tniuqs

I got some pictures of before and after on a river. First picture is a idyllic river and the 2nd picture is a raging torrent of a river, huge undulating waves.

Consider there is a person (alive by grace of god) being swept down the river. The river is only going to get worse downstream.

Do you attempt a swiftwater rescue or not ? Are there some rescues that are just not safe enough.

ALL Swift Water Rescues are inherently UNSAFE.

You never without the proper training, experience, gear, to jeopardize your own life to potentially meet your maker (whom ever that may be) Unless Heroism or Martyrdom is your end game. Or I will get a call (from God or his designate) to go find your beat to rat shit body.

Reach, Throw, Row, DON'T GO !

http://www.saw.usace...ater_safety.htm

Curtesy of PNN news http://www.paramedic-network-news.com/

** A Sunday morning water rescue attempt in New Jersey has cost the life of an EMT. WPVI (August 29) said Princeton rescuer Michael Kenwood succumbed to injuries incurred after being swept away by fast moving rapids brought on by Hurricane Irene. According to the newspaper, Kenwood was a member of the swift water rescue team. He had been dispatched to a vehicle on a flooded waterway to determine if any occupants were still inside. Told to stand down when conditions became too dangerous, Kenwood apparently lost his grip as an attempt was made to move him to safety. The vehicle was later determined to have been abandoned.

http://www.cbc.ca/ne...g-kootenay.html

A dive team has recovered the body of a 29-year-old search and rescue volunteer who drowned Wednesday during efforts to check a submerged car on the fast-flowing Goat River in southeast B.C. Sheilah Sweatman, of Ymir, a small community near Nelson, died after falling from a boat, and is the first search and rescue volunteer in B.C. to be killed in the line of duty."At about 4:15 p.m. during the course of their search efforts, utilizing swift-water line equipment and a swift-water craft, one of the search and rescue members went overboard into the river and did not surface," the RCMP said in a release Wednesday, before the body was found.The vehicle was later determined to have been abandoned.

Well as we let AK and Ruff sort out Gods involvement (in another thread) we are seeing an alarming trend here with drowning's during swift water rescue, hence one must logically must address cause, in case one this all dependant on "reporters" and some "conjecture" but both were called "trained" so just who trained them would be my first question, is that the famous International 3 course and golden accepted standard ?

I personally have a fair amount of experience in this area and have been involved with many real rescue situations in SW, Open water and Heavy Seas (more being in the right place at the right time that said) and I do NOT have that "ticket" in my plethora of cards in my wallet. Recovering the bodies, well I have too much experience in that area ... so what to do ?

So what is going on, is the training received delinquent ?

Or are the rescuers not following the established safety rules ?

When I was involved as an Instructor in this area .. Lines, Lines, Lines they can help or they can kill you.

No intent to disrespect the lost but to rationally deal with this issue one must put emotions aside and address the root cause, point being we can learn from others tragic mistakes and typically / statistically 3 errors are made before a fatality occurs.

Bummer .. but don't knock the perkys .. I have been known to eat them like pezz LOL ... weeeeee !

Yup you would be a great instructor .. and gimme a call any-time bro.

Curtesy of PNN news http://www.paramedic-network-news.com/

** A Sunday morning water rescue attempt in New Jersey has cost the life of an EMT. WPVI (August 29) said Princeton rescuer Michael Kenwood succumbed to injuries incurred after being swept away by fast moving rapids brought on by Hurricane Irene. According to the newspaper, Kenwood was a member of the swift water rescue team. He had been dispatched to a vehicle on a flooded waterway to determine if any occupants were still inside. Told to stand down when conditions became too dangerous, Kenwood apparently lost his grip as an attempt was made to move him to safety. The vehicle was later determined to have been abandoned.

http://www.cbc.ca/news/canada/british-columbia/story/2011/06/30/bc-sar-drowning-kootenay.html

A dive team has recovered the body of a 29-year-old search and rescue volunteer who drowned Wednesday during efforts to check a submerged car on the fast-flowing Goat River in southeast B.C. Sheilah Sweatman, of Ymir, a small community near Nelson, died after falling from a boat, and is the first search and rescue volunteer in B.C. to be killed in the line of duty."At about 4:15 p.m. during the course of their search efforts, utilizing swift-water line equipment and a swift-water craft, one of the search and rescue members went overboard into the river and did not surface," the RCMP said in a release Wednesday, before the body was found.

