Treating hyperglycemia on a BLS level.

[Explorer127]

Is there anything that can be done for the pt?
For example, BGL of 220, what can you do for them?

 

[vquintessence]

Nope, nothing for ALS either since we don't carry insulin, and thank god. Who the hell would want to guess the units to give. No training - education = me? no thanks. Damn now ya gots me curious.

Willing to bet that pt can tolerate that BG anyhow. Just keep in mind what the number could represent. High BG can represent an active infectious process.

 

[Ridryder911]

Take them to the hospital.

R/r 911

 

[rhan101277]

Take the to the hospital is my answer as well.

 

[akflightmedic]

You tossing 220 out as an example reflects the lack of knowledge you posses in regards to care and treatment needed for diabetic patients.

Do them a favor and transport.

Do yourself a favor and continue advancing your medical education and once you are at an educated and experienced level to treat these sort of things, you will look back and realize how silly you once were.

Yes, I was silly. I still am silly. I learn more each year, look back and say, man...just last year I was silly.

 

[daedalus]

You tossing 220 out as an example reflects the lack of knowledge you posses in regards to care and treatment needed for diabetic patients.

Do them a favor and transport.

Do yourself a favor and continue advancing your medical education and once you are at an educated and experienced level to treat these sort of things, you will look back and realize how silly you once were.

Yes, I was silly. I still am silly. I learn more each year, look back and say, man...just last year I was silly.

Amen.

Yesterday I got a call from an EMT co-worker asking me if a BS of 300 needed CCT level transport (it was an IFT). I laughed and asked him what the patient looked like "Awake and talking, no apparent distress".

We regularly saw non-compliant DM II patients at a community free clinic I volunteered at, and would present to the outpatient clinic with BS sometimes up to 500. Dangerous and terrible for you, but geez they must tell EMTs to only worry about numbers in school or something.

Note- the following is not directed at the OP, or anyone on the board, just some frustrations of mine
I also got into an argument with my partner last night, he thought as EMTs we had a solid grasp of medicine. I asked how his 2 hours of A&P, no pathophysiology, and cursory descriptions of the most basic diseases made him qualified to have a grasp on medicine. This guy thinks that knowing how to take vital signs and knowing high/low values is the same thing doctors are taught, he must think the pool of knowledge is pretty shallow.

Me "tell me about essential hypertension than, if you know all about it because you can take vital signs. I want the pathophysiology nuts and bolts"

Him "Hypertension means high blood pressure. Like, 150 and up is pretty high"

 

[JPINFV]

We regularly saw non-compliant DM II patients at a community free clinic I volunteered at, and would present to the outpatient clinic with BS sometimes up to 500. Dangerous and terrible for you, but geez they must tell EMTs to only worry about numbers in school or something.

Highest I've seen (well, heard during report) was on a CCT IFT for patient who walked into the ER with a BGL around 1500.

 

[Explorer127]

You tossing 220 out as an example reflects the lack of knowledge you posses in regards to care and treatment needed for diabetic patients.

Do them a favor and transport.

Do yourself a favor and continue advancing your medical education and once you are at an educated and experienced level to treat these sort of things, you will look back and realize how silly you once were.

Yes, I was silly. I still am silly. I learn more each year, look back and say, man...just last year I was silly.

I really, really do not need you tell me that I don't know how to care and treat diabetic patients and that my question "reflects the lack of knowledge" that I posses.

I am not yet an EMT and I have not yet taken an EMT class. I'm an explorer who is trying to learn a few things about patient care.

If you didn't mean that as an insult, I apologize for jumping out on you like that....

Anyways,

Let's say the pt is not diabetic, and has a BGL of 220 and is "not feeling right"... What can cause that? And once again, there is nothing that can be done for the pt? Is there anything that can cause a false-high reading?

 

[JPINFV]

No, there's nothing to do prehospitally for a patient with an elevated BGL of 220. Yes, the value you're using shows inexperience and you probably won't understand what we're talking about until you complete school and start working. Complaining that a BGL of 220 is elevated is like saying a respiratory rate of 26 is elevated. Sure, both are technically elevated, but neither are emergent situations.

 

[rhan101277]

I really, really do not need you tell me that I don't know how to care and treat diabetic patients and that my question "reflects the lack of knowledge" that I posses.

I am not yet an EMT and I have not yet taken an EMT class. I'm an explorer who is trying to learn a few things about patient care.

If you didn't mean that as an insult, I apologize for jumping out on you like that....

Anyways,

Let's say the pt is not diabetic, and has a BGL of 220 and is "not feeling right"... What can cause that? And once again, there is nothing that can be done for the pt? Is there anything that can cause a false-high reading?

