Scenario time.

[TTLWHKR]

We do the same thing with the large red biohazard bags. We also use those wooden needle point hoops to hold the bags open.

Now that I can relate to...

But a pillow case sounds weird.

 

[dhpd9807]

Speaking from personal experience I think the rumor that ETOH lowers blood sugar may be just that,a rumor. Unless all the bruises, lacerations and shame can be blamed on hypoglycemia.

 

[mightymom7]

Here's a nifty link from the American Diabetic Association about the effects of alcohol and diabetes.

http://www.diabetes.org/type-1-diabetes/alcohol.jsp

We're an all ALS system here -- so I'd check her BS, strap her to stretcher, throw her on the monitor, initiate ALS enroute -- and give hospital heads-up. Here we take all OD's to the closest hospital -- usually no more than 10-15 min away (unless they're on divert or closed) Monitor closely and diesel all the way to the ER.

 

[TTLWHKR]

I'd focus on the two meds she has taken, both of which can bottom out the BP, and one of the LISTED side effects is cardiac arrest in OD.

 

[EMR06]

I love reading all of your responses. Thank you.

 

[Kendall]

o/a - assess a+o, ABC's, vitals, drugs taken + approx vol. Start O2 @ 8LPM on an NRB, check sugars. If avail, ask BLS to start a line for fluids/diabetic substances & start 3-lead ECG. Monitor vitals and activate ALS. Prep for ALS transport and document.

The standard FR's route!

 

[DisasterMedTech]

I havent heard anything that sounds like HGL yes, so lets hang back on getting that BGL still since its one more thing our equation does need right now especially since we could be watching a patient who is preparing to code. EKG monitoring with other vitals q5m. Make report to receiving facility. If they advise interecept, you will probably have been thinking that way anyway and can just call it up. Treat pt as if for shock, 4 LPM/NC, start line in left a/c for acess and proceed as normal. What is time to facility now and what are our patients s and sx?

Advise.

 

[Rangat]

I am not entirely sure what all those meds do to a pt, but have picked up some things from the replies.

The BP is still normal for that patient, but you need more than one reading to see where it's going.

She is an Insulin Dependant Diabetic. So her cells will have trouble with glucose uptake. Won't this make her hyperglycaemic? She avoids the insulin question though, this could be because shes feeling guilty for not taking it.

I wouldn't administer glucose until a glucometer tells me to do otherwise, if she was cold/wet I would consider it more strongly.

fm_emt suggested that TCAs inhibit K+ uptake by myocytes?

But insulin supports K+ movement into cells, so would rapid acting insulin be a good idea if she starts showing some hypokalaemic EKG patterns? Just throwing it out there?

Lastly I would do something to protect the airway, perhaps lateral.

Lifting the legs and getting up a large bore should save you if her BP falls until u get to the hosp.

What u guys think?

 

[medic755]

I agree with TTLWHKR

Hold off on that Glucose...

Since it's BLS.. I'll try to contain myself.

Collect the med bottles, or at least write them down, note when they were filled and the dosage. O2 12 by NRB. Transport. Med Command>Poison Control for Charcoal. Get a sick bag ready, just in case, point head toward rookie. Get your aspirator set up, again, just in case. Maintain airway, use a nasal if she becomes unconscious, bag if the resps are shallow, labored or noisy.
Keep an eye on the BP, especially with a propranolol and amitriptyline OD. That's an HBP med and depression med, both can cause hypotension. Raise the feet if it goes to 90 systolic, plan ahead. The combination of the two, in high dose, can cause cardiac arrest really quickly.

Call ALS. In this case, it would be better to treat the diabetic problem via IV. You don't want her to aspirate the glucose. That will be the least of her problems.

This is an ALS emergency, in my eyes, if you have the resources.

If its ALS, the glucose will be checked, and treated appropriately. EKG will be put on and IV started. Plus the TCA overdose can be countered with sodium bicarb. The time of ingestion is also important to know, remember, activated charcoal cant be administered orally to someone who cannot maintain their own airway. Depending on transport time, and the aggressiveness of the medic, the patient can be administered the charcoal via NG tube.

For all levels: protect the airway, give her a NPA early, Rx for shock. And put the pt on a non rebreather, not a NC. This is a patient who is most likely going to crash, be wary and constantly assess and reassess

Also, this would be a good type of patient to restrain, just for safety sake. Here's one I learned from experience: patients who make a suicide attempt aren't always happy that they have survived and you are taking them to the hospital. Especially if they regain consciousness in the back of your rig. And ESPECIALLY if the patient is the size of a bull moose. like i said, you learn from experience (and bruises). lol

 

[1799687]

I'm with you on this one. ALS can also reverse that beta blocker with Glucagon, depending on DM status, and administer cardiac meds if necessary.

