to admit when I followed it up with the air bolus it was pretty nasty...:wacko:

 

[trauma1534]

If it's like an old roommate I had, just wave a bacon cheeseburger and she'll wake right up.

As for the rectal way? I've certainly read about it, but I dunno how happy a patient would be with a tube of glucose paste jammed in their arse. If it's on the allowed protocols, sure. But if it's not, here come the bloody lawyers again...

Well... I highly doubt I'd get sued for waking someone up from a low blood sugar. And I don't think they will care too much about the butt plug of glucose when they were unresponsive.

 

[Ridryder911]

Diastat is a trademark Valium rectal gel, that many EMS carry in case one cannot get a line. In comes in a syringe type dispenser made for rectal insertion. Most ER's should have this on hand as well... used it many times on kids, in lieu of I/O's when you cannot get a peripheral line.

I would not administer Glucose rectal. IV Glucose is very caustic to mucosa membranes, and if one ever has seen a infiltration and the necrosis it causes, one would understand. It is safe, however; to administer oral glucose (little at a time) to the mucosa and sublingual, if the patient is in a "coma" position (monitor for aspiration) understandably, one does not "squirt" the whole tube...

The reason for Thiamine, is Wernicke's encephalopathy. All Paramedic units should have protocols to administer Thiamine before D50W or concurrently, to prevent this from occurring (massive seizures due to rapid glucose). I as well routinely give all poor nourished alcoholics Thiamine and Mg++ ... their body is probably depleted.

R/r 911

 

[Epi-do]

Per protocol around here, high flow O2, request ALS, remove patient from hot environment, loosen clothing & apply cold packs to arm pits/groin area to attempt to cool patient if she appears hyperthermic. Since she is unresponsive, our medical director would string us up if we attempted to give oral glucose, even if we did it slowly, as some of you have described. We are not to give anything orally, under any circumstances, to an unresponsive patient. (And, unfortunately, after working for several different services in the area, I have seen the results of the actions of the very few basics and medics which led the med. dir. to that decision.)

 

[Fedmedic]

I've never heard of the rectal valium either, but it ...

I mean't to say I had never heard of giving oral glucose rectally, not rectal valium. I have given rectal valium many times, and not the Diastat. Our agency was to cheap to buy it. We just pulled up the valium in a syringe from the ampule and administered it rectally, minus the needle of course...ouch!!

 

[jeepmedic]

I mean't to say I had never heard of giving oral glucose rectally, not rectal valium. I have given rectal valium many times, and not the Diastat. Our agency was to cheap to buy it. We just pulled up the valium in a syringe from the ampule and administered it rectally, minus the needle of course...ouch!!

You didn't asst. the valium with manual air pressure did you???? :lol:

 

[Fedmedic]

You didn't asst. the valium with manual air pressure did you???? :lol:

Yeah I just stuck the IV tube up their rectum and blew it in manually............. w i t h ... m y ... m o u t h ........ha ha ha .....yeah whatever....although we know someone who did that.....don't we?(RIP):lol:

 

[trauma1534]

Fed, I tell you another old medic, now a PA who would do the rectal Instant Glucose in a heartbeat, and has ordered it when providers call in on a BLS truck. He was the king of thinking outside the box. To give you a hint of who I am talking about, if you haven't figured it out yet, he would say "have no fear, God is Here". He was the shet!

 

[jeepmedic]

Fed, I tell you another old medic, now a PA who would do the rectal Instant Glucose in a heartbeat, and has ordered it when providers call in on a BLS truck. He was the king of thinking outside the box. To give you a hint of who I am talking about, if you haven't figured it out yet, he would say "have no fear, God is Here". He was the shet!

Now you are talking OLD

 

[fm_emt]

Well... I highly doubt I'd get sued for waking someone up from a low blood sugar. And I don't think they will care too much about the butt plug of glucose when they were unresponsive.

I'm in California. You can't swing a dead cat without hitting a lawyer around here. :|

 

[jeepmedic]

I was told that I got an order for rectal glucose one time but my radio started doing funny things and I could not hear a thing they said.:blink:

 

[Anomalous]

I'm in California. You can't swing a dead cat without hitting a lawyer around here. :|

What;s the difference between a dead cat lying in the road and a dead lawyer lying in the road?