Well i am a new EMT myself. I don't know what would cause a false-high reading, besides outdated strips or hosed glucometer. If someone has a high BGL, then their body is not able to use glucose and it just keeps going up. Soon the body has to use fat reserves for energy which causes you to start to see the signs of hyperglycemia. Once it is high enough maybe over 400 or so, you may start to smell a fruity odor on their breath. They will be thirsty, complain about urinating alot, skin should be warm and dry. I think hyperglycemic patients are in a danger of dehydration if they don't continue to drink. The acids created from your body trying to get energy from fat causes your blood to become more acidic and your body works to maintain homeostasis to that point. Your blood Ph can't stand to much movement before you start getting hosed, long time hyperglycemics probably have damaged capillary walls as well.

Anyway my 2 cent.

 

[seanm028]

Highest I've seen (well, heard during report) was on a CCT IFT for patient who walked into the ER with a BGL around 1500.

Walked into the ER? I'm impressed. Just goes to show you, there's never a black-and-white value for anything, especially vital signs. We've got guidelines, but every patient has different tolerances.

 

[JPINFV]

http://forums.studentdoctor.net/showthread.php?t=115359

Emergency Medicine Residency Forums "Hall of Fame" thread. Chock full of amazing lab values.

 

[rhan101277]

Lol I like that forum..

Pick up a sprained ankle in the ortho room... Dont need an xray per your medical expertise... patient insists b/c her friend had the exact same fall and had a fracture..order the xray, easier than the fight.

This thread is a hoot.

http://forums.studentdoctor.net/showthread.php?t=595297

 

[mycrofft]

Cutting back to the OP...Good on you for asking the question!

Hm. I'd be a lot more concerned about other stuff which can kill or disable you between point A (pt location) and the receiving hospital. 220 is not emergent by itself. It is not good long-term. Look up the subject in the American Diabetes Association website, etc.

BLS level: any unconscious diabetic needs transport pronto. A diabetic pt who tells you they are hungry, are diapohoretic, or thirsty, as long as they are capable of swallowing safely and it is in your protocols, ought to either give them glucose (a little gel or honey at a time is safest), or allow them to do their glucose thing (most diabetics have a way worked out). If nausea or trouble swallowing are any sort of consideration, just get em in. Do not abbreviate your assessment due to discovering diabetes, they can also have other serious considerations like the rest of us, but don't dawdle because diabetic ketoacidosis IS an immediate emergency.(Again, look to your texts' portocols, and the ADA website).

Diabetic control is a wobbly tripod of insulin (endogenous or artifical), glucose metabolism (faster when exercise and wound healing or disease recovery are occurring), and diet (including sugars, starches which the body can convert to sugars, and proteins/fats which the body has a hard time using to fuel organs and esp. the brain). If you start pushing one leg of a tripod up or down, the whole thing loses balance, and subsequent attempts to recover balance while it's tottering can bring it crashing.

PS: Who had a blood glucose measurement of 1500?! Mrs Butterworth?

 

[mycrofft]

Metacommunicative note

Explorer and AK, (and everyone else) I wish we could get together for a beer (or root beer for us teatotalers). We're on the same page, it is just hard to read people's faces when they are immobile and the size of a postage stamp.

 

[WiFi_Cowgirl]

Call a helicopter, and take the time you would have used for transport, to get donuts.

 

[VentMedic]

PS: Who had a blood glucose measurement of 1500?!

I'm hoping you are asking that as a serious question since it could lead to a great discussion for DKA vs HHS.

 

[BossyCow]

Is there anything that can cause a false-high reading?

Yes there is. I saw a peg the meter reading (my glucometer read "HIGH") from a pt who was to all appearances fine. Turns out the EMT who did the stick didn't wash the area first. The pts hands were sticky and the sugar from the candy she was eating to raise her blood sugar was all over her fingers. Not allowing the alcohol to evaporate from the test sight also can skew a reading. But these are operator errors.

Highest reading I've ever seen was 800 and something

 

[mikeylikesit]

as a diabetic let me educate. a high for one diabetic may be a normal for another with poor control. 300 may be what the patient likes to keep his BS at for activities. 220 is normal for someone who works out as it is recomended so they don't crach while there exercising. high glucose can be treated in many ways, fastest in R or Regular insulin which take effect in 5 minutes and is out of there sytem in 1 hour, most common is give them liquads and let them pee it out if you have a long transport. most diabetics will pee out anything over 180 mg/dl. this is not as fast as insulin but it does work. keep in mind that there are hundreds of reasons a diabetic gets high readings for example adreniline will spike it due to the breakdown of glycogen. False readings can occur if the meter is not properly coded, unwashed hands, ALTITUDE, anxiety, water or alcohol still on the finger at the time of sampling.

 

[daedalus]

Lol I like that forum..

Pick up a sprained ankle in the ortho room... Dont need an xray per your medical expertise... patient insists b/c her friend had the exact same fall and had a fracture..order the xray, easier than the fight.

This thread is a hoot.

http://forums.studentdoctor.net/showthread.php?t=595297

There is an actual scale that can rule out ankle fractures diagnostically without x-ray. Its got like a 95-98% sensitivity and specificity. It escapes my mind the name of it.