Glucagon without an IV

[Reddfrogg]

I can't believe thats what your preceptor told you...she shouldn't be preceptoring and maybe she should get a preceptor for herself. You won't kill a patient by giving them glucagon.

The person I was talking to wasn't my preceptor, just a colleague. We were discussing a recent case where the crew were unable to get an IV line on a brittle diabetic. In our service we don't carry glucagon (I'm working with the EMS director to change this, if possible) and I commented that glucagon would have been an option at that point. That's when she brought up that she had heard that glucagon could be harmful if you aren't able to get an IV after administration.

That's why I brought this up to the forum. Incidentally, I'm male, not female.

Mr. Dana J. Tweedy, NREMT-P

[CTXMEDIC]

interesting, no glucagon. whats in your protocols for an altered patient that is hypoglycemic? i assume d50 but if you cant get a line..? do you have I/O in your protocols?

[mrmeaner]

Okay. If that's her argument, then I'm going to go out on a limb (I promised Spenac I wouldn't hide behind "I'm a student" anymore.) and say she's out to lunch. If the iv is started, give D50 and forget glucagon. If the glucagon's given and no IV, give oral glucose or food. If the first dose of glucagon doesn't work such that food can be given, give another dose 20min later. If the second dose doesn't work and you can't give D50 (which PCP's here can't) then you're SOL and you manage what you can until the hospital.

Don't you have advanced care or any other way to give glucose? Given that you can't give D50, I assume you can't use IO either. You could give more glucagon, but if you were just looking for something to do then you may as well start on paperwork. At least you'll be getting something accomplished.

[CTXMEDIC]

ROFL!

[WolfmanHarris]

Don't you have advanced care or any other way to give glucose? Given that you can't give D50, I assume you can't use IO either. You could give more glucagon, but if you were just looking for something to do then you may as well start on paperwork. At least you'll be getting something accomplished.

ACP's can give D50. As a PCP I can't unless my Base Hospital allows for IV therapy, which we're taught in school, but aren't necessairly able to do. My glucagon standing order states that dosage may be repeated if necessary 20 min following the first dose. I've got that and oral glucose in my bag so those are my options as a BLS provider. Afraid I'm not seeing the joke though.

[CTXMEDIC]

whats ACP and PCP stand for? i get that ACP is like an EMT basic in the states, is that right?

[mrmeaner]

ACP's can give D50. As a PCP I can't unless my Base Hospital allows for IV therapy, which we're taught in school, but aren't necessairly able to do. My glucagon standing order states that dosage may be repeated if necessary 20 min following the first dose. I've got that and oral glucose in my bag so those are my options as a BLS provider. Afraid I'm not seeing the joke though.

I believe a second dose of glucagon would be an exercise in futility. Just to clarify, this is not a dig in you. You should follow your standing orders.

My point is that if the first dose didn't release enough glycogen stores to make the patient alert enough to be able to control their airway, why would a second dose? With that long of a transport, plus on scene time, plus response time, plus time elapsed before recognition, the patient needs a higher level of care as available.

[WolfmanHarris]

PCP = Primary Care Paramedic

ACP = Advanced Care Paramedic

CCP = Critical Care Paramedic

Paramedic Association of Canada has a pretty good breakdown of the levels. Though there is some variation as to how closely each area resembles this.

National Occupatioal Competency Profile

The Professional Paramedic Association of Ottawa also has a decent breakdown of the levels for Ontario. There is some variation service to service and the list isn't complete in some areas.

PPAO

Mr. Meaner, I didn't take it as a dig. Just thought I might have missed a joke. Were I operating in a service that had ALS, they would likely be sent to this. Also it's becoming more and more common for there to be PCP/ACP crews. I agree they need a higher level of care.

[BushyFromOz]

Whats the other option, NOT give them glucagon and the pt will improve :roll:

[rock_shoes]

DocHarris I wasn't aware that some Ontario PCP's where not allowed IV access. Here in BC PCP's use a 100mL bolus D10W (additional D10W boluses are allowed if needed) with a 50mg push of Thiamine instead of an amp of D50W. I like it myself because it allows us to titrate the D10W to maintain BGL if feeding the patient isn't an option. If IV access can't be obtained or the attendant is not IV endorsed (unfortunate remains of the flopped Paramedic 1 program) we use Glucagon. I find it curious that your base hospital allows for a second dose of Glucagon. Stores are typically depleted by the first dose making it useless and expensive. You'd probably be better putting a patient in recovery position and rubbing glucogel on their gums