BLS and Glucometers

[chelleak]

One is a diagnostic technique. The other is a medical intervention. The AED diagnoses and treats an immediately life-threatening problem on a clinically dead patient.

You just said it yourself....AED DIAGNOSES & treats.

So give it up and get over it. Just because you're a Paramedic/RN doesn't make you better than anyone else. Paramedic or Paragod? Get back to your roots if you have them.

[Dustdevil]

You just said it yourself....AED DIAGNOSES & treats.

So give it up and get over it.

Yes, it diagnoses and treats.

A glucometer does neither diagnose nor treat. It's just a number. So what is your point?

And my "roots" are in patient care. Thirty five years worth. You're not talking about patient care. You're just talking about another fun little "skill" you can do to make yourself feel important, while providing absolutely no benefit to your patient. And if you're not doing anything to benefit your patient, you're just stroking yourself.

At least I have roots to look back on. Apparently, you still haven't found yours.

[ERDoc]

I gotta say, the comparison to an AED is foolish. AEDs were created so that people with no medical training can use them. It takes all of the thought process away from the user. The glucometer is a completely different beast. As others have said, it gives you a number. It does not diagnose and it does not treat. It depends on the user to have an adequate knowledge of what the number means, why it is what it is and what needs to be done about it. You cannot compare the two. The AED is made so that a monkey can use it and it will do what it is supposed to. You can teach a monkey to use a glucometer, but you cannot teach him how to respond to the results.

I have been going back and forth with this. I can see BLS providers using it as long as there is a good protocol written to cover what happens when they get their result or required medical control contact prior to using it. It is far from an ideal situation which leads us back to the whole, "Do we really need BLS," debate. I have a feeling it will become one of those situations where there is a new toy, everyone will use it, usually inappropriately.

[rock_shoes]

That's not necessarily what he's talking about.

For example, our Basics have Glucagon on standing order for any hypoglycemic unable to accept oral glucose.

Exactly. When I took my EMR (roughly the equivalent to EMT- course we were taught how to use Glucagon. Indications, contraindications, route, action etc.. The protocol hasn't made it into licensing yet and to tell you the truth I don't really care if it ever does. I'll be doing my PCP this year anyways.

Also a PCP is BLS and I'm quite familiar with the PCP scope of practice. I didn't say it with the intention of dragging PCP's down to that level. Those are just the facts. The PCP D10 with Thiamine diabetic protocol works excellently by the way.

[brentoli]

The poll results are interesting. 14 yes / 4 no. But we still haven't came up with a valid reason to put them on the BLS "skill" sheet. Taking AK's lowest denominator theory in mind, does anyone have a fail-safe protocol for BLS providers that includes their use, and treatment based on their use?

[Just Plain Ruff]

One is a diagnostic technique. The other is a medical intervention. The AED diagnoses and treats an immediately life-threatening problem on a clinically dead patient.

You just said it yourself....AED DIAGNOSES & treats.

So give it up and get over it. Just because you're a Paramedic/RN doesn't make you better than anyone else. Paramedic or Paragod? Get back to your roots if you have them.

Whew, yes the AED diagnoses and treats but it does all that without the lay person or EMT having to do anything. You are comparing apples to Boxcars on this one.

As a diabetic, I have a glucometer. I can teach my son who is 5years old (I have done this already) to test my blood sugar if he finds me not able to do so myself. He knows that if I'm down or sick, then he hits two buttons on our alarm system and then gets my glucometer.

He does not know why he does this other than to help the medics when they get to my house. He can give them the glucometer and they can see the result.

Does he know the patho behind why my sugar is low, sure he does, he knows that my sugar is low because I either did not take my meds or I ate too much of something with a lot of sugar in it. But that's the extent of his knowledge.

As emt's, there is not much to do for me if I'm unconscious but transport me. It's a good thing I'm covered in a area of Missouri that does not have bls crews. I have no problems letting a bls crew do a glucose but I do have problems allowing them to give glucagon or glucose.

