Would you take a blood sugar here?

[JakeEMTP]

My primary partner and I usually get a BGL with the 2nd set of vitals on medical pt's depending on the severity of the call. Maybe it's due to the large number of large people here :roll:, but the ED seems to want this info. They're going to do it anyway I am told, so we might as well, "git - r - done!"

[N.S. ACP]

For some reason though, if I take a blood sugar on a patient with a GCS of 15, I get a "Minor Error" on my ACR and that goes on my record.

There must be a protocol somewhere for this, otherwise how can you get a "Minor Error". It's absoutly rediculous that have to wait for a gcs drop to justify a blood sugar check!

[HF-EMS]

The protocol issue aside:

If you have a medical patient, or any patient with confounding injuries or symptoms that just don't add up, the key aspect of treatment is a good, detailed assessment. While you may not be able to treat the patient's illness/injury, the better you utilize your txp time, and the better your assessment, the less time the hospitals have to spend figuring out what is wrong, and the faster the patient receives definitive care. After all, that is our goal, getting the patient to definitive care in the fastest and safest manner.

Additionally, any patient can have unusual symptoms for common pathological processes. A symptom is only an unusual one until we discover an association between it and a disease pathology. Similarly, with diabetes specifically, (& pt's lack of Hx) there is no Hx of anything, until it happens.

My opinion on taking sugar, a 45 sec procedure tops, is the same on what my original medic instructor said, all patients where you cant definitely rule out medical causes, gets a 12-lead, case in point the pt with bilateral thumb main with a massive anterior MI.

In New York State, I believe that Blood Glucose has been made a BLS Skill on the EMT level. I believe that as long as you treat your patient, and not your glucometer, BS can be a valuable vital sign if not for prehospital care, then as stated above to expedite the delivery to definitive ALS.

That said, im sure people will disagree with me, i look forward to constructive criticism

[Cookie]

I would on both. Regardless if there is a history or not, what is it going to hurt to check it? Nothing, just document the results.

[N.S. ACP]

I would on both. Regardless if there is a history or not, what is it going to hurt to check it? Nothing, just document the results.

Exactly

[Ridryder 911]

Exactly

The hurt is it may be " it is not appropiate" and here in the U.S the patient may be charged an additional $150 or more ....

R/R 911

[Cookie]

[jw-c152]

Just thought I'd make a post from another Ontario point of view.

Acosell, for this post I'm going assume you're a PCP (like me!) If not, apologies, please correct me.

Without reciting word for word, here's the provincial Primary Care Paramedic directive for Hypoglycemia.

--Indications - patients who exibit any of these SERIOUS signs and symptoms: agitation, altered LOC, syncope, confusion, seizures, symptoms of a stroke

--Conditions - patients who have a suspected BS level less than 4.0 mmol/L

-- Contraindications, etc.

So, as a PCP in Ontario, you would have to have a patient with one or more of those serious symptoms, plus suspect they are hypoglycemic in order to perform a BGT.

I know all Base Hospitals have slight variations in medical directives, but I believe most in Ontario follow the provincial directives fairly closely.

So in this case, if your auditor is a 'By the Book' kind of guy, he could rightly say that you may have deviated slightly from the directive. Personally, I don't think it's worth being written up for. Perhaps on that call I would have done a BGT as well, but I can't say. I wasn't there.

ACP's on the other hand are different. Their scope is much broader and are not restricted as to when they can check the blood sugar level of a patient.

Cheers,

Later.

[N.S. ACP]

The hurt is it may be " it is not appropiate" and here in the U.S the patient may be charged an additional $150 or more ....

R/R 911

I did not think of it that way, in my service you pay the user fee, no matter what is done, the way it should be.

[Dustdevil]

I did not think of it that way, in my service you pay the user fee, no matter what is done, the way it should be.

Should everybody pay the same for their hospital bill, no matter what is done for them?

Should everybody pay their mechanic the same, no matter what work he does on their car?

Should everybody pay the same for their meals at a restaurant, no matter what they order?

Should everybody pay the same for their home, no matter how large or small it is?

I fail to see your logic. :dontknow: