itku2er Posted June 19, 2006 Share Posted June 19, 2006 In one of the states I am EMT in we are allowed to give Glucagon at the basic level. Some people didn't agree with this. And a knockdown blowout ensued. I was just wondering if you think the use of glucagon IM, should be used by basic EMT's? Your reasoning behind it. The protocol states It can be given in the presence of altered LOC with a blood sugar of less then 60? And please dont post any web pages here. Someone blew up the last one doing that. He will remain nameless. No Basics should not be allowed to give Glucagon IM ........are you nuts?......you want to know why i think this ......because as a basic that is all you are trained to do is basic non invasive procedures....could you place your patient on a monitor after you gave this IM injection NO .....could you start a line on this patient if the glucogon didnt work to push a amp of D50 no ....all you could do would be give the the IM injection and moniotor the bs....it is fast acting most of the time and you have no way to counter an ill effects if you they occur......so for as a basic giving an IM injection of Glucagon NO WAY ......too many things can happen that you couldnt handle after the medication was given....allowing basics to give IM injections of glucogon is like allowing the POPE to do BRAIN SURGERY....... later TERRI Link to comment Share on other sites More sharing options...
whit72 Posted June 19, 2006 Author Share Posted June 19, 2006 Ok ace thanks for posting some information Can I now reply: First in one of the articles, I havent had the chance to read them all. I have been pretty busy. It states there are no contra-indica except pts that have a hypersensitivity to it. And the presence of pheochromocytoma, I believe I stated that earlier. Glucagon should be administered cautiously to patients with a history suggestive of insulinoma, pheochromocytoma, or both. In patients with insulinoma, intravenous administration of glucagon may produce an initial increase in blood glucose; however, because of glucagon's hyperglycemic effect the insulinoma may release insulin and cause subsequent hypoglycemia. A patient developing symptoms of hypoglycemia after a dose of glucagon should be given glucose orally, intravenously, or by gavage, whichever is most appropriate. I understand this. Lets me first state that Im sure we all undrstand the brain operates on oxygen and sugar, any prolonged interuption of either one could cause diasterous consequences, Far more greater then the containdications or warnings stated here. I find it a little disturbing that every MEDIC and ER doc I have asked about this discussion including the er doc on this board. Have stated in not so many words That witholding glucagon in the scenarios described could have a far more disaterous effect that any side effect or any complication that could arise from administering it. Could it be that the people on this board just in no way would ever agree with an EMT, Or even find it reasonable that this medication could and does have benefits that far outweigh any issue that could possibly arise from giving it. Link to comment Share on other sites More sharing options...
PRPGfirerescuetech Posted June 19, 2006 Share Posted June 19, 2006 I find it a little disturbing that every MEDIC and ER doc I have asked about this discussion including the er doc on this board. Have stated in not so many words That witholding glucagon in the scenarios described could have a far more disaterous effect that any side effect or any complication that could arise from administering it. Could it be that the people on this board just in no way would ever agree with an EMT, Or even find it reasonable that this medication could and does have benefits that far outweigh any issue that could possibly arise from giving it. They are absolutely correct. This is simple Whit. EMT's, by and large, are too stupid too administer meds of any type, with a rare exception. Medication administration required significant clinical and didactic education, regardless of the medication administered. There is not enough hours in a BS weekend "update" class to handle it. Period. You can continue to argue this until your blue in the face. You will lose the arguement. Link to comment Share on other sites More sharing options...
