NYS BLS Agencies Using Glucometers?

[Guest paramedico987]

I heard a rumor that NYS approved some sort of protocol for BLS use of glucometers in the field, but haven't seen anything on paper yet.

Anybody know if there's any truth to this, and if so is anybody doing it yet?

[Guest partyrock]

I know the proposal and study came out of Albany FD. As far as I know it hasn't be implemented by anyone yet.

[waful 0]

there is a pilot program going on in the Capital Region.

other than that idk

[Guest ab2se]

In the Hudson Valley region, Monroe VAC (Orange County) has been doing a Pilot program. Go to Hudson Valley Region's homepage www.hvremsco.org and click on the minutes from the June Training Committee meeting for some additional info.

[Goose 188]

Yup, BLS can do it. However, I'm pretty sure the agency has to come up with a training program and protocol (signed off by their Doc of course) which has to be submitted and approved by the state. Don't know of many agencies that are doing it in the field, however and there is, as far as i have seen, no BLS protocol update for it.

It's a nice skill and with the propper knowledge (thats the key here i think) and a solid assessment can turn into a good solid treatment modality. Problem is out of the hundreds of thousands of EMTs how many have the knowledge/experience/confidence to properly and efficiently utilize this...well i think thats something that remains to be seen.

As far as the mechanical skill, I've been grabbing BGs for my Paramedics for some time. The hands on has added a lot to my understanding of the metabolic processes.

As far as what the state will let us/have us do is beyond me. I can only imagine that they will incorporate it into the medical assessment and tell us if it falls below 70 mg/dl, contact ALS, administer oral glucose if a patent airways is present, if it is above 180 mg/dl contact ALS (to dilute it i guess?), and inform the ED? Not sure if they will have BLS do it on kids...i can only imagine they would, no?

[MerlinMedic 5]

Why not have BLS do this? Regular people take theirs all the time. Often they have little education on it. My father used to jump on every variance each hour until he learned.

[Guest alsfirefighter]

Problem is out of the hundreds of thousands of EMTs how many have the knowledge/experience/confidence to properly and efficiently utilize this...well i think thats something that remains to be seen.

The real problem is...how many will use this to replace confidence and knowledge to treat something they should already know has to be treated? Is it something that is going to be nice to have as a BLS provider? I would think so, but when I perform duties as a BLS responder I really don't need a device to tell me what I already know and what any provider should already know. The last thing I know I would like to see, is for the device to become a crutch or fad like I have seen with the albuterol administration where at a very high percentage it was getting slapped on patients who never fit the BLS criteria to do so, nor that even needed. Or with electronic BP devices where I have providers telling me BP's from a machine and pulses from pulse ox devices. First BP should always be manual and how can you get a pulse properly from a machine? Why is it that so many providers are bent on putting on pulse ox's for everything and anything? Do I think its terrible they might give all BLS providers glucometers...no...do I really think they are that necessary for the administration of oral glucose? No. To me good assessment training and recognition of hypoglycemia is more important and accurate (even these devices need to calibrated just like the BP devices). No one has ever died from admin of oral glucose.

if it is above 180 mg/dl contact ALS (to dilute it i guess?), and inform the ED?

You cannot dilute blood glucose in the human system. The biggest threat is DKA, which takes some time to present and the dehydration sufferred from the patient voiding to rid itself of the excess glucose. If the vitals are stable and they are CAO x 3, I do not ride in hyperglycemia ALS and I know many of my co-workers and close colleagues do not also.

[GM911 0]

Down in DC we do glucose sticks all the time (as BLS)... especially good for the drunks who have been vomiting for the past hour with altered mental status. I will completely disregard the above comment about how many thousands of incompetant emts there are out there, just for sake of argument. and about the readings, if it is below 80 and the pt is semiconscious (unable to take oral glucose), then call als. as for hyperglycemia, its really not that big a deal, and nothing als can do except keep a watchful eye on the pt.

as for the the pulse ox and electronic bp issue, remember rule number 1 (besides scene safety and all that bs )

TREAT THE PATIENT, NOT THE MACHINE!!!

