I prefer playing cards with the nurses in my downtime.When we're OOS for maintenance, or other reasons I'll try and rotate IV starts with the nurse while running calls in metro. And yes, doing the occasional OT ground shifts certainly seems to help keep things fluid.
It's the golden handcuffs challenge....it pays a lot (mostly as a result of the 24/48) and I need a job to find a (better) job with. Rent, bills, insurance, general life costs...it's frustrating, and thanks to this lease, we're relatively locked into Houston until 1/20.So why stay?
"Neonatal hypoglycemia, defined as a plasma glucose level of less than 30 mg/dL (1.65 mmol/L) in the first 24 hours of life and less than 45 mg/dL (2.5 mmol/L) thereafter."31 is not a normal newborn BGL.
I often forget about the American blood glucose metric. To us in the rest of the world a blood sugar of 30 mmol/L (540 mg/dl) would be cause for alarm lol."Childbirth is a BLS skill."
Mom partially delivers placenta and baby has a BGL of a 31.
Never once have I participated in a "normal" delivery.
What are we defining as symptomatic? There was discussion on scene that baby was symptomatic so a line was started and D10 given. Somehow it was an easy stick, if it wasn't I certainly don't think an IO was needed. A friend of mine is interning in the NICU and she says they just mostly use a little oral glucose for this so maybe we'll try that next time.Infants with a nadir below 40 are more likely to have a myriad of metabolic disorders and should be observed in the NICU. While rarely treated when unsymptomatic and greater than 30 (other than feeds) that doesn't make it normal. Many infants will not have need for further treatment, but that doesn't negate the need for evaluation.
Unfortunately I think that is a bit hard to nail down, and the answer is going to change from clinician to clinician.What are we defining as symptomatic? There was discussion on scene that baby was symptomatic so a line was started and D10 given. Somehow it was an easy stick, if it wasn't I certainly don't think an IO was needed. A friend of mine is interning in the NICU and she says they just mostly use a little oral glucose for this so maybe we'll try that next time.
This is some awesome info. Definitely a precipitous delivery with an initial APGAR of 8 and mostly from some blue hands and feet that improved with warming. Baby appeared tired to me, but seems expected. Definitely not floppy but again I think EMS is kind of afraid of non-feisty infants.Unfortunately I think that is a bit hard to nail down, and the answer is going to change from clinician to clinician.
To me speaking from more of a peds ED/PICU (we take premies through adults if they are cardiac) perspective I look at tone, perfusion, breathing, neuro status, and ability to feed. We tend to be a bit more on the aggressive side just because of the high risk nature of our patients.
If everything looks good and other than being low the kid has no symptoms I would probably just feed them, a newborn mom really isn't likely to have her milk supply come in well yet so I'd probably give them formula or we can give donor milk if the family prefers. Colostrum also doesn't have a great concentration of carbohydrates so for a kid who is low I wouldn't rely on it.
If the kid has less ideal tone (like poor hip strength or less than vigorous cry, not even close to a floppy baby) or has poor suck-swallow-breath coordination but otherwise looks good I would consider an OG for a first small feed and then reassess, since we have such a large number of cardiac kids we tend the pull the trigger on NJ placement pretty early but that certainly isn't universal.
If the kid has poor tone, altered neuro status, any form of distress, or is known to have any kind of medical issue that prevents feeding like a TEF then I would have no problem with UVC/IV placement and giving parenteral glucose. NRP/STABLE allows for a solution of up to D12.5 through a PIV (I would just stick to D10 initially unless there is an issue where we are concerned with overload), if there ends up being an issue where we need to give higher concentrations then we need to look at central access but that isn't really applicable to 911 systems.
I hesitate with the idea of oral glucose only because often the products that EMS carries are thickened and I'm not comfortable enough assessing swallow reflexes to give it to a newborn. We often think that thickened liquids are safer because that is what we give to older kids and adults with various dysphagias but I wouldn't be comfortable assuming the same would hold true to a newborn. If you wanted to give a glucose solution in lieu of formula or breast milk we give sweet-ease all the time which is essentially just D24, I think the recommendation is based off of D5 for oral feeds.
NICU nurses who see more normal births, pediatricians who see newborns in hospital, well baby nurses, and so on may have a bit different of a view just because of the population they see on a regular basis.
I don't think that a 2-4 mL/kg dose of D10 from EMS is inappropriate, especially if you have longer transport times and the kid is fairly easy to access. Keep in mind that you can also use an angiocath (without the needle introducer, historically we have used 20 guages) in the umbilical vein as a makeshift low line if needed, I believe they are still teaching this in NRP. My personal opinion is that all field births are inherently high risk, either something didn't go to plan with a home birth or something prevented them from delivering in a hospital/birthing center as planned (whether it is a precip, result of trauma, substance use, or whatever else); as a result I tend to be a bit more aggressive with field birth management.
I'll attach a couple of links from various programs, keeping in mind that this is largely from the view of NICUs and not EMS/Peds ED management. I'm not sure if your department has an affiliation with either of the pediatric systems but both offer outreach, we have a neonatal specific education team including premature and newborn simulations and I think that they are a great resource.
Guidelines for the detection and management of hypoglycemia, hyperglycemia, and normoglycemia in preterm and term neonatesGuidelines for detecting and managing hypoglycemia, hyperglycemia, and normoglycemia (blood glucose levels) in both term or preterm infants.uichildrens.org
I think the mg per decilitre are only used in US and Germany, the rest of the world is using mmol/L. But it is easily converted either way, after all it’s based off of glucose’s molecular weight.I often forget about the American blood glucose metric. To us in the rest of the world a blood sugar of 30 mmol/L (540 mg/dl) would be cause for alarm lol.