Doug Posted December 23, 2008 Share Posted December 23, 2008 Yes, D50 is very deadly when given to diabetics. You guys kill me (and your patients). The coma cocktail was invented for medics who treat the equipment and not the patient, because they would not push D50 for patients who obviously needed it, because their glucometer said no. I'm not really sure if you are pro or con treating the equipment v. pt. Please explain if you are for or against the "coma cocktail." Link to comment Share on other sites More sharing options...
ERDoc Posted December 23, 2008 Share Posted December 23, 2008 Yes, D50 is very deadly when given to diabetics. You guys kill me (and your patients). The coma cocktail was invented for medics who treat the equipment and not the patient, because they would not push D50 for patients who obviously needed it, because their glucometer said no. If you arent familiar there are a host of issues that can cause a false glucometer reading. Here is a small list: Abnormal blood sugar levels can also be found in patients who: Are pregnant. Have hepatitis. Have head trauma. Are septic. Have diarrhea. Exercise strenuously. Consume large amounts of alcohol or are chronic drinkers. Are on medications (beta blockers, quinine, prednisone). Overdose on medications (lithium, acetaminophen, antihistamines). Have Addison's disease. Have taken someone else's diabetes medications. Have expired medications. Have an unusual Hematocrit Level Not to mention, glucometers/strips/and control solutions are supposed to be maintained at a certain temperature extreme, which is often violated in ambulances. If you need a glucometer to treat a diabetic patient, you need to go back to school. If you utilize a coma cocktail you obviously have not kept up with current literature. So, what I am understanding is that you believe one of two things: 1. Diabetics do not get strokes and that any stroke like symptoms in a diabetic is because they have an abnormal set point for their blood sugars (please provide references to substantiate this). 2. You have a CT scanner on your ambulance or have xray vision (CT vision??) and can see that the pt clearly does not have a bleed or stroke (please provide proof as this could prove to be interesting). I usually can ignore your rants, but when you just start spouting malpractice I feel compelled to step in so that some of the newer providers do not become misinformed. Link to comment Share on other sites More sharing options...
spenac Posted December 23, 2008 Share Posted December 23, 2008 Yes, D50 is very deadly when given to diabetics. You guys kill me (and your patients). The coma cocktail was invented for medics who treat the equipment and not the patient, because they would not push D50 for patients who obviously needed it, because their glucometer said no. If you arent familiar there are a host of issues that can cause a false glucometer reading. Here is a small list: Abnormal blood sugar levels can also be found in patients who: Are pregnant. Have hepatitis. Have head trauma. Are septic. Have diarrhea. Exercise strenuously. Consume large amounts of alcohol or are chronic drinkers. Are on medications (beta blockers, quinine, prednisone). Overdose on medications (lithium, acetaminophen, antihistamines). Have Addison's disease. Have taken someone else's diabetes medications. Have expired medications. Have an unusual Hematocrit Level Not to mention, glucometers/strips/and control solutions are supposed to be maintained at a certain temperature extreme, which is often violated in ambulances. If you need a glucometer to treat a diabetic patient, you need to go back to school. Crotch get up to date. Heck read the research. If not please don't waste everyones time. I do not treat the machine I treat the patient, but you know what that diabetic can also have a stroke in fact I believe some studys say they are at higher risk for it. So just because they are diabetic does not mean they need glucose. At times you do need to treat based on what the machine says along with a complete exam. You are the one that tried to argue to save X number of people well now you are arguing against a change that has been proven to better patient outcome. The coma cocktail days are over if you still want them you are more detrimental to patients than the "lazy" medics that encourage patients that do not need an ambulance to refuse transport. Edit: Doc beat me to it but I'm still leaving my post. Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 23, 2008 Share Posted December 23, 2008 If you can not differentiate CVA from Insulin Shock or Ketoacidosis, you need to go back to school. Link to comment Share on other sites More sharing options...
spenac Posted December 23, 2008 Share Posted December 23, 2008 If you can not differentiate CVA from Insulin Shock or Ketoacidosis, you need to go back to school. Arrogant, ignorant, stupid, idiotic is all I can say about that statement. Please provide the documentation as doc asked. Link to comment Share on other sites More sharing options...
okmedic Posted December 23, 2008 Author Share Posted December 23, 2008 Meningitis may also need to be ruled out. Yea, the patient was transferred to a different facility where they where suspecting possible bacterial meningitis, but the tap was negative. Link to comment Share on other sites More sharing options...
ERDoc Posted December 23, 2008 Share Posted December 23, 2008 If you can not differentiate CVA from Insulin Shock or Ketoacidosis, you need to go back to school. :banghead: :banghead: :banghead: I cannot believe that I am letting myself get dragged into this. Read the second sentence of this article as well as the part about hypoglycemia. http://emedicine.medscape.com/article/1162340-overview Check out the differential diagnosis of a stroke: http://emedicine.medscape.com/article/793821-diagnosis A quote from Tintinali 6th edition (one of the most referenced texts in EM): "All patients with neurologic deficits should have their blood glucose checked for hypoglycemia." There are many mimics of a stroke. If is it so plainly obvious, why do we even bother with CT scans? Please enlighten us to how it is possible to definitively differentiate between hypoglycemia and a stroke. Link to comment Share on other sites More sharing options...
VentMedic Posted December 23, 2008 Share Posted December 23, 2008 Yea, the patient was transferred to a different facility where they where suspecting possible bacterial meningitis, but the tap was negative. MRI? Temperature? Lactate level? Link to comment Share on other sites More sharing options...
crotchitymedic1986 Posted December 23, 2008 Share Posted December 23, 2008 I am not for coma cocktails for any unconscious patient. But if I have: An unconscious insulin dependent diaphoretic, diabetic patient, I will most likely give 1/2 amp D50 if the blood sugar is anything below 120. Signs and symptoms overrule the machine, which is often faulty. When the body is reaching a blood sugar near zero, the body squeezes out every last ounce of sugar in the body, which can give a false positive, along with all the other issues that can cause a false positive. An unconscious person who is on prescriptions that would react to Romazicon or Narcan, I will give it (not D50). Link to comment Share on other sites More sharing options...
ERDoc Posted December 23, 2008 Share Posted December 23, 2008 When the body is reaching a blood sugar near zero, the body squeezes out every last ounce of sugar in the body, which can give a false positive, along with all the other issues that can cause a false positive. Provide references to support this. Also, if your blood sugar is "near zero" it is obviously not "120". Link to comment Share on other sites More sharing options...
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