To check a blood sugar, or not check?

I'll throw a complication into this...

The glucometers we all use in the field are the same used by patients for daily testing. FDA standards haven't changed for these units since the mid-1980s, where they were only required to have a sensitivity or accuracy range of +/- 20%. Yes, I said that right- glucometers in the US have a margin of error of +/- 20%.

Some links that discuss and provide research/evidence:

http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm187406.htm
http://www.scribd.com/doc/28534516/FDA-ISO-Standards-for-BG-Meters-06-24-2009
http://www.nytimes.com/2009/07/19/h...l=1&adxnnlx=1298124021-fEgRNPsG/iimfRts+yVQSg
http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=26309
http://www.ncbi.nlm.nih.gov/pubmed/16143321

So, thoughts? Knowing that this tool may potentially be inaccurate, how does it play into your clinical assessment?
 
emt.dan said:
I'll throw a complication into this...

The glucometers we all use in the field are the same used by patients for daily testing. FDA standards haven't changed for these units since the mid-1980s, where they were only required to have a sensitivity or accuracy range of +/- 20%. Yes, I said that right- glucometers in the US have a margin of error of +/- 20%.

Some links that discuss and provide research/evidence:

http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm187406.htm
http://www.scribd.com/doc/28534516/FDA-ISO-Standards-for-BG-Meters-06-24-2009
http://www.nytimes.com/2009/07/19/h...l=1&adxnnlx=1298124021-fEgRNPsG/iimfRts+yVQSg
http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=26309
http://www.ncbi.nlm.nih.gov/pubmed/16143321

So, thoughts? Knowing that this tool may potentially be inaccurate, how does it play into your clinical assessment?
Click to expand...

Every piece of medical device or test has some level of inaccuracy. You correlate what you see as the results with what you see on the patient.

When we see asystole on the monitor, the first thing we do isn't open the airway, check for breathing, give rescue breaths, and start CPR.

The first thing we do is look at the patient to see what they are doing.

Why would a blood glucose be any different?

If it came back as say 60, with the error, that could be 48 or 72. If it was 72 and I gave them some glucose, so what?

If it was 500 it could be 400 or 600. How does that change anything?

What really makes a change is the pathology of why the number is such. Which is not always going to be possible to discover without more specific testing.

In EMS as well as all parts of medicine, you make the best decision you can with the information you have. It is not always perfect.
 
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usalsfyre said:
Statements like this always confuse the heck out of me. How is a BGL "arbitrary"? It's a pretty concrete number, if it correlates clinically than you treat it. The whole "treat the patient not the monitor" argument is complete bull skat to me, if we're going to do that why do we carry the dang things around? To me this is just an excuse that really says "I can't clinically correlate vital signs and diagnostic results to patient condition".




Agreed



So hospitals don't routinely run labratory diagnostics, including BGL, in these types of cases? I'm fairly big on patient comfort, however your the first person I've ever heard describe this procedure as "cruel". It's a pin pr!ck. I've had it done, it hurts for 10 minutes then stops. A lack of critical thinking is saying things like "syncopal episodes (an alteration in LOC) are NEVER caused by hypoglycemia". I've had a patient who when asked the normal four questions was alert and oriented, but seemed just a little "off". His BGL was 24.



Why are we sticking patients at all? My patient just a few minutes ago complained about the B/P cuff, so is it cruel to use it? Medical care is sometimes uncomfortable. I won't argure our education is horribly deficent, but I can't say routinely obtaining a BGL is ANY proof of that. A FSBGL is, if not exactly a benign test, pretty dang close to one. I'm having a hard time wraping my head around how obtaining another piece of information in a relatively harmless manner marks one as a bad medic.




Agreed.
Click to expand...

You didn't read the post, people seeming "off" should get a BGL. I don't base AMS off whether they can answer the magic 4 questions.

Also in the hospital a BGL is automatically run with labs, not at the point of care. For example, the iStat devices run a BGL with the Chem test automatically so it's a number that will just come with the other numbers that you want.

My question is: if you take a BGL on an 18 yro male, mechanical fall from a bike with no past history that is awake and appropriate, and it comes back at 55. Are you going to treat that? If not than why did you take it in the first place.

I'm not saying there isn't a large portion of patients that need their BGL checked. I think I check about half my patients BGL due to being drunk or "off". But I certainly don't check it routinely on everyone.
 
Anyone with a hx of diabetes, patients with altered conscious states and PTS where I am unsure of the cause of their woes get a BSL done. This means most pts. The amount of times I have done a BSL just in case including on trauma PTS and found hypo/hyperglycaemia warrants this. Let us be real, this is not really a very invasive procedure particularly on diabetics who do it on themselves frequently. If in doubt check it.
 
Amycus said:
On arrival, the medic asks why I took a sugar, saying it was basically not indicated due to not being true AMS, and the nature of the call being cardiac- also making a point that if the glucometer gave an incorrect reading, patient care/treatment may have gone in the wrong direction. My partner basically agreed, said if it was her tech, she wouldn't have checked.
Click to expand...

They are entitled to think whatever they like; it doesn't mean that they are correct. Good job getting a BGL.
 
I tend to go for a CBG if it's an elderly female hispanic, someone on dialysis, someone w/ a hx of diabetes, hx of malnutrition, hx of ETOH abuse or intox, actin funny, suspected CVA, or just about whenever I feel that it might benefit the patient.
 
Interesting, Thanks Must have a read up when I have time
 
Let me preface this by saying I only read OP's posts.

I don't see any reason to not take the BGL, especially considering that the pt has a hx of DM. I don't care if the pt is presenting with obvious hypo or hyperglycemia. I'm going to get a BGL just to add that in to the overall picture. It only takes a moment to check, and there is no contraindication for obtaining a BGL. Just remember to treat the patient and not just the numbers.

Don't let the other medic get to you. It's your call.
 
Given the scenario in the beginning.... totally appropriate. Did well grasshopper.

To expand on further posts... I don't do them on every call or every pt, I will take in account of history, scenario, clinical findings, good judgement and go from there. We actually have protocols that define when it will be used, if it is outside of that and appropriate, it will be done. But I do not support the "Lets do every test in the book cause we can and cover our butts".... Many new doctors do this, and it drives up unneeded bills. The missed diagnoses is far and few in between when a strong clinician does a good job and does not do drive-thru medicine. Media pumps that malpractice fear into us.
 
you did the right thing, although the pts sob and cp could be contributing to the ams, pt is a diabetic so its better to check. plus our local protocol is that any pt with ams not from an obvious traumatic inj gets a finger stick, even obvious strokes....
 
I check blood sugars on just about every patient I come across. I've seen people be standing up talking to me, c/c of just not feeling well, and their BGL be in the low 40's. It does'nt hurt to check!
 
I see nothing wrong with checking a BGL on the pt you described. I check a BGL on almost all of my PT's, if they are sick enough for an IV they are sick enough for a BGL check, just treat it as you would a BP, Pulse, respirations, O2 sat, cardiac monitor ect its all a dianostic tool to help you determine the proper course of treatment (yeah I know EMS dosen't diagnose , we only treat S&S)
BTW a finger stick is not crule I am a diabetic and check mine ever day twice on sunday.
 
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