AZCEP Posted June 19, 2006 Share Posted June 19, 2006 Whit, You need to re-read the response that was given by ERDoc. He stated that the hypoglycemia was bad, and that glucagon is not the method of choice to correct the problem. Yes, hypoglycemia is bad. However, there has been no evidence that transporting a hypoglycemic patient with signs of neurologic involvement without vascular access for IV dextrose administration is deleterious to the patient's condition in the short amount of time that most EMS agencies operate under. Have you had an opportunity to research this drug's actions on your own? We have been more than willing to assist you in educating yourself, and you don't seem to be able to take the hint. READ the description that I provided for you. It will help you understand that glucagon IS NOT GLUCOSE. Link to comment Share on other sites More sharing options...
whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 PRGP wrote: This is simple Whit. EMT's, by and large, are too stupid too administer meds of any type, with a rare exception. I am not looking to win any arguments. (Thats the difference between you and me) Thanks that was helpful. Your opinion is noted and will never be asked for again. glucagon IS NOT GLUCOSE. I know exactley what glucagon does. It releases stores of GLUCLOSE in the liver, yada, yada,yada I probaly no more about glucagon now then I would ever need to know. Not necc. a bad thing, even with all the negative responses I still have to administer it if confronted with the situati Link to comment Share on other sites More sharing options...
paramedicmike Posted June 20, 2006 Share Posted June 20, 2006 glucagon IS NOT GLUCOSE. I know exactley what glucagon does. It releases stores of GLUCLOSE in the liver, yada, yada,yada I probaly no more about glucagon now then I would ever need to know. Not necc. a bad thing, even with all the negative responses I still have to administer it if confronted with the situati You obviously haven't read a thing anyone has posted. AZCEP gave an excellent description of glucagon and what it does. Glucagon is not glucose. Glycogen isn't glucose either. Glucagon does NOT release stores of glucose in the liver. Go back and read it again...and again...and again...and again....and yet again. Because it's obvious to everyone here, except you, that you don't have a flippin' clue as to what you're so poorly attempting to discuss. And I see you're still looking for that spell check button. I think it's an accurate assessment of the educational level with which the rest of us are dealing. But still... ...-be safe. Link to comment Share on other sites More sharing options...
whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 Glucagon stimulates breakdown of glycogen stored in the liver. When blood glucose levels are high, large amounts of glucose are taken up by the liver. Under the influence of insulin, much of this glucose is stored in the form of glycogen. Later, when blood glucose levels begin to fall, glucagon is secreted and acts on hepatocytes to activate the enzymes that depolymerize glycogen and release glucose. Ok I must be missing somthing. Anyway The fact that I know way more then I ever wanted to know about glucagon. I have exhausted this issue completely. Thanks for the input. Whit Link to comment Share on other sites More sharing options...
paramedicmike Posted June 20, 2006 Share Posted June 20, 2006 Yep. You sure are missing something. But unfortunately for you I don't think anyone here can spell it out any more clearly. And you can continue to be a threat to every patient with whom you come into contact. Because it seems you're quite happy being a danger to the public at large. -be safe. Link to comment Share on other sites More sharing options...
whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 So if it is so dangerous why would it continue to be an accepted form of treatment in RI. I do agree that I no longer work there. If there were continual disastrous effects from the administration of this medicine, do you think maybe it would have been removed? No offense but the people who write these protocols have significantly more education, and experience with this, then either of us. Link to comment Share on other sites More sharing options...
ERDoc Posted June 20, 2006 Share Posted June 20, 2006 Putting aside the battling going on (I'll let you guys finish that one), is everyone here against EMTs giving meds period? Or are we talking about EMTs giving IM glucagon as standing orders? Are you more experienced guys okay with EMTs giving IM if they have medical control approval for it? People have said that skills can be taught to a monkey. Do you feel that EMTs can be taught how to give IM meds as long as they have been given approval by online medical control, especially in a case like this where you have very objective info (you know what the FS is)? How about with more subjective things (ie steroids for asthma/COPD)? Has anyone ever seen a bad reaction to glucagon (personally I have used it quite a few times both in the ER and as the medical control doc and have never had a problem with it)? If so, what did you do about it? Would it not be more beneficial to the pt to have some form of treatment instead of killing brain cells? What do you think? Link to comment Share on other sites More sharing options...
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