New Scenario

[Medivixen]

38 y/o F
Found lying in the middle of a maintenance shed UnCx by her brother
Unresponsive to painful stimuli
Scene is safe, no evidence of trauma
A-patent
B-deep and slow
C-rapid and weak
You are overcome by heat when walking into the shed (+38 celcius outside)
Pt is about 300+ lbs
Diabetic alert bracelet on
Brother cant give much of a hx since he hasnt been home since this AM (now it is 1pm)

Vitals
BP 90/60
Pulse 110
BGT 1.7 mmol/L

Using your local protocol what do you do?

 

[trauma1534]

38 y/o F
Found lying in the middle of a maintenance shed UnCx by her brother
Unresponsive to painful stimuli
Scene is safe, no evidence of trauma
A-patent
B-deep and slow
C-rapid and weak
You are overcome by heat when walking into the shed (+38 celcius outside)
Pt is about 300+ lbs
Diabetic alert bracelet on
Brother cant give much of a hx since he hasnt been home since this AM (now it is 1pm)

Vitals
BP 90/60
Pulse 110
BGT 1.7 mmol/L

Using your local protocol what do you do?

Well, first things first... what does BGT 1.7 mmol/L mean? Is that standing for blood glucose? If so, does anyone know what the numbers would convert to on a standard scale?

 

[FFEMT1764]

It's a maintanance shed...how can is be safe...hello HAZMAT team...until proven otherwise...too many people store fertilizers next to other hazardous stuff and one thing leaks into the other and whammo, organophosphate city!!!

 

[Medivixen]

It's a maintanance shed...how can is be safe...hello HAZMAT team...until proven otherwise...too many people store fertilizers next to other hazardous stuff and one thing leaks into the other and whammo, organophosphate city!!!

the scene is safe, it is a maintenence shed as in she keeps wood carving hobbies in it or something no chemicals involved.

Well, first things first... what does BGT 1.7 mmol/L mean? Is that standing for blood glucose? If so, does anyone know what the numbers would convert to on a standard scale?

And as for the BGT yes that is blood glucose test. I am not sure as to what it would be on your scale just say it is VERY low.

 

[FFEMT1764]

Well if the sugar is low, then IV NS large vein, like an AC, then D50 25 grams IV. Remove the patient from the hot environment. IV fluids 250cc bolus, reassess vs and sugar. High flow oxygen (15lpm by non rebreather). Remove excess clothing from patient if the are very hot to touch. Place patient on cardiac monitor and obtain 12 lead EKG to rule out cardiac involvement in the LOC.

 

[jeepmedic]

Well if the sugar is low, then IV NS large vein, like an AC, then D50 25 grams IV. Remove the patient from the hot environment. IV fluids 250cc bolus, reassess vs and sugar. High flow oxygen (15lpm by non rebreather). Remove excess clothing from patient if the are very hot to touch. Place patient on cardiac monitor and obtain 12 lead EKG to rule out cardiac involvement in the LOC.

This is a BlS thread. Not an ALS one. Let the EMT-B's handle this. This is how they learn to operate in there level.

 

[c-spine]

With a 300lb + pt, I'd be calling the fire dept for a lift assist. After the pt was removed from the shed, I'd want her on a cot in the rig ASAP with the AC on to try and cool her down. I'd begin the a rapid trauma assessment while my partner calls for an ALS intercept.

I would monitor the pt, apply high-flow O2, re-check vitals every 5 minutes or so, as I'm not sure how long she will remain fairly stable.

If the brother is around, I'd want him to give me as much of a hx as possible. I want the SAMPLE history....I'm sure he can tell me at least some of it... at least the AMP part.

Would you want to treat for possible shock with the low BP?

 

[FFEMT1764]

This is a BlS thread. Not an ALS one. Let the EMT-B's handle this. This is how they learn to operate in there level.

Ok, have fun with it.

 

[trauma1534]

With a 300lb + pt, I'd be calling the fire dept for a lift assist. After the pt was removed from the shed, I'd want her on a cot in the rig ASAP with the AC on to try and cool her down. I'd begin the a rapid trauma assessment while my partner calls for an ALS intercept.

I would monitor the pt, apply high-flow O2, re-check vitals every 5 minutes or so, as I'm not sure how long she will remain fairly stable.

If the brother is around, I'd want him to give me as much of a hx as possible. I want the SAMPLE history....I'm sure he can tell me at least some of it... at least the AMP part.

Would you want to treat for possible shock with the low BP?

Ok... remmber, we are dealing with a low blood sugar here. What would you do for an unresponsive low blood sugar at the basic level? There are a couple things you can do.

 

[yowzer]

Remove from the heat, call medics to give IV glucose as there's no way you can safely force frosting down her. O2. Check her temp? What does her skin feel like? Is she sweating? Dry?

 

[trauma1534]

Remove from the heat, call medics to give IV glucose as there's no way you can safely force frosting down her. O2. Check her temp? What does her skin feel like? Is she sweating? Dry?