I have some personal information that I cannot disclose in regards to the Workplace BC investigation .. I will say if you do not have a means of eliminating "all hazards" then just do not go.

For those interested some links.

The conclusions I take away from this is / are: the lower risk group of bleeding in trauma, because of the "high numbers" of that group statistically have the greater benefit over the higher risk groups, although in the high risk groups those with a systolic pressure < 90 and greater than 4 units of blood also will benefit, with very few adverse effects (best to watch the you tube presentation)

This from Ian Roberts is "considered" as Massive Transfusion. (~ 15:30 minute mark on the Ian Roberts presentation)

I can tell (in the ICU I worked) that compromised end organ perfusion and > than 10 units (this included cell saver or autologous blood salvage inter-operatively was included in "totals") ( inter-operatively and post operatively anything greater than ~ 20 units ) was defined as massive transfusion, the blood bank would be calling the unit and getting ethics committee involved.

http://www.google.ca...=UTF-8&q=CRASH2

I do not know if this pfd can be opened (had a tech glitch with this one)

http://download.thel...7361160278X.pdf

oops my bad ? ... dang those scrubs .

This is a "to follow" new treatment and because of the cost has the potential of positively affect many lives .. especially in 3rd world humanitarian zones.

kudos ERDoc

Dear Ruff:

I am so very sorry for your loss.

This was part of my Fathers eulogy ... I hope it helps, even if just a bit.

High Flight

Ems is far more racist than Fire, due to its short history on earth. So the fact that racial discrimination is commonly found in Fire, shows how bad it is in EMS

Yes that MUST be correct .. FF are the most sexist .

Most Excellent Find Mike.

Sure nice to know EMTCity is part of Sidewinder's hit the afterburners to supporting OUR troops and please never to forget the contracted Paramedics in the SandBox.

another version of Rolling in the Deep, Angie will be a new house hold word very soon.

A comment on youtube :How much better can it get than a good looking military women in camos with a knock-your-ass-over voice with heat strapped on her leg?

And hear, I thought, this website was about EMS, not the poor down trodden FF that can't make the cut.

PARTNER WANTED :

One that does not speak for his/her "people", will consider green skin, 3 hands, one eye in back of head and can pass or exceed qualification exams.

cheers

Unless your intubating for primarily "respiratory" reasons, the post-intubation ventilation target should be to match the pre-intubation ventilation status. The easiest way to do this with what's described is match ETCO2.

The patient will need support, as you've significantly raised the patients WOB.

Really have you with a tube has WOB really significantly raised, nope IMHO you have protected an airway.

To tniuqs or chbare, in the absence of a vent, would allowing the patient to breathe spontaneously through something like a Jackson Rees with a spring PEEP valve be better than trying to Ambu bag the hell out of him? My gut instinct is no, your looking at further bumping WOB because there's no inspiratory support, but stuffs not always as intuitive at it seems.

Whoo nelly ... I just read this and am under the influence or the dreaded pirate grog, Caribbean rhum ... but most seriously.

Ok so this patient needed Airway protection with a GCS of 3 .. good with that, ETI awesome, stay off the VAP it is the proven gold standard.

I would concure with chbare that PS or sensitively set trigger for AC would be the best way to match the WOB, and ETCO2 and well with a GCS of 3 not bucking the tube the patient is telling you something .. that said are you using long acting paralyticis i.e. Roc, Trac, Roc or Pav as one could screw up and plumet PH and increase Co2s something in DKA you really don't want to see.

