I promised a hard scenario, consider it delivered.
- Thread starter Veneficus
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why would you give this patient oral glucose?
I wouldnt because she was not responsive and unable to swallow. :sad:
Edited because I am an idiot.
Protocols in MD allow oral glucose in unresponsive patients. There's really no contraindication of it. At a basic level, if they're unresponsive/altered mental status, they're very likely to get a slab of goo in their cheek at some point during our care.
To quote protocol: "Unconscious for unknown reason"
I probably would have given it to her too. :unsure:
Lifeguards For Life
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tsk tsk tsk:unsure:
Are those protocols written on stone tablets?
I remember the days of of "coma cocktails." Thiamine, narcan, and D50 for all unconscious unresponsive patients. It didn't really work out too well for the DKAs, HHNKs, and strokes.
Before giving oral glucose or IV glucose (dextrose) to an unconscious patient with no other information on why they are in such a state, I would encourage you to look up what the outcomes of such are.
Just because a protocol allows you to do something doesn't mean it is always a good choice.
conversely, I once worked for an agency that did not have a protocol to control bleeding. Should that be interpreted to mean we should not have?
"The rules are more actual guidlines than actual rules"
Not being a smartass here, I just got my cert so I don't know otherwise. I understand they could aspirate on oral glucose, but whats the worst that could happen if given by IV? or other than aspirating orally?
our protocols say the contraindications are "clinically insignificant" or something of that sort.
our protocols say the contraindications are "clinically insignificant" or something of that sort.
increased organ or tissue damage resulting in more profound disability or death.
Melclin
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Glucose should be given on the basis of a cap glucose reading. There are a number of reasons why a person may be unresponsive and unfortunately the big one, esp in nursing homes, are stokes (its also not a great idea to be raising the blood glucose in a septic patient as far as I know, but I'm not sure if the amount we give would make a difference).
When we start talking about cerebral insult glucose solutions are generally withdrawn from the batting line up. Other than the osmolar troubles you get from a solution with a bit of volume, like D5W, raising blood sugar in these patients causes the sugar to be metabolized to lactic acid (somebody correct me if I'm wrong). This lowers the pH and is associated with poorer outcomes.
With IV admin, you take the risk of phlebitis just as with any other IV therapy. So as common as IVs are, you do still need a reason to stick them in the first place. Also there is the relatively rare but nasty risk of extravasation where the glucose makes its way into the tissue surrounding the IV access, causing necrosis.
I've also heard about the possibility of it causing troubles in alcoholics, but I don't know much about that.
Aside from the head injury/stroke issue, I'm not sure what the risk of aspiration would be in the circumstances you mention, however, I would not say that any increase in the risk of aspiration is irrelevant.
Remember that your protocols are not an accurate summation of the nature of drugs and the best evidence based practice out there, its just the particular way in which your MD has chosen to dumb the material down. Saying that the risk is clinically insignificant just means he has accepted the risk, not that it isn't significant.
A fifteen year old with no history of diabetes .... are you really going to dish out glucose?.
I am not having a go at you personally mate but gah, non diabetics do not get hypoglycaemic, I mean seriously hypoglycaemic they might get a bit wonky after not eating for a day but thats not the same.
And be sure to administer D10 IV into a free flowing line that runs coz you know if you slip in a drip and extravasculate dextrose you end up with a black arm that doesn't work for very long after that.
That may lead to a change in orange jumpsuits to one that does not say 'DOCTOR' or 'PARAMEDIC' on the back but hey you MAS guys wear blue ones anyway right?
I am not having a go at you personally mate but gah, non diabetics do not get hypoglycaemic, I mean seriously hypoglycaemic they might get a bit wonky after not eating for a day but thats not the same.
And be sure to administer D10 IV into a free flowing line that runs coz you know if you slip in a drip and extravasculate dextrose you end up with a black arm that doesn't work for very long after that.
That may lead to a change in orange jumpsuits to one that does not say 'DOCTOR' or 'PARAMEDIC' on the back but hey you MAS guys wear blue ones anyway right?
Melclin
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A fifteen year old with no history of diabetes .... are you really going to dish out glucose?.
