Glucagon without an IV

[celticcare]

Back to original topic before we got sidetracked with wild and kinky forms of anal pleasures and stimulations, IM Glucagon is a basic skill here (national cert in ambulance) and these providers are not IV providers so if the patient is Diabetic, displays a diabetic coma, hypoglycemic, then you grab that needle and shove it in their muscle. Plain and simple. Hopefully an Intermediate care officer *paramedic* is on their way or an advanced paramedic is on their way to start an IV to give back up dextrose if needed, but I've seen it give fast results and then you replenish the supplies with a carb and some more sugar and transport for evaluation. Its not a case of money, a medical transfer to a facility here is roughly 75 dollars and as long as you are a resident at least, then the health care is free, so there isnt a case of making money its a basic fact of treatment. But lets get off the topic of stroking egos, lubing et tubes to become AP tubes *anal path tubes* and focus on the topic, is giving dextrose without an IV in situ a good idea or not?

Scotty

[CharleeFoxtrot]

Interesting discussion, except that our regional Med Control protocols doesn't include the use of glucagon :? . They also don't allow RSI :roll:

[crotchitymedic1986]

I am not arguing both sides of this issue, I think my views on "ems" refusals versus patient refusals have been well documented in multiple threads. If your diabetic patient wakes up and refuses EMS care, then so be it. All I am stating is that when you talk them out of going to the hospital, based on a single glucometer reading post D50 admin, that you may be doing your patient a disservice.

10 minutes earlier, the patient was near death, now they are OK to stay home. I do not know of too many other cases where we make that decision:

Status seizures resolved by Valium -- leave at home ?

Anaphylaxis resolved by Epi & Benadryl --- leave at home ?

Chest pain resolved by SL NTG -- leave at home ?

Hypotension resolved by fluid bolus -- leave at home ?

Bradycardia resolved by Atropine -- leave at home ?

Unstable tach resolved by valsalva or shock -- leave at home ?

[spenac]

Status seizures resolved by Valium -- leave at home ?Yes

Anaphylaxis resolved by Epi & Benadryl --- leave at home ?Yes

Chest pain resolved by SL NTG -- leave at home ?Yes

Hypotension resolved by fluid bolus -- leave at home ?Yes

Bradycardia resolved by Atropine -- leave at home ?Yes

Unstable tach resolved by valsalva or shock -- leave at home ?Yes

Yes to all if they say they do not want to go. You can not force someone to do what they do not want to do.

[crotchitymedic1986]

again, we are not talking about AMA refusals, we are talking about the kind of call Kaisu referenced today where lazy medics dont do their job and talk someone out of going to the hospital.

[fiznat]

Jesus Christ. THAT is why this argument is so freaking infuriating.

...when you talk them out of going to the hospital..

NOBODY, nobody nobody nobody is advocating at ALL that EMS providers EVER EVER EVER "talk a patient out of going to the hospital." Case closed period dot end. Stop even saying that sentence because that is freaking noooot what we are talking about! Damn!

[scott33]

we are talking about the kind of call Kaisu referenced today where lazy medics dont do their job and talk someone out of going to the hospital.

It is actually a lot more "lazy" just to blindly transport every single patient, every single time. Those who would treat and release / treat and refer (for those fortunate enough to have that privilege) are those who have done a complete and thorough assessment, ruling out all your "what ifs".

It takes a little more effort and clinical skill than sticking the BS patient on the pram and transporting.

[spenac]

It is actually a lot more "lazy" just to blindly transport every single patient, every single time. Those who would treat and release / treat and refer (for those fortunate enough to have that privilege) are those who have done a complete and thorough assessment, ruling out all your "what ifs".

It takes a little more effort and clinical skill than sticking the BS patient on the pram and transporting.

Bravo. [-o< =D> :thumbleft: :headbang: :hello1:

[crotchitymedic1986]

Yes, i think the EMS in washington dc subscribes to that theory.

[spenac]

Yes, i think the EMS in washington dc subscribes to that theory.

Nope they actually based on reports if accurate follow the lazy you discuss. They do not do proper exams then make a determination for need, again based on published reports that may or may not be accurate. You have condemned people based on news not on facts. Yes I am sure there are lazy medics out there. We are not lazy. It requires me more documentation to say no than it does to transport. But I think it is worth educating patients by saying no. Eventually maybe EMS will return to what it was meant to be for EMERGENCY.