But you don't have an AC trigger on a vent

Yup wean his O2 down to maintaining sats of > 93% ... really no need to hyper oxygenate, as Dwayne suggest's we are Hyperoxia is that the best case senario ? but certainly sure, 5 of PEEP is physiological.

Paramajgc is also correct: re: ETCO2,

in the absence of in-field ABG is indeed what we should be using as a target for post-intubation ventilation management, with an understanding that there are going to be differences between EtCO2 and PaCO2. However this gradient is dynamic, so again, without ABG we just have to make an educated guess and get on with it.

Respiratory rate is not of tertiary concern, it is one of your primary concerns in this patient as RR is what dictates ventilation, and ventilation in this patient is of paramount importance. We don't increase ventilation by increasing tidal volume; all that does is cause lung injury.

If I could add its Minute Volume not tidal volume and RR.

The dangers of leaving this patient breathing on his own are much greater. If you had a PEEP valve on your BVM and could try to synchronise some support with their respirations you may be able to support them, but I have always found this to be rather difficult.

zactly ... watch the "duck valve" very closely and support as required in lou of the non long acting paralytics as they may be a complication to good patient care.

When the rhum wears off will follow this thread suspected DKA, serousy is not an easy, simplistic topic.

cheers

Agreed chris .. much to do about nothing .. if you have fur like a bear the wife will definatly not mind if when having chest pain steps are taken to cover all the bases in good patient care.

I blew a hole in my credibility ... interesting that.

Although I did change my avatar as I love looking for Pirates to walk the plank, har har my dark well hung beauty .. you have been hoisted by your own arrogant petard.

Should I apologise to hutsy or perhaps get back on the rails with this most valuable topic ?

]Quoting ME.

An excellent find have learned something today

I do remain sceptical about elevated BGL in any arrested patient for any length of time, this will undoubtedly result in decreased BGL, due cellular metabolism, complicated by anaerobic respiration, lactic acid production +++. besides I am under the impression (could be wrong) there are accuracy limits when typical BGL evaluation in regards to PH.

We have come a long way from drop the blood on a stick, wait a certian time and compare to now with jump drives that do record keeping graphs and spread pages.

This topic has really piked my interest in regard's to delivering hypoglycemic agents at the critical care level in the field during cardiogenic shock. If cardiogenic shock is being treated and hyperglycemia is documented. I will now be doing BGL on all Chest Pain even if no IDDM is the history, I did not in past. I have been doing bedside troponin as a diagnostic guide and am pushing to get these on car in my hood.

Evidence Based Medicine now entrenched in EMS / AHA these day, this study is suggesting that their is a decreased morbidity mortality. Could this study be pointing the way for improved delivery of pre-hospital care ? That said, the study is a prognosis indicator and not if relative hyperglycemia &quot;treated&quot; reduces mortality, (from what I read) then of course funding for a study in EMS .... hmm well ..... not a lot of cash for that these days.

Second thought getting into the books / studies, the increase in blood glucose is marginal (~ 9.2 ) to be using a typical insulin sliding scale (yup and controversy there too) as the sliding scales are used in know IDDM only, then, giving insulin SQ with decreased perfusion. Well it could be more more complex for my lil bean. Historically insulin has not been used to treat hyperglycemia in EMS, bucking the old school could be an issue as well.

Perhaps other hypoglycemics could be trialled, maybe worth some time in a follow up with a researcher. I know one a few doing transplants with islets of langerhan in livers at the University Hospital in Edmonton and having great success.

cheers

Quoting very respected jstalmm:

Just did a bit more reading today, as far as the evidence based stuff is concerned, treating with insulin isn't yet a standard practice, but may have its benefits. I think some of the intensivists/ED physicians down my way treat stress hyperglycemia, but definitely isn't a norm as far as I know. Also, I think there are still some issues regarding whether or not the sugar actually causes harm or if it's just an indicator.

