ACLS/PALS/iTLS VS AMLS/EPC/PHTLS

[LucidResq]

Please explain this statement

if an EMT can check BGL, determine it to be low, and administer D50, without the aid of a medic, how is it horrifying?

or if they are just starting a line, for the sake of making things easier for the ER, again, how is this horrifying?

and how is it very helpful if they do it in the presence of a medic, but doing it on their own is a sin against nature and dangerous to the health and safety of humanity?

D50 is not a benign drug. Even if the person is profoundly hypoglycemic, a simple error can turn in to devastating extravasation and necrosis. I'm not arguing for or against it, really, but it's something to consider.

 

[46Young]

D50 is not a benign drug. Even if the person is profoundly hypoglycemic, a simple error can turn in to devastating extravasation and necrosis. I'm not arguing for or against it, really, but it's something to consider.

As another example, if someone has a suspected stroke there may be a hemhorragic bleed (no way to tell). There are considerations with given D50 to someone with stroke like S/Sx and also a low BGL. This is but one situation to illustrate why it's not appropriate to administer meds without the proper education and diagnostic equipment. At the EMT-B level, the education just isn't there.

All drugs need to be treated as if they have the potential to kill. Even drugs that some perceive to be benign, such as O2, D50 and 0.9% NS.

For example, hyperventilating a pt with head trauma may drop their CPP to the point that the brain receives no perfusion. In cardiac arrests, what effect does hyperventilation have on coronary perfusion? D50 can extravasate and cause local tissue necrosis. Diabetics are already prone to PVD, so how far will that necrosis spread in the presence of poor perfusion that impedes healing? What about extravasation to the brain if there's a bleed? There's a reason we now have permissive hypotension protocols, both for penetrating and blunt trauma. There's also a reason we reassess L/S after each 500 cc bolus. You may have learned a few things from the medics or possibly a CME or inservice, but that is certainly not a substitution for a paramedeic level education.

I can agree with EMT's starting lines by diection of the medic. Maybe also for certain protocols that specifically allow an IV to be placed only with certain inclusion criteria based on pt presentation, when there are no medics present. IV access is an invasive process, is not without it's complications, and ought to be reserved for pts that really need them. Again, the EMT-B level of education is inappropriate to make this determination.

Edit: "Monkey see, monkey do," aka cookbook medicine has been a bone of contention within the ALS community, let alone BLS. Doing something as simple as starting a line and giving D50 for a pt with a low BGL at the BLS level is an extreme example of that. There's a whole lot more to it than just giving sugar for a low BGL, O2 for the hyperventilating pt, fluid for the hypotension, etc.