The cat has skid marks around it.

 

[ffemt8978]

What;s the difference between a dead cat lying in the road and a dead lawyer lying in the road?


The cat has skid marks around it.

And the lawyer's has burn out marks heading straight for it...h34r:

 

[Medivixen]

Also, we were taught that you can give glucose rectally, if you had to.

I dont know but around here you can't just get away with shoving things in peoples orifices, one day it will catch up to you and you may find yourself on the other side of things.

Rolling the patient 3/4 prone and applying oral glucose to the dependant cheek is an excellent alternative when dealing with uncx diabetic pts.

I am a little confused as to what your protocols are like wherever you work? Do you set have a set out algorithm that has different steps as to what the situation hands you ?

 

[trauma1534]

I dont know but around here you can't just get away with shoving things in peoples orifices, one day it will catch up to you and you may find yourself on the other side of things.

Rolling the patient 3/4 prone and applying oral glucose to the dependant cheek is an excellent alternative when dealing with uncx diabetic pts.

I am a little confused as to what your protocols are like wherever you work? Do you set have a set out algorithm that has different steps as to what the situation hands you ?

Our OMD will tell you, along with the ER staff, that our protocol's are ment as a guide, not a stone written law that you must follow.

For example... you get a call for chest pain. Are you going to automaticly follow chest pain protocol, if it is not cardiac related? In other words, are you going to give nitro if the pain is more consistant with a pulled muscle, or a breathing problem even? I mean just because they say it is chest pain, are you going to give Aspirin, Nitro, Nitro Paste, Morphine, if you have a 16 year old who's chest pain started after he was lifting weights?

You have to be able to think outside the box. In our area, the OMD, ER staff and Doctors, PA's, all promote taking the knowledge that we have and applying it the best way we can for the best outcome for the patient.

Alot of EMS treatment is based on trial and error. You try one thing, if that's not working or isn't possable, then you find something else that will work, as long as it does no harm. That's where it comes into play knowing your signs and symptoms, knowing your indications and contraindications of every drug. Knowing what that drug is used for and what it will do. What you can and can't give it with.

 

[Medivixen]

Our OMD will tell you, along with the ER staff, that our protocol's are ment as a guide, not a stone written law that you must follow.

For example... you get a call for chest pain. Are you going to automaticly follow chest pain protocol, if it is not cardiac related?

That goes without saying tho, I mean, we would first investigate the complaint before giving any kind of drug tmt. My chest pain protocol is called "Chest Pain (Cardiac in Nature) Protocol" and we only give Nitro if the pt has a previous Px for Nitro and they met the criteria for the protocol.

I can give up to 0.3 mg Epi SC for anaphylaxis but my pt must meet 4 seperate criteria before I declare it anaphylaxis instead of an allergic response. The four indications of anaphylaxis here are:
- Pt with S/S of anaphylaxis (urticaria and/or angioneurotic edema and/or hypotension/shock)
- Pt with PHx of allergy
- Pt exposed to known allergen
- UNSTABLE (decreased LOC or hypotension or respiratory distress)

If my pt meets that, they will get a needle in the thigh and then some Benadryl tabs. But if they don't meet all four, then they are just getting the Benadryl and I'll mix up some Ventolin for them if they have asthma secondary to allergies (that's actually 2 protocols run together). But it is all an algorithm that I follow including when to initiate transport and when to call EP if things are going south.

Now obviously, we will have to adapt when the time comes to do so; EMS is famous for adaptability, but on paper it better follow the protocol or we may as well start applying for work at McDonalds.

 

[BossyCow]

Glucose paste can be used. 'Just a pinch between the cheek and gum' to keep it from getting into her airway. The glucose will absorb through the skin. Aside from ABC's and monitoring for that impending seizing episode, I'm getting ALS with needle sugar for her.

 

[medic2be]

Per protocol around here, high flow O2, request ALS, remove patient from hot environment, loosen clothing & apply cold packs to arm pits/groin area to attempt to cool patient if she appears hyperthermic. Since she is unresponsive, our medical director would string us up if we attempted to give oral glucose, even if we did it slowly, as some of you have described. We are not to give anything orally, under any circumstances, to an unresponsive patient.

exactly...