brentoli Posted February 11, 2008 Share Posted February 11, 2008 [align=center:97dfc96eb0]THE FIRST PERSON THAT TURNS THIS IN TO AN "US VS. THEM" FLAME WAR, I WILL PERSONALLY REQUEST ADMIN TO LOCK THE THREAD[/align:97dfc96eb0] [hr:97dfc96eb0] I have seen a few BLSers trying to fight for the right to take a BGL on patients. Why? I, as a BLS provider, have thought this over in my head a few times. I can't see what difference it would make. Does any BLS have anything to administer to an unconscious diabetic? If someone is a known diabetic and conscious and exhibiting diabetic symptoms with no other indicators for stroke, won't you give them a tube of glucose anyway? Who can offer reasons for and against this diagnostic tool for BLS providers? Link to comment Share on other sites More sharing options...
JPINFV Posted February 11, 2008 Share Posted February 11, 2008 I say "No" and it's due to the education issue. I do see the utility of a glucometer as an assessment tool [LA Prehospital Stroke Scale, for example], but there's too many bad apples among us to justify extending the scope. Link to comment Share on other sites More sharing options...
afd1307 Posted February 11, 2008 Share Posted February 11, 2008 New Hampshire allows this at the BLS level, and there are talks about this happening in Maine as well. I work in both states. I have issues with both so my answer is yes and no. Helping medics on difficult calls is always a plus so that would be a pro. The con is that all we can do to help is give standard glucagon if they are conscious. Sure we can give BLS unites these tools, but what matters is the education that they receive before they use them. Link to comment Share on other sites More sharing options...
Niftymedi911 Posted February 11, 2008 Share Posted February 11, 2008 For a tiered BLS/ALS service or strictly BLS I could see a glucometer being used. In situations where let's play the devil's advocate and think........ You respond Hot BLS to a diabetic (26B1 I think) or whatever code you use. UPA, you see a 68 y/o/w/m seated in dining room chair. Patient looks at you when you enter but cannot talk. Patient is pale, clammy, slightly moist skin, breathing somewhat increased. You send your partner to find info and meds. You do a quick bp: 182/90. He brings back a medication list which includes Insulin, Digioxin, and Norvasc. You see a glucometer out of the corner of your eye. You do a quick neuro exam and notice facial droop, inability to talk but is able to open mouth, but is aware to surroudings. It's 2134 hrs in the evening. So you prepare oral glucose and call for ALS back-up. Dispatch advises you that the nearest ALS truck is 10 minutes away. Your 4 minutes L/S from the nearest ER. You administer oral glucose and wait for 3 or 4 minutes for it to take effect. You reassess the vitals and neuro exam. Facial droop still present, inability to talk still present, and now isn't very aware to what's going on. You and your partner quickly grab the patient and place him on the stretcher and "load and go". UPA hospital, blood glucose levels were in the mid 200's. The MD orders CT of the head and reveals an hemoragic stroke. Not only did you give glucose to a known insulin dependant diabetic that was not warranted, but now you administered glucose to a stroke patient. A simple glucometer reading could of been accomplished to determine that this is a stroke patient versus a diabetic patient. Those extra 6-10 minutes you spent on scene administering the glucose and waiting for it to take effect, are brain cells that patient was losing due to your limited capabilities and assessment skills. I do not believe in BLS/ALS tiered response. I believe Full ALS response is the only true definitive care for any patient (Besides a fall or Lac). EDUCATION #1 ASSESSMENT SKILLS#2 Link to comment Share on other sites More sharing options...
medibrat Posted February 11, 2008 Share Posted February 11, 2008 For a tiered BLS/ALS service or strictly BLS I could see a glucometer being used. In situations where let's play the devil's advocate and think........ Not only did you give glucose to a known insulin dependant diabetic that was not warranted, but now you administered glucose to a stroke patient. A simple glucometer reading could of been accomplished to determine that this is a stroke patient versus a diabetic patient. Those extra 6-10 minutes you spent on scene administering the glucose and waiting for it to take effect, are brain cells that patient was losing due to your limited capabilities and assessment skills. That's what I was going to say. At the very least, a blood sugar reading will help with your assessment...just because someone is exhibiting hypoglycemic symptoms doesn't automatically make glucose the right option... Brat :angel8: Link to comment Share on other sites More sharing options...
brentoli Posted February 11, 2008 Author Share Posted February 11, 2008 You do a quick neuro exam and notice facial droop, inability to talk but is able to open mouth, but is aware to surroudings. That is classic first week BLS right there. Go from high to low, assessing your ABC's and then high priority to low priority. I always try to rule stroke out before moving to diabetic, even on known diabetics. Does your senario show more towards BLS could use the extra diagnostic tool, or BLS needs more education in assessment? Link to comment Share on other sites More sharing options...
Niftymedi911 Posted February 11, 2008 Share Posted February 11, 2008 Both. I hate trying to put senarios in words because sometime I leave things out. sorry Link to comment Share on other sites More sharing options...
Dustdevil Posted February 11, 2008 Share Posted February 11, 2008 That's what I was going to say. At the very least, a blood sugar reading will help with your assessment...just because someone is exhibiting hypoglycemic symptoms doesn't automatically make glucose the right option... EMTs don't have anywhere near the educational foundation necessary to even concern themselves with medical assessment. Give them a machine to use, and the next argument will be, "Well, now that we know what's wrong with them, we need protocols to give them IV meds to fix it... without all that book learnin'". This is no different from those EMTs arguing that they need to run 12-leads that they have no way of interpreting or treating. It's a slippery slope that we don't want to go down. No way. They shouldn't be sent on these runs in the first place. But, if they are, the only thing they have the training to do is to load and go. That's all they need to be doing. Advanced diagnostics of this sort serve no purpose in the field for a BLS provider. It's just a waste of time and money. Link to comment Share on other sites More sharing options...
Niftymedi911 Posted February 11, 2008 Share Posted February 11, 2008 :hello1: Thanks Dust for putting my big post into 3 sentences. Link to comment Share on other sites More sharing options...
JPINFV Posted February 11, 2008 Share Posted February 11, 2008 Your 4 minutes L/S from the nearest ER. You administer oral glucose and wait for 3 or 4 minutes for it to take effect. Playing devils advocate here, but why would you wait to see if it has an affect? It doesn't change your transport decision regardless if the patient is suffering from hypoglycemia or a stroke. Link to comment Share on other sites More sharing options...
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