[Goose 188]

ALS, im just shooting out hypotheticals, and as always appreciate your responses. Obviously i don't know what the state's thought processes is on this.

GM911, not quite sure what your trying to get at

[GM911 0]

Re-reading my post, i guess it is kinda all over the place lol. (plus not too sure how to use the quotes box so i'll try my best here.)

als wrote: The real problem is...how many will use this to replace confidence and knowledge to treat something they should already know has to be treated?

As a DC EMT, we take glucose readings on all altered mental status pts. I think that it is a very valuable tool that can change the entire way a patient is treated. The example that comes to mind is if somebody is acting belligerently drunk on a friday night, it might not occur to the responder that he's hypoglycemic, so a glucose reading is absolutely needed on him. Confidence and knowledge had nothing to do with it - you can't tell someone is hypoglycemic simply by looking at him, a definitive blood sugar number is needed.

The next thing I was saying was with regards to the quote, "Problem is out of the hundreds of thousands of EMTs how many have the knowledge/experience/confidence to properly and efficiently utilize this...well i think thats something that remains to be seen."

That comment just makes it seem like the majority of EMTs are incompetent and will mess up the simple task of using a glucometer. To me at least, it just seems like its the medic vs emt battle again, that emts are unable to handle the responsibility of using the glucometer.

Now I'm not trying to start any fights or nothing here, I'm just saying that's what I understood your comment to mean.

[ckroll 101]

Could someone explain to me how BLS glucometer testing is going to improve patient care? Testing, especially invasive testing, should be limited to situations where the results of the test will change treatment. The alert patient with suspected hypoglycemia gets a tube of glucose or a glass of OJ, no testing necessary. If a person is not alert, then none of us can give oral glucose, no testing necessary at the BLS level. AEMTs need to test BG prior to dumping in 50% dextrose because that is an insult to the system. BG is part of more comprehensive ALS testing to distinguish between overdoses, or stroke, but in the the BLS arena it isn't going to change treatment.

Look at the patient. The cold, pale, sweating, angry person standing at the deli counter who doesn't know why he's there needs a soda NOW. The drooling person in fetal position in aisle 5 needs ALS. I don't see what a glucometer in the hands of BLS does to change outcome save that it may delay treatment while someone fools with the machine. And if the glucometer is wrong....... not that that's ever happened...it might well delay treatment when a soda or glucose is not likely to hurt anyone. Sometimes there is a very short window where a hypoglycemic person can still manage to swallow. Don't miss it looking for the glucometer and trying to remember how to use it.

What would be extremely useful would be for urban/suburban EMS,--now that ALS so handy,-- is to start looking at EMTs as proto AEMT's and put more emphasis either in the basic course or region by region into familiarizing EMTs with AEMT protocols and skills so that they can participate more effectively on critical calls and have a better understanding of what will come next in terms of patient care.

Should EMTs know how to use a glucometer? Absolutely. They should know how to spike a bag and how to assist the AEMT in drawing bloods or securing IV access, and how to hook up the EKG monitor, the list goes on. Any AEMT can tell you that a good EMT can add immeasurably to the call. AEMTs save patients and EMTs save AEMTs. I think EMTs need to know how to do lots of stuff, but I'm not convinced sending them out alone with a glucometer is going to help anyone. If I'm wrong, educate me.

[ny10570 745]

Glucose monitoring is nice little tool, but far from necessary. Even 500 of D50 isn't going to have a significant negative impact on a hyperglycemic patient in the time to definitive treatment. If its a stroke the D50 will depending on who you talk to have either a positive or no effect. I believe it was on this site that someone mentioned some research promoting administering glucose to stoke patients. If the drunk is a frequent flyer then you should know their medical history better than they do. If they're not acting like their normal self them throw 'em some glucose. Besides, the best test for how AMS someone really is, nothing beats glucose paste. If they don't gag on it then they really need it. Like others who are ar more knowledgeable than me have said, treat the patient and not the tool.

