Give a half amp D50W, reassess. Give the other half if necessary. I'm not sure if I ever had specific protocols for this, but that's the sort of situation where I was allowed to use judgment.
I don't know enough about the effects of glucagon in closed head injury to feel comfortable enough going with it if I have IV access. If I can't get IV access, then, yes, absolutely I'd give the glucagon IM.
Hypoglycemia is going to absolutely increase the rate of neuronal death in this patient. It needs to be treated. There's no point in ensuring the cerebrum is perfused, if the perfusion isn't transporting glucose.
My understanding is that glucose and neurologic outcome in head injury are correlated, but that no one's established causation yet. That is, sick head injury patients who end up more severely disabled have high blood glucose, but this may just be a consequence of the stress response. While avoiding iatrogenic hyperglycemia makes sense, I'm not sure if anyone's shown that this translates into better outcomes.
I don't know enough about the effects of glucagon in closed head injury to feel comfortable enough going with it if I have IV access. If I can't get IV access, then, yes, absolutely I'd give the glucagon IM.
Hypoglycemia is going to absolutely increase the rate of neuronal death in this patient. It needs to be treated. There's no point in ensuring the cerebrum is perfused, if the perfusion isn't transporting glucose.
My understanding is that glucose and neurologic outcome in head injury are correlated, but that no one's established causation yet. That is, sick head injury patients who end up more severely disabled have high blood glucose, but this may just be a consequence of the stress response. While avoiding iatrogenic hyperglycemia makes sense, I'm not sure if anyone's shown that this translates into better outcomes.
