Blood sugar?

[dhpd9807]

Of late I have been subjected to a trend of RN's and doctors asking me if I did a blood sugar on every effing pt I bring through the door, regardless of the nature of the illness/injury. Is this ridiculous practice limited to my corner of the world or is it happening everywhere?

[rescuecpt]

No, it happens in a lot of places. I usually politely say "No, I didn't, it's not in the protocols for this patient". That's usually enough.

I tend to D-stick anyone who has a history, who feels lightheaded, anyone AMS, (+) Loss of consciousness, sometimes people who were in car accidents but aren't sure how it happened (with their permission). But the typical "I stubbed my toe"... no way. Waste of a perfectly good lancet.

[RALS504]

I know in the ER I work in we draw a BMP (basic metabolic panel) right off the bat for almost all patients with the exception of a lac. or dislocation. I also know that most of our doctor look down on EMS for doing BGLs on non-diabetic patients. I follow the rule of treat your patient and it holds true for the field and the ER. If you do a BGL for because you think the patient needed it and the patient did not there really is no foul; However, if you miss a hypoglycemic/altered LOC well the consequences are severe.

[TTLWHKR]

Protocols or not, it could be pertinent to any patient, if you think about it.

I fell and cut my forehead one night... It could be the fact that I tripped over a cat toy, or that I didn't have the lights on... or that I was hypoglycemic.

All three.

MVA? Did the person black out? Were they dazed and not paying attention?

Chest Pain? Is it a panic attack brought on by the inability to function?

SOB? Is it caused by extreme hypoglycemia

Hypotension?

Hypertension?

I'd check it anyway.. Only takes a minute.

Just checked my own.. 92. I should probably eat something, while it is WNL, it's too low for me. Should be in the 120-130 region.

[coloradoemt]

This is becoming somewhat of a trend here as well. I agree with what goddess has to say. I suppose it could become a basic standard. I can deffinately see how it can help decide treatments with a wide variety of pts, but I can also see it being added to the list for those who simply like to practice cookbook medicine...

[Jon]

Most times the medics start a line, they get a BgL from the venous blood. not perfect, but gives you a "high" "medium" and "low" range.

[rescuecpt]

Most times the medics start a line, they get a BgL from the venous blood. not perfect, but gives you a "high" "medium" and "low" range.

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.

[dhpd9807]

If someone is altered, sure, I can see it. If your pt. is not altered, tachy or diaphoretic I just can't see the point. Not to mention that regardless of what I tell the ED staff they are going to check BGL before they treat anyhow. Hey coloradoEMT, my last encounter occured at MCA and I thought this fool doc was going to sock me for not doing a BGL. I wanted to tell him it wouldn't have made him (the doc) any taller. Can't wait for the day when I don't have to hold my tongue.

[MedicPrincess]

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.

Our medics here do it. There is a little blood in the end of the part of the IV that you pull out to leave the catheter in...just drop some on the test strip.

If they don't do an IV they do the finger stick. But not on every patient.

[Celtictigeress]

Its reasons like this I wear my Med ID..

I tend to monitor it but at least if for some reason *knocks on wood* I black out or become disoriented, they can read my bracelet and goo "Mmmmhmmmm" and handle the buisiness.... Like it was stated if they fell (could be over a cattoy) best to check but its a waste of time if say for example, someone steps on a patch of ice and busts their Arses... because they didnt see the ice to begin with yanno?

[dgueldner]

We used to have some medics that used an ink pen at the end of the safety cap and push a small drop out it was dangerous. However you are not by far alone in the every pt must have a CBG as you can tell. I used to tell the doc, my pt is Awake, Alert and Oriented, and that was usually enough, but remember you can never go wrong by doing one.

[rescuecpt]

Our medics here do it. There is a little blood in the end of the part of the IV that you pull out to leave the catheter in...just drop some on the test strip.

If they don't do an IV they do the finger stick. But not on every patient.

OK, nevermind me being dumb, but are you talking about blood that remains on the needle? So you're trying to maneuver a used needle around?

Or are you talking about blood that comes out of the cath prior to hooking up the IV if you don't tampenade well enough?

I am confused, and a little scared.

[MedicPrincess]

No no...not screwing around with a used needle. When they pull the needle out, there is a little metal piece that covers the needle on the end. Blood collects there, hold it over the test strip, some drops out.

I guess you'd have to see it...or I will have to get some more expierience and be able to figure out what the heck I am talking about. I can do it, just don't make me explain it. :P :wacko:

[TTLWHKR]

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.


I do it. When I get the flash in the cath, I remove the needle, draw my labs, and before I connect the tubing, I let a drop of blood on the tip of the test strip.

Quick. Saves the patient any unnecessary pain.

[MMiz]

No no...not screwing around with a used needle. When they pull the needle out, there is a little metal piece that covers the needle on the end. Blood collects there, hold it over the test strip, some drops out.

