p3medic Posted February 12, 2008 Share Posted February 12, 2008 Not too worried about giving the patient oral glucose, I'm more concerned about the patient being delivered to a facility without the ability to perform appropriate intervention, i.e thrombolysis, angiography, etc.. With a thorough H&P you can usually differentiate between a stroke and hypoglycemia. I don't think anyone would fault a BLS crew for giving oral glucose to someone with a stroke. It may not be an idea situation but it is easily corrected in the ER. Link to comment Share on other sites More sharing options...
ERDoc Posted February 12, 2008 Share Posted February 12, 2008 Damn Wikipaedia. Since when do bad asses from Texas speak English and not American? Link to comment Share on other sites More sharing options...
ERDoc Posted February 12, 2008 Share Posted February 12, 2008 This is where I am a small problem with "stroke centers." Any ER can get a CT scan and push lytics. I've done it several times in non-stroke center designated hospitals. It's nice to have all of those other people who can take the pressure off of you having to make the decision to push lytics or not but it is not necessary. Get the CT, push the lytics and arrange for transfer. There is not much else that a stroke center is going to do in the early phases. Link to comment Share on other sites More sharing options...
p3medic Posted February 12, 2008 Share Posted February 12, 2008 I understand your point, however in a busy ER, a patient with slurred speach and an unsteady gait may not get the attention they deserve. On the other hand, same patient with a documented normal blood sugar, no etoh on board would highten your suspicion, no? Thrombolytics can be given in any ER with a competent ER doc with a set of balls, but in my experience, this is the world of neurologists, who in addition to thrombolytics have other tx modalities such as angioplasty, coiling, and surgery at their disposal. All I'm saying is that the extremely low risk of the procedure of checking a blood sugar by BLS could expedite the care at the recieving facility, which is in the patients best interest. Its so simple a firefighter could do it. I agree that education is a requirement, and that not any EMT straight out of school should be doing it, but with good medical ovesight and a dedicated physician led training department, it isn't rocket science. Link to comment Share on other sites More sharing options...
ERDoc Posted February 12, 2008 Share Posted February 12, 2008 I understand your point, however in a busy ER, a patient with slurred speach and an unsteady gait may not get the attention they deserve. On the other hand, same patient with a documented normal blood sugar, no etoh on board would highten your suspicion, no? Thrombolytics can be given in any ER with a competent ER doc with a set of balls, but in my experience, this is the world of neurologists, who in addition to thrombolytics have other tx modalities such as angioplasty, coiling, and surgery at their disposal. All I'm saying is that the extremely low risk of the procedure of checking a blood sugar by BLS could expedite the care at the recieving facility, which is in the patients best interest. Its so simple a firefighter could do it. I agree that education is a requirement, and that not any EMT straight out of school should be doing it, but with good medical ovesight and a dedicated physician led training department, it isn't rocket science. I don't think any pt with slurred speech and trouble walking is going to get lost in a busy ER. These pts usually get shuffled to the front of the line (of course everyone has their story about this one pt that did). Many of the things you mention would not be used in a case like this. A pt who has had lytics is not going to to OR any time soon. Coiling is done in a bleed, not ischemic stroke. Some stroke centers (like the large academic type) can you intraarterial lytics, but most community hospitals that have been able to get the stroke center designation do not have this capability. Personally, I think more research needs to be done on the topic of stroke centers. Until then I am not a big fan of them as I see no advantage. Link to comment Share on other sites More sharing options...
p3medic Posted February 12, 2008 Share Posted February 12, 2008 So in your opinion, a blood glucose would be of no use to you if provided by a BLS crew transporting this patient? I realize that different stroke etiologies require different intervention, but as part of any stroke workup a blood glucose needs to be assessed. Hypoglycemia is one of, if not the number one mimic of CVA, ruling it in or out seems to me to be of great benefit, with little risk. I won't beat this issue to death, (unless I've already done that) buy I see no down side to having that information at your disposal when the patient hits your ED, not 20 minutes later. The BLS crew doesn't need to be an expert on the Kreb's cylce to perform this minimally invasive test, IMHO. Link to comment Share on other sites More sharing options...
JakeEMTP Posted February 12, 2008 Share Posted February 12, 2008 I'm sure you would agree, it only takes 30 sec to obtain a BGL. I can get it when I start an IV eliminating an extra "stick" of the patient. I've been watching this thread and finding it hard to add something and be objective, as we are all ALS. I've had EMT-Bs hand me a strip and place it in the glucometer for me and relay the number. Then it can help me with my assessment. Link to comment Share on other sites More sharing options...
mrmeaner Posted February 13, 2008 Share Posted February 13, 2008 After looking at the NHTSA guidelines for the Emergency Medical Technician (Basic), it looks like the ability to give oral glucose is intended to remain a skill appropriate for this level. • Pharmacological Interventions o Assist patients in taking their own prescribed medications o Administration of the following over-the-counter medications with appropriate medical oversight: Oral glucose for suspected hypoglycemia Aspirin for chest pain of suspected ischemic origin That being the case, I agree it would be appropriate for the EMT to use a glucometer. The reason being if they are going to make the intervention, it should be a more informed one. This is given that: they are calling med control, this is being done en route, and there is no indication that the pt. can not control his/her airway. It would appear that glucagon is no longer an option for the EMT. Good. It has already been explained why this is appropriate. Even though I agree in this case that the EMT should be able to use a glucometer, I voted no in the poll. The reason being that I don't believe that an EMT (Basic) should be solely responsible for the transportation of a pt. in an emergency therefore no reason to have a glucometer. I don't have anything against Emits personally, I work with Basics and Intermediate Technicians (a Wisconsin thing) all the time. Your level of care doesn't necessarily reflect your commitment to patient care (I know Dust, if they were that committed, they would get as much education as they can and become medics). I just believe that the reasons there are still EMT services are not enough to justify the lower level of patient care. Link to comment Share on other sites More sharing options...
CBEMT Posted February 13, 2008 Share Posted February 13, 2008 Primarily, you are screwing up the lab results that ALS or the ER is going to be wanting soon, making their assessment (which they actually have the education to understand and interpret) more difficult, ultimately delaying assessment and care of the patient. Isn't that like withholding pain management from the abdominal pain patient? Link to comment Share on other sites More sharing options...
backinboston Posted February 13, 2008 Share Posted February 13, 2008 I work in a tierd system in the urban environment that allows BLS to use glucometers. We often have 911 coverage for the duration of time that ALS is out on a call. Many of our cities use BLS more than ALS due to sheer call volume. Glucometers are an important tool that doesnt always mean that the BLS can make a difference with medication but it is a tool for assessment. Everytime we go to a syncope, low sugar, high sugar, general weakness, seizures, possible stroke... etc... When we go to meet up with ALS or when we BLS the pt to the hospital it is one of the first things asked because both will be moving on to get a sugar quite eairly in their assessment. It is something that the regular lay person can do on their own, so why not get it out of the way en route to ALS or the hospital. It is not a difficult skill nor does it require vast knowledge. Something to think about that was mentioned by Dust eairlyer. Giving EMT-B's a glucometer is not going to propetuate giving them more tools , expecally 12leads. However, even if they did it would be the same as when the pt hits the hospital since... Many RN's cant read a 12lead... let alone the monitor. They often dont even take the 12lead the tech does (lower than EMT- and... when they hit the hospital, they can just pass it off to the MD just like the RN will do about 20 minutes after they have bumbled around to take a report. just food for thought tho Link to comment Share on other sites More sharing options...
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