Thoughts on taking BGL as part of your assessment.

[Iowaemtb]

When you have a call and it's medical or even a mva, do you routinely check the BGL? Why or why not? Is it part of your protocols? Just your routine assessment?

 

[TransportJockey]

Unknown medical I usually do it. Unconscious unresponsive I do it... And any time I start an IV I get one from the stick.
Edit: of course any diabetic call gets a CBG stick.

 

[NYMedic828]

Syncope, unconscious, unknown, diabetic history.

It's minimally invasive and can't hurt...

 

[Iowaemtb]

Syncope, unconscious, unknown, diabetic history.

It's minimally invasive and can't hurt...

We do it for those reasons as well. We did a stick on a guy who had a minor accident on the interstate, he was confused, sweating profusely, etc. One of the not so bright firemonkey's said he was drunk and that was that, I took his BGL and it was 40, he was still conscious, administered Glucose on the way to the hospital he was coherent by the time we got there.

I don't see it as invasive, yet some states think it is and it is not a B level skill.

 

[CANDawg]

I would definitely do it for any trauma, especially MVCs. (Who knows WHY she crashed into a tree?) As for medical, I would even say most medical patients should get it too. It's very minimally invasive, and can sometimes come in VERY handy.

You have a 65 y/o male, hx of angina complaining of chest pain? May not seem related, but maybe he hasn't eaten recently because of the pain. He could be on the verge of AMS without you even knowing it. One stick and all of a sudden you're ahead of the curve instead of struggling to catch up to something you could have prevented.

 

[leoemt]

I wish I could do it, but even though its a Basic skill here in WA State - King County doesn't allow basics to do it. Have to call a medic which makes no sense to me.

I have had two patients in the last week that unresponsive due to being Hypoglycemic. One patient was a legitimate Medic call - didn't even respond to IV Glucacon (or what ever it is you medics give).

 

[TransportJockey]

I wish I could do it, but even though its a Basic skill here in WA State - King County doesn't allow basics to do it. Have to call a medic which makes no sense to me.

I have had two patients in the last week that unresponsive due to being Hypoglycemic. One patient was a legitimate Medic call - didn't even respond to IV Glucacon (or what ever it is you medics give).

D50. And i still can't understand basics not being allowed to check a CBG... our basics in nm do it all the time

 

[CANDawg]

D50. And i still can't understand basics not being allowed to check a CBG... our basics in nm do it all the time

I agree. It seems so weird. There must be some type of mental barrier in the brains of some medical directors about 'breaking the skin'.

Odd. :wacko:

 

[Fish]

When you have a call and it's medical or even a mva, do you routinely check the BGL? Why or why not? Is it part of your protocols? Just your routine assessment?

I do it if I have a reason to, altered, unresponsive, CVA, seizure....... stuff along those lines. I don't follow the "it can't hurt" I do stuff for a reason. If I followed the "couldn't hurt" mentality, I would also perform stroke scales, 12Leads, and a tilt test on every single patient as well. But I don't, I do these skills or assessments as indicated.

I do not do it for traumas, unless they had a medical cause to them. Had a seizure then crashed, got dizzy and crashed. Not, I was texting while driving and ran into the guard rail. I would slap someone trying to stick me with a lancet in a collision that I didn't even cause just because it was ther "routine" I think it hurts to get your sugar checked, and I do not like it.

I don't do it on every patient as part of my normal vitals, checking a BGL stings and it is another added cost to the patient's bill.

 

[TransportJockey]

I agree. It seems so weird. There must be some type of mental barrier in the brains of some medical directors about 'breaking the skin'.

Odd. :wacko:

I dunno.. then again nm has an extremely broad definition of BLS

 

[NYMedic828]

I don't actually take it on every patient with diabetes like a hospital does. BUT, if I am RMAing a patient I do everything but a 12 lead (unless its a chest pain or something)


For the record to the above posts, anything that breaks the skin is considered invasive even if it is as minimal as a fingerstick.

 

[Fish]

I dunno.. then again nm has an extremely broad definition of BLS

Round these here parts our Basics can check BGL, give ASA, Albuterol, Nitro, Epi 1:1000 IM(by drawing it up, not an EPI pen) Oral Glucose, and Oxygen. They give a good amount of life saving drugs.