I am not having a go at you personally mate but gah, non diabetics do not get hypoglycaemic, I mean seriously hypoglycaemic they might get a bit wonky after not eating for a day but thats not the same.
And be sure to administer D10 IV into a free flowing line that runs coz you know if you slip in a drip and extravasculate dextrose you end up with a black arm that doesn't work for very long after that.
That may lead to a change in orange jumpsuits to one that does not say 'DOCTOR' or 'PARAMEDIC' on the back but hey you MAS guys wear blue ones anyway right?
Is this at me? I wasn't suggesting glucose..just discussing its use.
EDIT: Looking back over the post, I see now "Glucose should be given..." I wasn't saying that it SHOULD be given in this scenario. I was responding to this talk about giving glucose to unresponsive patients...I was just saying, it should be given based on a BGL reading, not based on unresponsiveness in itself.
Like I said, I'm a new EMT. I vividly remember correcting someone in class giving glucose to an unresponsive patient, and having everyone jump down my throat about being able to do that, which is why I'm following through with this inquiry, because its the first time I've ever heard the other side of the argument.
For this particular scenario in the thread, we had someone there to give us patient history, so we could rule out diabetes. There were many signs presenting themselves that screamed more than diabetes, but at a BLS level, I would have requested ALS intercept, O2, def would have considered glucose, and load and go...
BUT
I understand the reasoning behind not giving her glucose- when my protocols dictate that an unresponsive person gets glucose, and i DONT give it to them, am I due to get reprimanded for not following protocols? Someone mentioned that they're more like guidelines, but is that the feeling for every state's?
In her condition, without a SAMPLE history, would it really have been that poor of a thought to give her glucose? (at a bls level)
For this particular scenario in the thread, we had someone there to give us patient history, so we could rule out diabetes. There were many signs presenting themselves that screamed more than diabetes, but at a BLS level, I would have requested ALS intercept, O2, def would have considered glucose, and load and go...
BUT
I understand the reasoning behind not giving her glucose- when my protocols dictate that an unresponsive person gets glucose, and i DONT give it to them, am I due to get reprimanded for not following protocols? Someone mentioned that they're more like guidelines, but is that the feeling for every state's?
In her condition, without a SAMPLE history, would it really have been that poor of a thought to give her glucose? (at a bls level)
thatJeffguy
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If a patient can't protect their own airway, you can't administer oral glucose.
If you're talking about some D50 in an IV, it's above my level of training and I have no clue
You may want to talk to your medical director and get her input. That is the authority that can tell you what you may or may not get in trouble for.
Having said that. All the physicians I ever met would rather that a EMS provider use their clinical judgement before administering a medication.
It is not even consistant within a state. However, a well written protocol will be able to make exclusions or additions for the benefit of the patient.
I would say that it would definately not help. It would be impossible to stipulate how much damage it might cause, the evidence suggests that it would likely be harmful.
As was mentioned in the walkthrough. This patient is most likely to die. With such a remote chance for even a survival to discharge with major deficits, doing anything that may reduce the chances seems like a poor choice.
SAMPLE history or not, the physical findings alone suggest this is not diabetic in nature. I have never seen a hemorrhage or trauma protocol that directs the administration of glucose.
LucidResq
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Not saying this is what was going on... but I've heard of severely low BGLs in Addisonian crisis.
I think there are exceptions (chronic alcoholics are another) however I was taught those who are not diabetic will not become hypoglycaemic the same as a diabetic ... because they have a nroamlly functioning endorcine system.
Bloody hell I don't know this orange jumpsuit used to say "WHACKER" on the back, I just crossed that out and wrote "DOCTOR"
Sassafras
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I was leaning toward miscarriage, or some form of obstetrical emergency, however, I'm not sure I would ever get all that information in an exam since we were told repeatedly that unless there is a serious reason to examine the genitalia we are to leave that up to the hospital to examine. I would not have known if she was bleeding vaginally unless it was to an extent that it was obvious enough to observe. Sort of makes me question our training. And yet, I'm not so comfortable looking at an elderly patient and saying "excuse me mamm but can I look at your vajayjay?"