From personal experience I can recall one recent cardiogenic shock patient, initially with a BSL of 9mmol or so, on arrival to emerg about 30mins later who had a BSL of 20+...needless to say he followed the trend

Care to positively contribute to the real thread crotch or continue your "the machine was wrong" "I am right and you kilt a patient"

LS said it best ... Kill em in the classroom so they live on the streets. NO one has ever said it better in my books, sure wish I could staff a fixed winger with LS as a partner... we need that attitude up here in Kanukistan.

crotch well not so much ... but a black friend in LA Acadian EMS FTO (call sign zantelhunt) thank my god I know a great paramedic that just so happens to be black as well as EMT-B saint Mikey and Videl, and Ferguson Kennedy in the Commonwealth of Dominica who would put you to shame dear crotchety in there knowledge of "bush EMS medicine"

OMG thats the rhum speaking I so hate when that happens !

Yes happy very confusing with the multi thread jacking going on by you know who, point being in this thread was that high blood glucose in the perfusing MI patient is a predictor to outcomes it statred out as an excellent debate hell even this old bastard learned something from a "rookie query" .. where it went from that was "treat the patient not the machine" whatever really. So its open season on any topic now

I can not believe you would let a known unconscious diaphortic diabetic patient die because you needed to do a head CT to rule out a CVA.

And here's your sign ... someone is going to die !!! OMG Panic give dextrosed based on LOC and sweaty with a bracelet !!!

ps ... no one said anywhere they would withhold D50W if indicated.. the follow through was good patient assessment, repeat BGL as in Herbies note and consider ALL the possibilities, CVA, Trauma, MI, OD, ETOH, DTs +++ (apperantly the link provided to Blesoe's Handouts link was ignored)

So following all of you guys line of thinking, we should not push Narcan for unconscious patients when we have no evidence of an overdose ?

Narcan should never be used as a diagnostic med, little things like depressed V/S, marginal RR, Bradycardia and those pin point pupils, track marks, burnt spoons and hypos can be a "tell" but there are some adverse side effects.

Heck the use of fluazamils was dc ed as a direct result of "I dunno lets try this stuff" and find out in a mixed OD .. that WAS part that was benzos and now refractory seizure's needing very big pharmaceutical guns to stop them . EPIC EMS FAIL.

Why would we ever push thiamine ?

DUH (ever see the IVs of yellow smelly fluid in ER called Berroca C ? ) .. perhaps because of WKE "locked in" and becuase all IDDM alchololics take their vitamines and have awesome diets.

Very similar as to giving large volumes of NS in the hyponatremic patient quickly then of course gluconeogenesis and thiamine crazy stuff. http://scholar.google.ca/scholar?q=gluconeogenesis+and+thiamine&hl=en&as_sdt=0&as_vis=1&oi=scholart granted most of the studies are the rat model ... almost seams fitting at this juncture ?

what test do you have to prove the patient is an alcoholic, versus just being drunk today ?

Unconscious and diaphoretic ? well one never know's, one could have had a DT siezure with no one around as a witness .. hey, its your scenario.

btw Seizure as far as call volume is concerned is the highest on current statistical the hit parade, but no .. push the glue first the machine is wrong.

Same thing. And I guess we should never backboard an unconscious patient lying on the side of the road, if there is no bleeding or fractures ?

ok that's just silly.

Happiness, to save you from reading 5 pages; The original scenario was an unconscious diaphoretic, diabetic patient who has all normal v/s including the glucometer reading of 120. My treatment scenario, after experiencing faulty glucometer readings, was to push 1/2 amp of D50 and see if there was a response (because unconscious and diaphoretic diabetics usually equates to hypoglycemia). All of the newbies said I was crazy and should have my licensed revoked. So I asked if you had a symptomatic chest pain patient but the 12 lead EKG was normal, would you withhold NTG and ASA ?

Finally, some rationale voices have joined the conversation, as I have had to argue with the rookies who believe that you should treat the machine before the patient. Thank you all !

