Obtaining BGL

[frdude1000]

In Maryland, EMT-B's cannot check a BGL.

 

[HMartinho]

Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:

Anyway, how can you detect hypoglycemia without getting the BGL?

Sorry to say but this is ridiculous...h34r:

 

[adamjh3]

Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:

Anyway, how can you detect hypoglycemia without getting the BGL?

Sorry to say but this is ridiculous...h34r:

Its considered an invasive procedure and is thus prohibited in many areas.

It doesn't make sense but that's how it is.

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[jjesusfreak01]

Its considered an invasive procedure and is thus prohibited in many areas.

It doesn't make sense but that's how it is.

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We stuck each other in my high school science class to do blood typing...

 

[adamjh3]

We stuck each other in my high school science class to do blood typing...

As did I. I've also stuck my mom when she was AMS due to being hypoglycemic.

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[Lurch]

As noted above, in PA we may not check BGL. Our EMT instructer unloaded on another student when during practice sessions he would ask a diabetic patient if he would check BGL. The instructor said administering glucose to someone hypoglycemic may save them, and giving it to someone with a BGL of 200 won't make any real difference.

Our protocols state to give all suspected diabetic episodes glucose if they can protect their own airway thus no need to check BGL per our protocol.

 

[JPINFV]

As noted above, in PA we may not check BGL. Our EMT instructer unloaded on another student when during practice sessions he would ask a diabetic patient if he would check BGL. The instructor said administering glucose to someone hypoglycemic may save them, and giving it to someone with a BGL of 200 won't make any real difference.

Our protocols state to give all suspected diabetic episodes glucose if they can protect their own airway thus no need to check BGL per our protocol.

...because ruling out a differential diagnosis for such things like CVA isn't important. After all, the altered patient with a history of diabetes MUST, MUST MUST, be hypoglycemic, right?

 

[Lurch]

I didn't write the state protocol, just presenting it for a point of reference.

A suspected stroke would obviously be treated differently than a diabetic episode. That said, what harm could come of giving a conscious stroke patient that can protect his airway glucose? I am not trying to be difficult, but am curious as I am not yet an EMT but a student taking the state exam this weekend realizing that I still have a lot to learn.

 

[JPINFV]

That said, what harm could come of giving a conscious stroke patient that can protect his airway glucose? I am not trying to be difficult, but am curious as I am not yet an EMT but a student taking the state exam this weekend realizing that I still have a lot to learn.

First things first, if you haven't taken the exam yet, be a little careful learning from forum topics like this. For multiple reasons, most importantly being the difference between the difference on a cognitive level between real life and the exam, a lot of topics could be considered "wrong" by a testing standard, but "right" from an appropriate level of care standard. EMT-B exams assume you can't think. A lot of what goes on in the clinical threads is, arguably, well beyond the minimum standard for EMS providers, but especially so at the EMT level because it requires that the provider thinks instead of mindlessly saying, "but it doesn't hurt, so..." (and... yes... it isn't your fault).

Ok, that out of the way, yes giving oral glucose to a patient with an unknown BGL is appropriate and essentially harmless in the grand scheme of things if the patient is ultimately not hypoglycemic. However, if you can determine the blood glucose level, then why administer something that you now know is ultimately not indicated? The protocols that say to administer oral glucose to all altered patients is based off of being ignorant of the BGL. I say, why be ignorant of the BGL if you don't have to be?


Next, does your state/area have dedicated neuro centers like trauma centers or cath labs? Hypoglycemia can present with stroke like symptoms to the point that it's a rule out category on at least one stroke scale (the Los Angeles Prehospital Stroke Screen). As such, and assuming no other indication for paramedics, being able to rule out hypoglycemia vs stroke allows me to make the argument that having paramedics ultimately provides little additional benefit (again, assuming no other indication or need for paramedics) and allows you to bypass the closest hospital in favor for a specialty center if your system recognizes them.

 

[technocardy]

Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:

Anyway, how can you detect hypoglycemia without getting the BGL?

Sorry to say but this is ridiculous...h34r:

I guess the rational in not allowing EMT-B's to check a BGL is that regardless of the result, it wont effect the treatment they can provide. Hyper/hypo it wont make a difference. I don't know if EMT-B's can give oral glucose to a pt or not, but in the prehospital setting if you give some oral glucose to a pt who is hyperglycemic it wont make too much of a difference, however if they are hypo and you give the pt glucose then it will help improve the pt's condition. So either way you don't need to know? I dunno.. I don't necessarily agree with it, but that's what I came up with.

