BLS and Glucometers

[Scaramedic]

My quick comparison is this.

It would be really cool if Paramedics had a portable Olympus Chemistry Immuno Analyzer on board. We could get LDL's, HDL's, Amylase, Sodium, Calcium, etc, levels. But, if we cannot do anything with those results what is the use of having them?

[mobey]

correct me if I'm wrong but doesn't glucagon deplete the stored glucose in the liver and if not treated appropriately post administration this could cause significant problems in the diabetic patient.

I've not had the luxury of having glucagon as a med choice in a long time so I'm not up to speed on glucagon.

My thoughts exactly, it causes the liver to dump all of it's glycogen stores and inhibits glycogen synthesis. (Thats why sometimes it works and sometimes not. No stores no glucose).

You can't just give a mg of glucagon then have the patient sign the release form.

[EMS49393]

I won't correct you simply because you're correct. It's a dangerous drug, like all drugs.

I had an interesting diabetic case a few years ago. I had a patient, 50's year old female, insulin dependant diabetic that had been vomiting for two days. She had not taken any insulin during this time because she was concerned her glucose would fall to a level that would render her unconscious. She was alert and oriented, however she felt that her glucose level was lower than normal. I established an IV for fluid replacement, and to administer an anti-emetic, since she was still actively vomiting while I was there. Her BGL level was in the 40's. Her normal range was 100-130 mg/dl. I gave D50W 25 g IVP. Oral glucose was a bad option with the vomiting. Her BGL level rose to 75 mg/dl. I transported her, rechecking her glucose once more before arrival to the ER. It maintained in the low 70's. A follow-up revealed that her electolyte balance was very much less than balanced, and she had used up any available glucose in her body attempting to maintain her homeostatis while being sick. She would not have been a canidate for glucagon.

What if she would have been met by a BLS crew? Hopefully, they wouldn't attempt to adminster oral glucose, since she's actively vomiting. Glucagon wouldn't have done much for her, and they still would have needed ALS to handle this very sick diabetic patient. On top of that they would have stuck her at least three times to come to the determination that they wouldn't be able to raise her glucose level. If they would have understood the pathophysiology behind this illness, they wouldn't have spent all those minutes on scene with a sick patient when they could have been on their way to definative care.

There is one other very important reason to stick a diabetic as little as possible. They do not heal as well as a person that is healthy. They often have neuropathy, and if they are a poorly controlled diabetic, they may already have skin breakdown and sores that will not heal. The last thing they need is another route for infection.

[DwayneEMTP]

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.

The sentence in bold is an outstanding example of why this entire idea is bad.

In this thread I've seen several examples of "Well, at least we can give glucagon!"

Terrible idea...which I'm not going to explain here....If you're curious, do some research on glucagon. Then look to see who has stated the above opinion, and from now on understand that they are far too ignorant of even the the most basic understanding of physiology/pharmacology to be caring for patients without direct supervision...much less looking to expand their scope of practice.

You don't have to believe me that it's a bad idea. Do the research. Look to see how many are ignorant of that research. Then decide if you want those same people caring for your family members. It's that easy.

Dwayne

[JPINFV]

correct me if I'm wrong but doesn't glucagon deplete the stored glucose in the liver and if not treated appropriately post administration this could cause significant problems in the diabetic patient.

I've not had the luxury of having glucagon as a med choice in a long time so I'm not up to speed on glucagon.

It also upregulates gluconeogensis and fat breakdown [glycerol backbone can be converted to glucose as well].

[Dustdevil]

Really, you're qualified to tell me that "I don't know how much I don't know" from a few posts of mine with a differing viewpoint on BLS use of glucometers. Seems somewhat hypocritical, even.

More evidence that you don't know what you don't know.

Yes, after a decade and a half of paramedic practice and a few years of college level medical education, he is more than qualified to determine how little you know. It is perfectly clear in your posts that you have little understanding of medicine or EMS reality. In fact, anybody with a grasp of grade 5 math is qualified to figure out that a 19 year old with nothing a three week first aid course and a couple month ALS skills course doesn't add up to a well educated medical practitioner. And again, everything you have posted so far only goes to prove that.

You may well become teh aw3some some day. You have as much potential and opportunity as anybody else. But you aren't even close yet. In fact, you're behind the 8-ball already for having gone the EMT-I route. And you still won't be close after finishing paramedic school. You're the one who is going to have to drop the attitude and get a grip on reality before you even understand what you don't know. Until then, trust me, Akflightmedic is one of the last people here you want to argue medicine with.

[brentoli]

I still find it hard to believe that that many BLS services have Glucagon in their protocols. I still haven't seen good reason following the LCD theory to allow it on a BLS truck however.

But why do some providers now feel that Oral Glucose is a bad thing? What can it hurt used under protocols and not delaying care? (Don't take in to the account the dumbass shoving it down unconscious grandmas throat.)

[Dustdevil]

But why do some providers now feel that Oral Glucose is a bad thing? What can it hurt used under protocols and not delaying care? (Don't take in to the account the dumbass shoving it down unconscious grandmas throat.)

I don't have a great deal of trouble with that. However, some problems still exist. 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. Also, it's not often that a hypoglycaemic patient is fully conscious and alert for oral administration anyhow. If they are, they usually don't call EMS. They take care of the problem themselves, which they know more about than any EMT. So what you are left with is all those borderline consciousness patients, who then create the scenario you mentioned above. EMTs simply cannot stand being cheated out of a chance to use a "skill", so they make the erroneous determination that the patient is "conscious enough" and slam it anyhow. Especially with all these backwards systems actually allowing buccal administration in unconscious victims to begin with. Sorry, but with three weeks of first aid training, and nothing more, I'm not comfortable with their ability to make that judgement call.

[Scaramedic]

ultimately delaying assessment and care of the patient. Also, it's not often that a hypoglycaemic patient is fully conscious and alert for oral administration anyhow.

Hey it only took two years but I finally caught a Dustdevil typo!!!

[Dustdevil]

Close, but no cigar! :wink:

From http://en.wikipedia.org/wiki/Hypoglycemia:

Hypoglycemia (hypoglycaemia in British English) is the medical term for a pathologic state produced by a lower than normal level of glucose (sugar) in the blood.