Oral Glucose question...

[EMSpassion94]

Dispatched last night for difficulty breathing. Arrived to find patient c/o n/v. Difficulty breathing earlier in the day, but took 1 nitro tab which relieved symptoms. Stated he was diabetic, so I obtained BG which stated 47. The AIC in charge gave the tube to the PT and told him to eat it slowly. I was always taught in EMT class that you never want the patient to "eat" the oral glucose, but to put it on a tongue deppressor and apply it between the cheek and the gum. Which is the right answer, or are they both acceptable??

Thanks.

 

[MrBrown]

We give the patients something sugary to eat if they have something around; fruit juice, soda, jam (jelly) sandwich etc or 50ml of 10% glucose in a syringe to self administer (we also do the same with paracetamol).

Brown is more interested to know in why you gave this patient GTN?

 

[Shishkabob]

I give them a tube and have them take the whole thing.

Brown is more interested to know in why you gave this patient GTN?

They didn't, he said the patient took their own earlier and it relieved the symptoms.

 

[Anjel]

Brown: The pt took the GTN on his own earlier from what I could understand.

And to the OP. If a patient is conscious and alert enough to eat then I would tell them to suck on the tube and eat it like frosting. If they are unconscious then you take a tongue depressor and just put it in their cheek. According to my protocols anyway. I don't really agree with that, because they could choke. But whatever.

 

[Cup of Joe]

Here, if the patient is not alert enough to swallow, no glucose for them at all. Preferred method for administering is using the tongue depressor to place it between the cheek and gums.

 

[Shishkabob]

It's not so much that you'll "choke" on the glucose, it's the fear of aspiration from over-zealous people putting the whole tube in at once.


Or family members, for that matter... yup... I've had a family member empty 2 tubes in to a patients mouth before calling us, and we had some suctioning to do on arrival.

 

[traumaluv2011]

I've got my book here (Brady Emergency Care 11th Edition) and they say the preferred method is to put a little bit at a time of glucose on a tongue depressor and put it between the gum and the cheek. It will take effect faster than it would if it goes to the stomach. They do say that the patient can alternatively squeeze the glucose into his/her mouth.

It also says if the patient is completely unresponsive, transport managing the airway, checking pulse often, etc. Do not try to administer glucose. You may also want to request ALS intercept if possible.

 

[EMSpassion94]

Exactly WHY would it work faster between cheek and gum verses ingestion? And yes, the patient administered their own Nitro earlier in the day. We did end up intercepting with ALS, who then administered D-50, which boosted his BG up to 116.

 

[crazycajun]

Exactly WHY would it work faster between cheek and gum verses ingestion? And yes, the patient administered their own Nitro earlier in the day. We did end up intercepting with ALS, who then administered D-50, which boosted his BG up to 116.

Quicker route between cheek and gum vs digestion into blood stream. Think Nitro sub vs digestion.

 

[Hunter]

. According to my protocols anyway. I don't really agree with that, because they could choke. But whatever.

I was taught to NEVER do this, like someone else said, the danger here is aspiration, I would just go with glucagon or 50% Dextrose in these cases if possible, if not than monitor and high flow diesel. Either get em to a hospital or ask for ALS back up.

 

[Anjel]

I was taught to NEVER do this, like someone else said, the danger here is aspiration, I would just go with glucagon or 50% Dextrose in these cases if possible, if not than monitor and high flow diesel. Either get em to a hospital or ask for ALS back up.

I dont agree with it but its protocol. I might accidently loose the glucose before getting to the hospital. Or before ALS gets there which they should be there first anyway. But things happen.

 

[mikie]

it varies...

having never done it i will say anecdotally...

I was taught to NEVER do this, like someone else said, the danger here is aspiration,

Well, the fine state of Maryland does permit the administration of oral glucose for the unknown [etiology] unconscious/AMS pt (BLS level), applying between the gum and teeth.

At the NR level...no. Oral glucose is contraindicated for the patient with an uncontrolled airway (i.e. unconscious, inability to swallow secondary to AMS)...

 

[JPINFV]

It's not so much that you'll "choke" on the glucose, it's the fear of aspiration from over-zealous people putting the whole tube in at once.

I honestly wonder how many rules are because of the all/none training that's prevalent in EMS.

 

[Shishkabob]

I honestly wonder how many rules are because of the all/none training that's prevalent in EMS.

*cough* paper bags and hyperventilation *cough*

 

[jjesusfreak01]

*cough* paper bags and hyperventilation *cough*

Pt this week with an ETCO2 of 15. He was tripping on something and ended up getting some vitamin H to calm him down a bit. Still couldn't stop him from pulling his IV when we arrived at the hospital though.

As for oral glucose. I don't think I would personally have a problem administering a little bit on the gums if I was the only EMT onscene with no close ALS unit. I might call Med Control for a little moral support though since its against protocol. Its going to get absorbed and if you don't overdo it then its unlikely to be an airway problem. Being as I work in an ALS system though, i've never seen oral glucose used. IV + D50 + Sandwich is usually the cure. If we can't get an IV immediately, glucagon + sandwich and a BGL of over 100 before we leave them at home.

 

[EMSpassion94]

Pt this week with an ETCO2 of 15. He was tripping on something and ended up getting some vitamin H to calm him down a bit. Still couldn't stop him from pulling his IV when we arrived at the hospital though.

As for oral glucose. I don't think I would personally have a problem administering a little bit on the gums if I was the only EMT onscene with no close ALS unit. I might call Med Control for a little moral support though since its against protocol. Its going to get absorbed and if you don't overdo it then its unlikely to be an airway problem. Being as I work in an ALS system though, i've never seen oral glucose used. IV + D50 + Sandwich is usually the cure. If we can't get an IV immediately, glucagon + sandwich and a BGL of over 100 before we leave them at home.

You're allowed to give you patients a sandwich to eat? In MY class we were taught to not give out patients ANYTHING to eat or drink by mouth. What are your protocols?

 

[NomadicMedic]

You're allowed to give you patients a sandwich to eat? In MY class we were taught to not give out patients ANYTHING to eat or drink by mouth. What are your protocols?

Most ALS agencies allow for a "treat and release" for hypoglycemia. Once you correct their sugar, they need some carbs, not a trip to the hospital.

 

[Shishkabob]

You're allowed to give you patients a sandwich to eat? In MY class we were taught to not give out patients ANYTHING to eat or drink by mouth. What are your protocols?

Welcome to the real world of medicine where things tend to be 50 different shades of gray instead of black and white.



If I'm able to treat a patient and leave them at home, that's my goal. I'll start an IV, give them some D50 so they wake up, and then spend some time with them so they can eat crackers / eat a sandwich / drink soda. D50 brings their BGL up fast, but it crashes back down almost just as fast, and they need something more substantial.


I've been known to spend over an hour on scene with a diabetic just to secure a refusal, when a trip to the hospital and back would have been the same length of time.

 

[usalsfyre]

The two most dangerous words in medicine are never and always.

 

[Shishkabob]

The two most dangerous words in medicine are never and always.

I thought they were "Quiet" and "Slow"?:rofl:



Speaking of which, usal, I hope you're having a very quiet, slow, boring, and uneventful shift in H-town today