I'm just assuming that's the rational because EMRs in Alberta can take a BGL.

 

[Flightorbust]

An extra 21 hour class in Colorado and pending medical director approval Basics can start IVs, give fluids, D50, narcan (IV and IN), and first line cardiac drugs under a medic's direction during an arrest. IOs are allowed under a waiver in some areas.

the class tigger is talking about is the IV class. Its my understanding that they have changed it to where a basic w/o IV can now get a BGL as well as it has become a NREMT skill. Once a Basic has their IV they can give IVs, D50 and narcan. The more ALS stuff a basic can do under direction of a Medic because of Rule 20 (I think its 20).

 

[DrParasite]

Someone can explain me why some EMT-B's can not verify the BGL? They are afraid that the patient bleed to death? :unsure:

Anyway, how can you detect hypoglycemia without getting the BGL?

Sorry to say but this is ridiculous...h34r:

I believe there are two reasons for this. The first is that checking a BGL is considered invasive (as you are puncturing intact skin), and EMTs are not permitted to do invasive procedures.

the other reason is assuming you find the person to be unconscious or not alert and possibly hypoglycemic, and you check the BGL and find it low, what can you do? you can't administer any IV sugar. if the person is alert, and a diabetic, they should be able to check their own BGL.

at least that was what I was told when I asked. I think if a 12 year old can check his family's BGL, than an EMT should be trained in how to do it as well. but that's just my 2 cents.

 

[Underoath87]

I'm supposed to take a BGL on every pt I bring to the ER (working IFT in Florida).

 

[HMartinho]

I believe there are two reasons for this. The first is that checking a BGL is considered invasive (as you are puncturing intact skin), and EMTs are not permitted to do invasive procedures.

the other reason is assuming you find the person to be unconscious or not alert and possibly hypoglycemic, and you check the BGL and find it low, what can you do? you can't administer any IV sugar. if the person is alert, and a diabetic, they should be able to check their own BGL.

at least that was what I was told when I asked. I think if a 12 year old can check his family's BGL, than an EMT should be trained in how to do it as well. but that's just my 2 cents.

Sure, we can not give IV glucose and unfortunately in Portugal we do not use glucose gel. However, as say our protocols, and as I learned in the various courses that I attended, we can give a pope of sugar (sorry but do not know the English term). We put 16 to 24 mg of sugar in a cup, 3 ml of water, and make a thick and concentrated pope of sugar, which is placed inside the cheeks, or under the tongue, which will be absorbed into the bloodstream.

 

[bushinspector]

Interesting thread. In Oklahoma you are allowed to check. In addition to this I been thinking about getting our medical director to be able to transport Pt with a class 5 drug.

 

[ethomas4]

I dont like to be rude online, but CA has got to change their protocols. For some reason in this state when you become an EMT you actually become a certified RETARD. The state needs to demand more out of their EMTs, if that requires more training, class, practice, weeding people out etc so be it, that is actually a GOOD thing!!


The only place where I have been able to check a blood sugar in CA was when I was working in an elementary school and the principal asked me check it on a 2nd grader twice a day. Ironic.

EMT B in CA is a joke. I have had the pleasure of working as EMT I and P in other countries and since we love to boast about how awesome we are here I love to educate people on how dumb we really are in EMS. I worked 8 months in MExico. Most Mexican EMS personnel put usa EMT Bs and Is to shame...unfortunately they lack money.

 

[JPINFV]

California doesn't have a statewide protocol.

 

[Akulahawk]

California doesn't have a statewide protocol.

They have something more like a state-wide menu of skills that the Local EMS agencies can pick from... and those agencies get to set the protocols for their system. I don't think I've heard of the State EMS Authority rejecting a LEMSA EMT-1 Protocol, as long as it's within the typical EMT-1 scope or a specific trial study.

Actually, it's the same way with Paramedics too...

 

[JPINFV]

"Statewide menu of skills"? I like the way that sounds.

 

[SeanEddy]

The service I work for allows EMT-Basics to check a BG. They can also administer oral glucose to correct the problem, assuming no contraindications for PO medications exists.

Having worked in California for most of my career, I can feel your pain.