I guess you'd have to see it...or I will have to get some more expierience and be able to figure out what the heck I am talking about. I can do it, just don't make me explain it. :P :wacko:

I've seen this in the field. The person in charge of our Our CQI committee reviewed our glucometer documentation and found that using the blood from this method could give readings of +/- 30. It is now standard policy to do a finger poke.

[mofiremedic]

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.
our iv's have a flash tube built in to them and all you have to do is push on a white button with a pen and blood comes out of the syringe. it's very clean and controlled and saves the pt a stick.

[mofiremedic]

I've seen this in the field. The person in charge of our Our CQI committee reviewed our glucometer documentation and found that using the blood from this method could give readings of +/- 30. It is now standard policy to do a finger poke.
the research that i have read shows that venous glucose is 10 points higher than a finger stick. however keeping an open mind i would be interested in your cqi committee's resourses

[MedicPrincess]

our iv's have a flash tube built in to them and all you have to do is push on a white button with a pen and blood comes out of the syringe. it's very clean and controlled and saves the pt a stick.

RescueCPT....that is exactly what I was trying to say.

Thanks mofire.

[rescuecpt]

Ah, ok. I don't think ours are capable. We have the nifty needles where you press the white button and the spring sucks the needle back into the handle... and that's it. No more needle, no more blood.

We don't draw labs, and a lot of my patients are bleeders (damn thinners) so that's why I could imagine it being messy to take a sample from the cath site before hooking up the tubing.

Thanks for the explanations everyone. :)

[squid]

This might a totally dumb assumption, but I wonder if giving everyone a blood sugar is an overreaction to not having done that in the past? We've (I mean, people in my region) run into trouble before assuming a patient is drunk. There have been people who died in jail becuase it was assumed they were "just another drunk Native," which is tragic and criminal. I wonder if anything similar is going on in other places.

Or is it info the hospital can use... nah, they'd do their own if they needed it. At least here.

Of course, yeah, all bets are off if you don't have an altered LOC or anything other signs or symptoms. I'm not saying every paitent *needs* a CBG, just that there might be a push for them that's gone a bit far.

[RALS504]

I've never seen anyone do that, and I don't do it. Sounds kinda messy to me.

I have started an IV and used the needle (or go strait to the freshly placed cath.) for a venous blood sample for a BGL reading since 2001. This works quite well and is not at all messy. I also had someone show me a new trick while working in the ER. If you are going to draw blood from your IV, take an unprimed NS lock (Heparin lock to some of you), start your IV, then hook up your NS lock, lock it closed, remove the buffalo cap, attach a vaccutainer hub or syringe, open the slide lock, let the NS lock prime with blood rather than NS, draw all the desired test tubes, lock the slide lock, replace the cap, and flush the line. When I drew blood off of my IV in the field I always put the vacutainer hub directly to the newly place IV cath. I find this new way neater because you do not have to tamponade off the vien, you have a control valve. I know we do not draw blood all that often in EMS, but if you switch to the hospital or need to draw blood it is a neat little trick. Also per my hospital BGL policy we may use a capilary, venous, or arterial blood sample with the same range 60-120 mg/dl.

[TTLWHKR]

I know we do not draw blood all that often in EMS


Every time I start an IV, I draw four vacutainer tubes of blood for labs.. It's my protocol.

[RALS504]

Every time I start an IV, I draw four vacutainer tubes of blood for labs.. It's my protocol.
That sounds like very forward thinking protocols you have. I think we under estimate the value of drawing labs early for the best possible patient outcomes. Your system may have hospitals that do not accept your blood draws, so be it. But draw them anyway, label them (date/time,initials, and agency), and tape them to the IV bag this way they have to decide to get rid of a perfectly drawn labs. I mean how nice is it to roll into your local ER with a level one trauma and have a purple top test tube ready to go to the blood bank to get typed and screened.

[TTLWHKR]

The hospital system could care less.. I meant that it's something that I personally do, on every call. Saves the patient from getting stuck twice. If it's a trauma, I try to not only get labs, but both IV's.. again.. so they don't have to go through it while everything else is going on. If the trauma victim doesn't get field labs locally, they draw them from the femoral artery.... which hurts like an SOB.. :unsure:

[emtbass]

In my part of the world... we do a d-stick on EVERY patient that gets an IV regardless of hx. When you start the IV... you get the blood from the catheter (you can stick your pen in one end and a drop of blood from your flash chamber comes out the other). alot of transfers we'll get a d-stick as well... I would say 98% of the pts get a d-stick.

[EMTI&RESCUE]

I might be labeled a "randy rescue" but if their sick enough or hurt enough to get in the back of my bus then their going to get the full work up. IV, D-stick, and all the vitals. Its "CYA" by doing them I think. It will help keep you out of court, or looney bin if ya dont do them and your patient dies on your bed. That and it gives me something to do on the way to the E.R.