 

[leoemt]

D50. And i still can't understand basics not being allowed to check a CBG... our basics in nm do it all the time

We can do it in the rest of the State. When I work in Whatcom County I can do it.

Whats weird is King County wont let me check a BGL but I can transport a patient with running D50 and I can calculate and adjust drip rates based on doctors orders. I think that is probably a lot more risky than giving someone a finger stick.

I can also have the patient or their family check the BGL for me and administer Oral Glucose based on that.

 

[NYMedic828]

In NYC basics can't check BGL. In NYS, they can.

It's really stupid. Would save me a lot of runs to BLS CVA jobs that the BLS crew assumes to be a diabetic... Granted they should still know better without BGL but it can be tricky sometimes...

 

[Fish]

We can do it in the rest of the State. When I work in Whatcom County I can do it.

Whats weird is King County wont let me check a BGL but I can transport a patient with running D50 and I can calculate and adjust drip rates based on doctors orders. I think that is probably a lot more risky than giving someone a finger stick.

I can also have the patient or their family check the BGL for me and administer Oral Glucose based on that.

Weird

 

[Fish]

In NYC basics can't check BGL. In NYS, they can.

It's really stupid. Would save me a lot of runs to BLS CVA jobs that the BLS crew assumes to be a diabetic... Granted they should still know better without BGL but it can be tricky sometimes...

We can't call a Code stroke without getting a BGL first, since it can mimmick. The stroke centers want us to rule out hypoglycemia before we activate the team at the Hosp.

We run off of the LA Stroke Scale

 

[NYMedic828]

We can't call a Code stroke without getting a BGL first, since it can mimmick. The stroke centers want us to rule out hypoglycemia before we activate the team at the Hosp.

We run off of the LA Stroke Scale

I don't think anyone should competently activate a stroke team without ensuring it is not a hypoglycemic event. It takes all of 30 seconds and you look pretty dumb to top it off if it ends up in fact being a hypoglycemic and you don't check. People remember...

But for BLS units to not be capable of the same diagnostic a patient can perform on themselves, which may save 20 minutes in me having to show up to reassess the patient for them and allow for more extensive cerebral damage, is ridiculous.

The state allows EMTs to do glucometry for the last 3 years. The city has not adopted it.


Though the city does allow our EMTs to administer an epi pen for asthma and the state does not.

The state just started BLS narcan pilots and the city has not.


It's all ridiculous. One of my biggest gripes with EMS is how insanely diverse our scopes of practice are. As a medic my scope changes notably within 20 miles of my home in either direction between 3 sets of protocols.

It's fine when a provider is competent and works by clinical knowledge and experience and not a cookbook but it still leaves room to get in trouble when I go to give Valium for a seizure and forget it isn't a standing order where I volunteer and is where I employ.

 

[Fish]

I don't think anyone should competently activate a stroke team without ensuring it is not a hypoglycemic event. It takes all of 30 seconds and you look pretty dumb to top it off if it ends up in fact being a hypoglycemic and you don't check. People remember...

But for BLS units to not be capable of the same diagnostic a patient can perform on themselves, which may save 20 minutes in me having to show up to reassess the patient for them and allow for more extensive cerebral damage, is ridiculous.

The state allows EMTs to do glucometry for the last 3 years. The city has not adopted it.


Though the city does allow our EMTs to administer an epi pen for asthma and the state does not.

The state just started BLS narcan pilots and the city has not.


It's all ridiculous. One of my biggest gripes with EMS is how insanely diverse our scopes of practice are. As a medic my scope changes notably within 20 miles of my home in either direction between 3 sets of protocols.

It's fine when a provider is competent and works by clinical knowledge and experience and not a cookbook but it still leaves room to get in trouble when I go to give Valium for a seizure and forget it isn't a standing order where I volunteer and is where I employ.

I agree, a trained Medical professional should most certainly be able to on standing orders do a simple skill that people do on themselves all of the time. And Heck, they don't even clean the site first!

 

[Refino827]

We're actually required to take BGL as a part of our normal patient assessment. The only times we really don't are in the case of something like a lift assist, etc.

 

[Fish]

We're actually required to take BGL as a part of our normal patient assessment. The only times we really don't are in the case of something like a lift assist, etc.

Strange, so if I get rear ended at 5mph your gonna poke my finger?