Oral glucose

[emt322632]

In my world, sticking a thick gel into an unconscious person's mouth is ALWAYS a bad idea...always;-)

[mobey]

In my world, sticking a thick gel into an unconscious person's mouth is ALWAYS a bad idea...always;-)

It depends on the circumstances (protocols aside). My ALS intercept is at least 1/2 hr away. Pt lays on their side, I admin glucose onto buccal membrane, massage cheek, suction, repeat. With 1hr transport time I do what makes sense, in my world sticking a thick gel into an uncx patients mouth makes perfect sense.

[Just Plain Ruff]

well we all have our own opinions. I'd be hesitant to figure a way to explain the EMS aquired pneumonia that ends up killing the patient by saying in my world it makes sense.

One big deep breath by your patient and down goes the thick sugary glob into their lungs. That would I suspect be kind of similar to a chemical pneumonia

i do not profess to know the world of BLS transport as I've always been ALS based but I'd encourage you to ask your local ER doc this question

"Doc, let's say I have an unconscious diabetic patient in my rig. I just put a glob of instaglucose in his mouth, Is that a good idea?"

let's hear your answer.

ERDoc or BBledsoe - what are your thoughts on this?

[Thunderchild145]

If you're worried about aspiration, I was taught you can administer glucose paste PR (yea. per rectum.)

[Disclaimer: When your patient wakes up with sticky butt cheeks, they -will- be pissed off.]

[Disclaimer 2: I wasn't taught that by any EMT/Medic instructor. I've been a type 1 diabetic for 17 years and that's what the docs told my parents to do for me in lieu of glucagon.]

But yea, totally serious about that. You can absorb it PR but it may not be the most practical way to administer it. (Due to the speed of absorbtion and the nature of a hypoglycemic emergency)

[scratrat]

REALLY.??? be careful with the "always and never" statements,, Oral Glucose for "unconscious or Altered Mental Status patients" with known diabetic history, is in a lot of protocols.

Even if the patient is unconscious.

I know for a fact that it is in the MD Protocol for 10-15 Grams paste between gum and cheek.

So, don't tell him "your teacher should know better." That may be directly out of the protocol book from the state or county they they are in.

Now you may not agree with it, and being an ALS provider you may have a better way of doing it, and it can be a airway problem if you are not careful, but Glucose paste is protocol for Unc. Pt's.

Thank you

If someone is stupid enough to follow that protocol and administer a sticky gel to an unconscious person, then shame on them. And shame on that medical director. Someone should be speaking to that medical director to change their protocols. It's all fun and games until someone aspirates on this and it will come back to haunt the EMT. The medical director may have written the protocols, but it still falls back on the person administering the medication. If someone chokes and dies, I GUARENTEE you the lawyers will eat the person alive who gave it. The medical director may get into trouble too, but he/she probably will not stick up for you in that case. You should NEVER give oral glucose to someone who cannot follow your commands to eat it themselves, or you're just asking for trouble.

[paramedicmike]

It depends on the circumstances (protocols aside). My ALS intercept is at least 1/2 hr away. Pt lays on their side, I admin glucose onto buccal membrane, massage cheek, suction, repeat. With 1hr transport time I do what makes sense, in my world sticking a thick gel into an uncx patients mouth makes perfect sense.

So, what I hear you saying is that it's totally fine to place a substance into the mouth of a person who can't readily maintain his own airway? Do I have that right?

And what's more, you're saying that even after you place it there you suction it out? What good are you doing? It will not absorb fast enough to do any good by the time you're suctioning it out.

Good luck trying to explain why your hypoglycemic patient is now fighting a wicked aspiration pneumonia to your medical director and the patient's family...and your service's attorney, and your attorney et cetera...

Come on! You're smarter than that! Do you really believe what you're doing, as you wrote it above, is working? Or do you stick bite blocks into the mouth of a seizure patient so he doesn't swallow his tongue, too?

Thunderchild...well...stole my thunder.

You'd be better off giving it rectally than you would be by potentially compromising a patient's airway. And the absorption rate is faster, too boot! Is it gross? Possibly. But it's better to wake up with a tube of oral glucose sticking out of your butt cheeks than not wake up at all because the provider taking care of you stuffed a bunch of goo into your mouth.

There's another poster to these forums who has a story of a fellow medic in a wilderness situation. This fellow medic was a diabetic and became unresponsive. The only thing they had was a Snickers bar. Guess where it went? Guess what else?! It worked!

Can we please find some common sense in this thread? Some here have it. Some don't. And it's those who don't who are scaring me.

-be safe.

[mobey]

So, what I hear you saying is that it's totally fine to place a substance into the mouth of a person who can't readily maintain his own airway? Do I have that right?

And what's more, you're saying that even after you place it there you suction it out? What good are you doing? It will not absorb fast enough to do any good by the time you're suctioning it out.

Good luck trying to explain why your hypoglycemic patient is now fighting a wicked aspiration pneumonia to your medical director and the patient's family...and your service's attorney, and your attorney et cetera...

Come on! You're smarter than that! Do you really believe what you're doing, as you wrote it above, is working? Or do you stick bite blocks into the mouth of a seizure patient so he doesn't swallow his tongue, too?

Paramedicmike thank you for the alternate perspective... being fresh out of school I still have faith that our protocols are whats always best for the patient. I never considered the aspiration perspective, but it makes perfect sense. Appreciate the eye opening,

Mobey

[JPINFV]

I was doing a Google Scholar search to see just how dangerous using the buccal route in AMS patients would be when I drug this up.

Bioactivity of instant glucose. Failure of absorption through oral mucosa

R. R. Gunning and A. J. Garber

The efficacy of instant glucose as a potential treatment for hypoglycemia was studied in normal volunteers, with therapeutic doses administered in the buccal cavity. 2-Tritiated glucose (50 mu Ci) was homogenized into each dose before use. Mean blood glucose and serum insulin concentrations were unaltered by instant glucose. Glucose absorption was less than 0.05 mg at any time, and total glucose absorbed was less than 0.1 mg. For comparison purposes, volunteers swallowed a dose of instant glucose. Approximately 88% of the dose was absorbed during a 30-minute interval. Blood glucose and insulin levels increased. Instant glucose appears to be of therapeutic value only if swallowed by fully conscious, hypoglycemic patients. It should not benefit unconscious patients because of its poor absorption through the buccal mucosa.

http://jama.ama-assn.org/cgi/content/abstract/240/15/1611

I'll see if I can get the full text sometime tomorrow.

[sledogg1]

Go glucagon SQ 1.0 mg if unable to start IV or 25-50 gms IVP.

[paramedicmike]

Go glucagon SQ 1.0 mg if unable to start IV or 25-50 gms IVP.

This is not an option for BLS providers in most of the US. Nor should it be.

Do a search on glucagon and BLS providers and you'll find it has been discussed at beaten to death. Let's please not rehash the same dead arguments here. Thanks.

-be safe