If they don't have a glucometer then what the heck are we giving them the ability to give glucose or glucagon?????? You don't just look at a patient and say "oh boy, they have all the signs and symptoms of hyper or hypoglycemia so they must need glucose or glucagon." "I don't have the ability to determine what their sugar is but I have this new fancy shmancy medication called glucagon and I'm gonna give it to them. To heck if they are having a stroke"

To provide partial tools to help someone and not providing the total set of tools is tantamount to negligence in my book. If you cannot see a blood sugar number then you have NO business giving a medication for that problem. Any service that allows for this type of scenario to happen is just plain wrong.

As for the AED, you can train a monkey to use that device because there is no real class to go to for it nor any real training. You just bare the chest, put the patches on, push the button and let it work. Comparing the AED to the glucometer is really a piss poor argument.

[Dustdevil]

The poll results are interesting. 14 yes / 4 no. But we still haven't came up with a valid reason to put them on the BLS "skill" sheet. Taking AK's lowest denominator theory in mind, does anyone have a fail-safe protocol for BLS providers that includes their use, and treatment based on their use?

We actually see quite a bit of this here. It's simple. Those people have no valid justification. All they have is this childish, "because I want to!" mentality, without the education or experience to examine the issue from a logical, medical, legal, or scientific standpoint. So they just respond to the poll and sit back with a grin as if their point is validated by anonymous votes in a pointless poll.

These arguments are not about patient care. They're not even about patients. They are about the provider. They are about wankers with nothing more than an advanced first aid course wanting more and more "skills" to perform without the prerequisite education necessary to understand them. To them, it doesn't matter that it is a pointless and expensive waste of time that does their patient no good. They aren't looking for justification, because "I want to!" is all the justification they need in their pea brains. They're always going to fall back on, "so what does it hurt?" And even when you show them what the potential harm is, they are done listening. It's a pointless conversation. And the concept of even involving EMTs in such a discussion is about as valid as asking surgeons to involve nurses aides in their decision making process.

[brentoli]

On the plus side I came up, after 1050 posts, with a post worth something to generate discussion.

[hr:8d90556569]

Pros:

No more blind giving of glucose.

More detailed reporting

Cons:

More time taken up by providers better suited to other tasks

Inability to help with unconscious diabetic in most areas

What else can be added to this list?

[Dustdevil]

I would make sure that "other tasks" is specifically noted as transportation. That is all they should be doing for this patient, beyond ABCs. Every second you waste dicking around with "skills" that do not benefit the patient, you are negligent. Drive.

Con: Invasive procedure risks infection of both you and the patient.

Con: Those strips aren't free. They cost money. You get no return on that investment, since you can't do anything with the results. And the hospital is not going to accept your number anyhow.

Con: Having a number, but not the education necessary to interpret the results and the overall picture, leads to incorrect assumptions by the provider, resulting in improper and delayed care.

[PatrickW]

Scenario: 60yo F complains of bilateral leg weakness. Gradual onset, it's 3AM now, she woke up to go to the bathroom and noticed her legs were very weak. No other complaints. History of IDDM and HTN. Good strong PMS. BGL turned out to be 48 mg/dl. Gave her some orange juice (or oral glucose) and suddenly she feels fine and has no complaints. With a BLS crew that didn't have the option of checking BGL, their options would have been: Transport while twiddling thumbs saying "I don't know what's going on!", or request ALS so that ALS can do the exact same thing BLS would have done on scene if they had a glucometer. Is that really what's best for the patient?

It's also important to remember that not all BLS providers are part of BLS-only crews. I work with a paramedic and being able to check someone's glucose is a valuable tool for me as a Basic or Intermediate to have. When we have an unconscious patient, for example, it's nice for my partner to accomplish the "more ALS" aspects like starting a line, hooking up the monitor, etc. while I check the BGL (among other things, of course). It's just one less thing the medic has to worry about and one more thing the basic can accomplish for the good of the patient.