Unresponsive

[NomadicMedic]

You'll have more success if you lay it in the inguinal fold (fat crease in the groin).

So I've heard, however... Physio says we're doing it correctly and we want to continue to do it this way and attempt to correlate the temps with the hospital. I think they want the data...

 

[URI]

If you guys can pardon my ignorance:

Im just trying to get a better understanding of why the D50 didn't raise her bG.
I can understand that in liver failure she's not going to produce glucose from glycolysis. So giving her glucagon did nothing. But can someone explain to me why giving her an amp of dextrose IV didn't at least raise her levels? Is it because her insulin levels that far off because her pancreas and liver not talking? I guess I was under the impression that by giving the Dextrose your no longer relying on the liver to produce glucose and the pancreas will simply supply the insulin.

Thanks for additional clarification

 

[Aidey]

Probably because she was so profoundly hypoglycemic that it simply wasn't enough sugar.

 

[NomadicMedic]

Because the liver is damaged, it's not converting glycogen to glucose, which causes an over abundance of insulin, or hyperinsulinemia. This means that any dextrose the medics give will be quickly used. Like Aidey said, there just wasn't enough sugar.

 

[URI]

Wow, that seems to me like that's a lot of sugar to do absolutely nothing. But what do I know.

 

[URI]

Thanks for the clarification guys. That does help, I just didn't realize the body would produce that much insulin in the absence of glycogen.

 

[Shishkabob]

Wow, that seems to me like that's a lot of sugar to do absolutely nothing. But what do I know.

I had a patient a few months ago... I personally gave 3 vials of D50 to no effect on her sugar level, hospital gave a crap load more on top of mine, still to no effect.

Damn oral hypoglycemia / insulin overdoses.

We also have the "temp strips" that give you a guesstimate at temp.

Most of my patients are between 95* and 103*. I don't need yo stinking technology!

 

[VFlutter]

We also have the "temp strips" that give you a guesstimate at temp.

Are they TempaDots? From my experience they are fairly accurate if you correctly use them.

 

[NomadicMedic]

Are they TempaDots? From my experience they are fairly accurate if you correctly use them.

Nope. They're these guys:

 

[Veneficus]

Nope. They're these guys:

That looks useless.

 

[abckidsmom]

I really prefer the thermometer where you hold the one part in your hand and stick the other part in somewhere and the the part in your hand tells you what the temperature is.

Must be the nurse in me.

 

[Veneficus]

I really prefer the thermometer where you hold the one part in your hand and stick the other part in somewhere and the the part in your hand tells you what the temperature is.

Must be the nurse in me.

I am guessing there is a reason other than nurse preference that continuous temperature monitoring in the ICU is not done with an axial probe or a light refractory chrystal.

Just a thought...

 

[abckidsmom]

I am guessing there is a reason other than nurse preference that continuous temperature monitoring in the ICU is not done with an axial probe or a light refractory chrystal.

Just a thought...

I meant the nurse in me who loves precision. I think that continuous temperature monitoring in EMS is neat, but unnecessarily complicated in all but a very few applications. And that trusty thermometer has a monitoring mode for those.

 

[Veneficus]

I meant the nurse in me who loves precision. I think that continuous temperature monitoring in EMS is neat, but unnecessarily complicated in all but a very few applications. And that trusty thermometer has a monitoring mode for those.

Lol.

I must really find a way to better express my intent and sarcasm on here.

I was not suggesting continuous monitoring for EMS, just one of those probe things you stick somewhere.

That whole "vital sign" thing i guess.

While I understand temperature alone is not reliable for all infective dx, it does provide a very good clue when it is found. There are only a handful of pathologies that cause temperature increase. (not all infective) But up regulation of IL-1 can definately provide a very good clue where all of those follow on providers need to start looking.

I find it very interesting that EMS is quick to embrace a host of technological quantatative assessment device, but for some reason see no need for temp.

It reaffirms my position that EMS is not using these devices for advanced care, they are using them as a very expensive crutch.

 

[Handsome Robb]

We're having trouble getting our medics to think that temperature is something they need to check.

I'll admit I don't take a temperature often unless it's indicated by their complaint, if they feel absurdly hot/cold or if I have a long transport and have run out of things to do, questions to ask and if they aren't interesting to talk to and/or wont stop talking...sticking the thermometer in their mouth gains me some peace and quiet for a couple seconds at least... :lol:

It's a useful piece of information but it's not high on my list in many of the patients I see.

Pediatric seizures all get temps as well of course, usually rectal via mom, dad, a firefighter or my partner

Nope. They're these guys:

At least we get a normal thermometers. We carry your standard run-of-the-mill oral thermometer with the sterile covers. I still think we should ahve one for rectal temps and one for oral temps though...even with the probe coveres and cavi-wiping the hell out of it I still feel bad asking someone to hold it in their mouth..."if only you knew where that thing had been..."

We supposedly cary the tempadot things too, only used them a few times and they were too smart for me. It's hit or miss if they're stocked in the ambulance or not.

We also carry the disposable continuous temperature monitoring probe for the MRx. Use it as either an esophageal or rectal probe for temp monitoring of post VF/VT arrest patients for our hypothermia protocol. The King LTD provides a fantastic way to place it in the esophagus but that hole is usually filled with an OG tube so refer to my above statement about checking a temp in pediatric seizures

 

[Veneficus]

At least we get a normal thermometers. We carry your standard run-of-the-mill oral thermometer with the sterile covers. I still think we should ahve one for rectal temps and one for oral temps though...even with the probe coveres and cavi-wiping the hell out of it I still feel bad asking someone to hold it in their mouth..."if only you knew where that thing had been..."

Well I guess the only difference is the taste right?

It is probably not a good idea to use the same thermometer interchangably.

 

[NomadicMedic]

That looks useless.

Agreed. We also have the little sticky probe for the LP, but like I said, it seems to not correlate with the "shove a probe in the mouth or bum" measurement that is obtained at the hospital. I've not had a "correct" temp yet.

It's an issue that I'm sure will be addressed...eventually.
I like to take a temp and include it in my vital sign work up. (But I think I'm in the minority)

 

[KingCountyMedic]

We use the Exergen TAT-500 temporal artery thermometer that works pretty well. They cost about $400 a piece. We also have the esophageal temp probe on our LP15 that is really good but only for intubated patients. Sounds like a sick lady.

 

[Summit]

Fascinating

 

[NomadicMedic]

Yeah. I don't know why we don't carry some other "real" thermometer... Kind of annoying.

And yeah... She was sick.