Hold off on that Glucose...

Since it's BLS.. I'll try to contain myself.

Collect the med bottles, or at least write them down, note when they were filled and the dosage. O2 12 by NRB. Transport. Med Command>Poison Control for Charcoal. Get a sick bag ready, just in case, point head toward rookie. Get your aspirator set up, again, just in case. Maintain airway, use a nasal if she becomes unconscious, bag if the resps are shallow, labored or noisy.
Keep an eye on the BP, especially with a propranolol and amitriptyline OD. That's an HBP med and depression med, both can cause hypotension. Raise the feet if it goes to 90 systolic, plan ahead. The combination of the two, in high dose, can cause cardiac arrest really quickly.

Call ALS. In this case, it would be better to treat the diabetic problem via IV. You don't want her to aspirate the glucose. That will be the least of her problems.

 

[reaper]

This is a ALS call.

But, the Betablocker issue was covered before. I have never seen a unit that carries enough glugagon on the truck to help with a BB OD.

 

[1799687]

understood, reaper, i'm just a basic, in medic school, going by protocol

 

[reaper]

If you have a protocal for glugagon for BB OD, then maybe your service carries enough on board? I know most around here only carry 2 mg on board. It is a very expensive drug. ($100 a pop) They don't like it used, except as a last resort.

 

[Mercy4Angels]

shes altered if shes slurring to you. so thats your contra indication for glucose usage. call medics i dont care if her vitals are what they are. her vitals can be fine one minute and not the next. get ALS in route. activated charcol is no longer used and we dont carry it so that rules that out also. Oxygen, bring her to the rig wether she likes it or not. shes altered so you can force her if you have to. wait for ALS or meet them line of sight.

 

[joo]

shes altered if shes slurring to you. so thats your contra indication for glucose usage. call medics i dont care if her vitals are what they are. her vitals can be fine one minute and not the next. get ALS in route. activated charcol is no longer used and we dont carry it so that rules that out also. Oxygen, bring her to the rig wether she likes it or not. shes altered so you can force her if you have to. wait for ALS or meet them line of sight.

thats what I would do. Only thing under my protocol I can't give glucose unless I can check her sugar, and I don't carry a glucometer so I better hope she has one around. More than likely for us PD is going to be enroute on scene because its a possible overdose. If its not dispatched as a poss overdose, you might want to get them enroute.

 

[DisasterMedTech]

shes altered if shes slurring to you. so thats your contra indication for glucose usage. call medics i dont care if her vitals are what they are. her vitals can be fine one minute and not the next. get ALS in route. activated charcol is no longer used and we dont carry it so that rules that out also. Oxygen, bring her to the rig wether she likes it or not. shes altered so you can force her if you have to. wait for ALS or meet them line of sight.

I think its time to go back to school. Simple altered mental status is not a contra-indication for glucose. Check your Brady's. Contras for oral glucose are: loss of consciousness/responsiveness and inability to swallow. The only time that being altered might be a contra for oral glucose is if you suspect that the patient is altered due to a TIA/CVA. Remember, water goes where glucose goes and since glucose goes directly to the brain since that's all it can "eat" you dont want to send a shot of it to the brain and then have possible increased ICP due to the homeostatic process. And if you are going to "force" a patient to do anything you better be %$#& sure they are altered or you may as well go home and flush your license down the toilet along with your paycheck. We dont "force" patients. Its called implied consent and you better document the hell out of it or your going to be staring down the business end of a malpractice suit. Remind me never to get sick in New Jersey.

 

[Rangat]

?

Why don't the USA have glucometers?

There's money to use Dual Lumen Airways on the road but not a glucometer?

It must be one of the safest invasive things to do pre-hospitally.

And I think the benefits of having a sugar reading is far more useful than the odd cellulitis, or the expense?h34r:

 

[DisasterMedTech]

Why don't the USA have glucometers?

There's money to use Dual Lumen Airways on the road but not a glucometer?

It must be one of the safest invasive things to do pre-hospitally.

And I think the benefits of having a sugar reading is far more useful than the odd cellulitis, or the expense?h34r:

We do have glucometers, its just that a lot of areas dont let EMT-Bs use them. We have them on my service, in fact I carry one on my belt and use it all the time. Im not sure what you mean by "the odd cellulitis" though....

 

[Rangat]

Ok. Yes I also saw the glucometer thread downstream.

Erm... Cellulitis was the only complication I could think of?

That and a paediatric patient will NEVER let you near him again. Once you drop the needle, you are out of the circle of trust buddy.

 

[bravofoxtrot]

Haven't finished reading this, but keep in mind that amitriptyline also inhibits noradrenaline reuptake.