Well... there is something you can do. Think outside the box.

 

[Jon]

#1 - Unconscious Person - if ALS isn't already in on the job, get them rolling.
#2 - Big Person - if I don't have at least 6 folks onscene... call FD for lift assist.
#3 - Remove patient from warm enviroment.
#4 - Unconscious Diabetic - If they have an intact gag reflex and aren't totally out, give oral glucose.

 

[trauma1534]

#1 - Unconscious Person - if ALS isn't already in on the job, get them rolling.
#2 - Big Person - if I don't have at least 6 folks onscene... call FD for lift assist.
#3 - Remove patient from warm enviroment.
#4 - Unconscious Diabetic - If they have an intact gag reflex and aren't totally out, give oral glucose.

Two things I remember we were taught back in EMT-B class, you can take a toungue depressor and put some instant glucose on it a little at a time and administer it under the toungue, or in the cheek area. I've never had to try it. Also, we were taught that you can give glucose rectally, if you had to. I've heard of alot of providers administering oral glucose under the toungue or in the cheek a little at a time in an uncontious patient and it working. Like I said though, never tried it.

FD always comes in handy for lifting assistance!

You may be left there with this patient for a little while untill adiquate lifting assistance and ALS arrives. You will have to manage this one thinking outside the box. If you can get the sugar up, then you won't need the lifting assistance or the ALS anymore, since this is more than likely the sole problem. After you get the sugar back up and the patient comes compleatly around, you can even go as far as fixing them something to eat! LOL That has even been done at 2am, a certain provider I know cooked a patient a full course breakfast meal, got a refusal signed and went back to quarters, and was no longer next up! LOL

 

[FFEMT1764]

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

Interesting, no one around here was taught to give glucose rectally, I even asked our med control and he gave me a dirty look, then asked if I was joking.

Not saying that you weren't taught it, just very wierd to me.

 

[Medivixen]

yes definitly remove pt from the hot environment, transport 3/4 prone, opa(if taken)O2, oral glucose on dependant cheek, iv n/s piggyback 100mls d10w and 50 mg thiamine push, if no improvement 100ml d10 again and cont assessment, check bgt if below 4.0mmol/L another d10w. continuing assessment with vitals , contact EP if bp is still below 90 start for NS bolus

 

[trauma1534]

yes definitly remove pt from the hot environment, transport 3/4 prone, opa(if taken)O2, oral glucose on dependant cheek, iv n/s piggyback 100mls d10w and 50 mg thiamine push, if no improvement 100ml d10 again and cont assessment, check bgt if below 4.0mmol/L another d10w. continuing assessment with vitals , contact EP if bp is still below 90 start for NS bolus

Not putting your judgement down because everyone has thier own way of treating thier patients, plus, I don't know what you were taught. But, why would you consider an OPA over a NPA if the patient has a simple low blood sugar? Nasal airways fix the problem of the smoring resp found in low blood sugar patients.

Also, why thiamine? Why not D-50 or Glucagon?

This patient just needs to come back from the low blood sugar. This just seems like a long way around an easy solution. Do your Basics start IV's there and give thiamine? Just wondering. I know different places allow basics to do different things.

The thing about rectal Glucose, it is not anything that is in the curriculam, or in our proticols, it just can be done. Why not? It works like a supository. It still can me soaked into the blood stream. It's just one of those think out side the box things.

 

[yowzer]

Two things I remember we were taught back in EMT-B class, you can take a toungue depressor and put some instant glucose on it a little at a time and administer it under the toungue, or in the cheek area. I've never had to try it. Also, we were taught that you can give glucose rectally, if you had to. I've heard of alot of providers administering oral glucose under the toungue or in the cheek a little at a time in an uncontious patient and it working. Like I said though, never tried it.

My teaching was that you don't give anything orally to someone who's unconcious. Only if they can swallow on their own.

And I'm not giving ANYTHING rectally, even if it was in a protocol. Especially not to someone who's big enough they probably can't reach to wipe... =)

 

[yowzer]

This patient just needs to come back from the low blood sugar.

With an unknown downtime in a really hot room, it's quite possible that she now has more going on than just that.

 

[Medivixen]

Not putting your judgement down because everyone has thier own way of treating thier patients, plus, I don't know what you were taught. But, why would you consider an OPA over a NPA if the patient has a simple low blood sugar? Nasal airways fix the problem of the smoring resp found in low blood sugar patients.

Also, why thiamine? Why not D-50 or Glucagon?

This patient just needs to come back from the low blood sugar. This just seems like a long way around an easy solution. Do your Basics start IV's there and give thiamine? Just wondering. I know different places allow basics to do different things.

we dont do NPA's out here and we dont give d50. Glucagon is only given if IV access is unobtainable. Thiamine always goes in conjunctions with d10 for our protocols.

 

[fm_emt]

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...