Absolutely incorrect .. that's your thread High Jinks as is your provocative no such thing as PTSD, just weak of mind, then mercury used as preservative causes Autism, then of course your favourable ME thread Whitey put me down.

ERDoc has suggested that we don't respond to crotch's delusional musings .. personally the knee jerk posts that crotch makes and my responses is not as a result of any annoyance its more ... well ... as quoting Charlie Sheen .. It simply amuses me and entertainment value.

Please crotch keep it up, I have lots of time on my hands to respond to your irrational rants, I enjoy blowing holes in your vast knowledge of EMS.

cheers

And to be Repedantic, ASA could improve if it is a musculoskeletal issue.

Yes sure 160 mgs of ASA is a therapeutic dosage for chostocondritis .. wow crotch that's a stretch even for you.

And Aspirin reduces blood clotting, which can help blood flow through a narrowed artery that's caused a heart attack, which is probably what is causing the cardiac type chest pain -- but thanks for trying, and no, there is no doubt that I am right on this one.

Actually ASA's mode of action is more succinctly, prevents the formation of a substance (thromboxane A2) which causes platelets to aggregate and arteries to constrict. Will you observe a change in a patients symptoms .. again a huge stretch .

tnuigs if you cant tell the difference between hypoglycemia and CVA, that is a whole other issue. For the record I was asking for the "veterans" (meaning like more than 10 years experience in a busy 911 environment) to voice their opinion.

pfft how silly you make yourself look, a pattern of behaviour that is predictable in fact.

Dear crotch I have seen many a CVA that had a history of IDDM and alcoholism (getting back to the normal BGL well thiamine would be my first choice understanding if a diabetics glucose was within normal accepted limits) that said after eliminating the possibility of CVA.

As suggested I am a proponent of a thoughtful physical examination prior to jumping to conclusions and push drugs .... that could predispose my patient to increased mortality/morbidity its just the way I roll.

edit for a contextual change.

AMAZING !!!!!!!!!!!!!!!! I know all you old-timers hate my guts, but for the love of God, please jump in and help with these rookies.

Interesting that when your "scenario" presented the unconscious IDDM and not thought through clearly as evident now.. ie the "normal V/S " and a very pithy example IMHO most clearly an attempt to support the view that your "machine" is incorrect and the historical treatment of "treat on speculation" is the gospel to follow.

Yet now you introduce yet another scenario, a pathetic "call-out" for help me prove my point <sniff, sniff> and "I know what I am talking about" and rookies do not, yet another jaded opinion. Fortunately and clearly these "rookies" are looking at a far bigger picture, not an emotional knee jerk response and personally I have never had a false positive high reading from new state of the art glucometers .... but then ask for help from god himself, well good luck with that.

The tread did progress to the point that hyperglycemia was a predictor in survival rates of the AMI, was very informative and enlightening, until our beloved crotch derailed the train once again, believing only in 2 colours, black and white and ignores that shades of grey is more often than not "the typical presentation" of most patients that we are called to treat.

So just push on spec a half amp of D50W (btw 1/2 is not in my guidelines) claiming that the machine was wrong, on a CVA and see how that works out on arrival to ER, a missed dx and incorrect treatment ... just saying .

In light of the STEMI non STEMI perhaps a new or previously unrecognised BBB ? (the sidebar) then the 12 lead field ECG "interpretations" by non cardiologists, agreed entirely this is part of the picture only and why I am a huge advocate of serial bedside Troponin CPK Myoglobin.. yet another tool in my toolbox (that I have learned to trust) before pulling up the TNK.

cheers

ah remember the day when an IV on a chest pain call was just a "lifeline" and never a volume of fluid be permitted .. the wonders of modern science and the improved understanding of left vs right ventricular infarct, this when banks were never open past 4 oclock .. those were the days.

No argument here ..

We are so PC its retarded, because we feel so guilty because that our political forefathers treated so many, so poorly 200 years ago, or maybe just too much back bacon that makes one insane ?

Two wrongs never make a "Right"

Not in Canada, a white >40 y/o Male (Euro-Canadian) protestant, is not included in our Human Rights definition ... pitty eh ?

So my son who is Haida (or Status Indian) has attended a RCMP information meeting and he was told there that if you are of first nations your test score has to be this number which is lower that if you are white.

Doesn't that define racism ? Do the exam papers have a spot (where one puts in ones name) that asks "what colour are you" ?

STATEMENT:

Hiring based on gender, ethic origin, religious affiliation (or headdress) based on the breakdown of " the aforementioned" is without a shadow of doubt, political correctness at its finest and a means to end that will result in the failure of the concept called multiculturalism.

cheers

ps Crotch your right again, thanks for enlightening all of we white racists.

Herbie: I have been witness to this as well, vomiting fecal matter from bowel obstruction, a skinny little "trapper" this hermit blamed it on his christmas fruit cake. Although he had pretty much all the "other" fragrances as well..... Nasty stuff All.

I count myself lucky as I can tolerate most smells, when I was a rookie we had to "bag 2 bad ones" before we were "accepted" that's back in the day when EMS did body removal. A trick we used is a mask with menthol shaving cream on the outside, works quite well, not 100% but better than full breaths of decomp's sweet fragrances.

A way for BCAS to not pay for:

1- Same scene, Same pay.

2- A means to keep more accountants employed, in a top heavy beurocracy.

3- Make my head implode.

4-A reason to have CUPE argue needlessly over penny's.

4- All of the above.

Hey look what crawled out from underneath a rock ... LOL !

To recap: After reading my posts over it sounds like I am drunk with the very poor english and lack of punctuation ... eh ? A known diabetic, (because no one has ever worn someone else's bracelet) unconscious and diaphoretic, all V/S normal, in a public setting with normal BGL readings.

I have been trained to not tunnel vision, sure this patient is pointing that way but with the very skinny S/S and zero P/E is just so very open ended to call, especially when this thread progressed to prognostic indicators of hyperglycaemia patient and poorer outcomes, just saying .

I would start looking for other possible reasons of decreased LOC ? Yuppers, the AEIOUTIPS mnemonic comes to mind if one need's a crotch to fall back upon, highly suggested for students to be thoughout.

I would be assuring an open airway ( while doing this ketone's on breath and Kusmalls type respirations (although in the senario presented "normal VS mentioned" as well as pupils size response to light and equality and GCS, the babinski reflexes checked as well (those would be observation that could be very useful and takes less than 20 seconds)

Rx: C Collar, O2 titrated to Pulse Ox, boarded, then a line and repeat BGL just to cover all the bases, before I jumped to the conclusion of the machine is wrong.

Perhap's then think thiamine, D50W, glucagon (btw the glucagon and the negative connotation (old school) of a back up for a poor Paramedic skills starting a line's) I sure would not want to give an IV medication with preservatives in it because it could cause Autism and / or ADD or worse <gasp>

Or am I like just like crotch and Challenging What You Think You Know ? (or perhaps even himself EH ?)

Quoting crotch "

and saving the patient's life (old school style)"

I just can not get behind this bs, get over yourself, this attitude belongs in a fire hall. I am no hero I am just doing my job .

<edit for spacing>

MY point all preventable loss of life and injures affecting may for years.

I contributed to the fund for the woman that lost her life in Camrose, she a single Mom and had won a stage pass on a local radio show, other wise she could not have afforded to go, her 7 and 9 year old were so happy for her.

... hello crotch ... get the picture <insert explanitive> starting with 6 letter in the alphabet and ending the same .

cheers

I apologize, you did ask 2 questions, but I am not sure I understand them. #1. I am not advocating not using your technology, but I submit that your generation is too reliant on technology and often lack some basic assessment skills,

Ahem .. sorry to inform you but I know I am way older than you .. your point being comparing old vs new and that the newer grads have less clinical evaluation ability an EPIC FAIL based on your "stereotyping" .

much like we no longer use as much of our memory, as there is no need to, since you can quickly look up anything on the internet.

Curious I do not have the internet on my phone to "look" up anything, your quite correct that my memory is weakening but that due to age ... curiously it has been said of some of my junior partners if they knew half of what I "forgot" they would be in good stead .. <insert blush smiley> what was your point again I forget.

I did not have a pulse oximeter, so I had to know breath sounds and severity of event without looking at a digital readout.

Even the best of the best Health Care providers are proven they can not to recognize life threatning hypoxia until sats of 77% and then only some using "cyanosis" as an indicator, then listening to breath sounds well another red old herring Jjust perhaps take a look at Bryan Bledsoes "handouts from his webpage" concerning administration of 02 .. outcome statistics in the non ischemic CVA patient, MI, and Poly Trauma ...your very possibly doing harm to your patients with NRM @ 15 lpm.

This leads to undertreatment in my opinion, as I often encountered patients in the ER that EMS did not treat appropriately, because the pulse ox was good in a sitting position, if they had made the patient walk 10 steps (or lay them flat)they would have seen that the patient was in far more distress than they recognized.

Your talking to an RRT .. this is called the "road test" / "exercise tolerance" of course O2 demands will increase with exercise, who stresses a patient to get a lab value needs a good swift kick in the ass.

#2 In cardioversion, I hope you are not just treating the machine. Just because a patient has a rhythm that is too wide, too narrow, or too fast does not necessarily mean cardioversion is necessary.

When I see VTach I treat it otherwise if delayed I just may be treating V fib PDQ .. the unstable of course being my rule of thumb.

And the choice to not treat the patient in my scenario would have lead to that patients death. I have had four patients in my career who were severely hypoglycemic with a normal glucometer reading. Yes you should try to rule out all the conditions you listed, but how could you in the field ?

Are you certain ? Firstly anecdotal recollection another attempt to rationalize FAIL ... So just how many survived to door with your iatrogenic induced hyperglycaemic ? Back to clinical observation, pupils, reflexes, smell +++

The better answer is to look at the patient. The patient is normotensive (I stated all v/s were normal which was intended to include every test you have at your disposal). So you are left with diaphoretic and unconscious, with a known diabetic history. Seizures, head injury, and ETOH rarely produce diaphoresis (yes possible).

Seizures can be the result of a hypoglycaemic reaction as can high ICP even MI ..but your missing my entire point there are diabetics that are alcholics ever hear of Wernicke-Korsakoff encephalopathy ... do you even have thiamine ?

A cardiac event could produce diaphoresis, but usually does not produce unconsciousness with normal vital signs. CVA or an aneurysm could produce unconsciousness and diaphoresis, but again you would probably see a shift in V/S. So hypoglycemia is the most likely cause.

Your making quite a stand on the diaphoretic patient as the diagnostic feature here, hence my third question what is the ambient temp ? I used to do a senaro about a hockey player fresh out of the shower and c/o of CP ... every one worked him up as an MI when he was 26 and had CP from a muscular skeletal, then an industrial acid spill 46 y/o just out of a emergency shower complains of CP because the water is just above frezzing and has an MI as a direct result of fear and sudden imersion into cold water ... hmmm the bright ones in the class .. well they used diagnostic tools provided.

So you push half an amp of D50, and see if the patient responds, if they do, you push the other half (draw blood first if you can so you will know if your machine was faulty). Worst case scenario, you have raised that blood glucose reading from 120 to something in the 200's, which is nothing for a diabetic.

Are you reading the links posted in this thread ? really ? are you aware that you could be causing harm in the Head Injury, the CVA, the MI patient the peaks and valleys decreasing total lifespan ... yeah ok grasping at some straws there.

If the D50 fails to work, then you can pretty much rule that out and move on to your other possibilities that you can not rule out in the field.

Yup and give narcan a go then and keep giving drugs until the patient wakes up EH ?

late edit .. dang chbar beat me to the punch line ... again.