[Guest alsfirefighter]

Confidence and knowledge had nothing to do with it - you can't tell someone is hypoglycemic simply by looking at him, a definitive blood sugar number is needed.

I disagree. Though who know me well as a provider, firefighter and instructor in both know I preach cognitive and pyschomotor proficiency is the key to be good at what you do. So knowledge of how to recognize the symptoms, find out the signs involved, and what to do once you get there is pretty important.

I don't see where having a definitive blood sugar is needed on a BLS level. Recognize the signs and symptoms and you treat it. I would call have a definitive blood sugar a nice to know...not a need to know. Even in your scenario about having an intox...if you don't have ALS there (which regardless of what the problem is, it should at least start off as an AMS) and you don't have the ability to do gluco sticks, is it the end of the world? Are intox's dropping dead in hords that I seem not to know about due to hypoglycemia? If they are conscious and that off, then you need ALS regardless under AMS and if they are conscious and a little off and its obvious they were drinking..transport them. If it makes anyone feel better give O.G. If your not sure...he will get a good run down when he/she arrives at the ED.

"Problem is out of the hundreds of thousands of EMTs how many have the knowledge/experience/confidence to properly and efficiently utilize this...well i think thats something that remains to be seen."

I'm not sure you meant me...but I want to clarify I didn't make that quote.

I will say this...that since the change in curriculums there has been a noticable change in EMT-B's coming out of the classes since the change then prior. Additionally in our area there is a heavy dependance on ALS and it shows in assessment and skill proficiency in many agencies we deal with. It might sound bad...and I think that is an accurate way to communicate about it...but its the flat out truth.

[Hatchet67 0]

I'm not quite sure what negative impact would be caused by EMT-B's taking a BGL would have on patients? In South Carolina that is the standard of care, BGL on everything! All levels can take a BGL here, but then again they can also intubate according to local protocols. As far as patient assessment, a patient with altered mental status with a history of diabetes does not automaticly get oral glucose, D50w or D5w for that matter. Check the BGL, firts to have a baseline to check your intervention (trending) and I myself would not want to administer D50w to a patient who is having a stroke. My medical control would not like it either! As I understand in New York your basics are alowed to administer albuterol, I would be more concerned about the improper drug administration then someone taking a BGL. Just my opinion.

[ny10570 745]

alsfirefighter is correct. I did my stint in Westchester as an EMT and the ability to operate effectively without ALS is the exception rather than the rule.

Hatchet, whats the harm in administering D50 to anyone? Everything I've read covers in great detail the damage associated with pre event hyperglycemia, but nothing mentions and negative effects of glucose administration during an event. There is some inconclusive data about the results of post event hyperglycemia.

As far as measuring blood glucose. In a South Carolina study every patient found to be hypoglycemic when presenting with symptoms of CVA had known histories of Diabetes. Of the cases of suspected CVA glucose resolved the symptoms in 4% of the cases. This study concluded that the time wasted on scene treated the hypoglycemia is better spent transporting and treating en route to a stroke center.

[GM911 0]

als, those are some very valid arguments....

When I vollie in NY, ALS is called for everything, and we have to call ahead to cancel if deemed necessary. You are right to say ALS would be there with all altered mental status pts, so emt-b glucose readings would be, as you said, good to know but not necessary.

That said, I agree to disagree with the statement that all NYS BLS agencies should not use glucometers. This is especially the case where ALS is not automatically dispatched on every call.

Just relating personal experience here, but as an EMT at a college in Washington DC, there are just too many intoxicated pts to send ALS on every call. There have been numerous occasions (not hords, but more than a few) where those patients were found to be hypoglycemic. I have to stress the fact that they are not necessarily diabetics having a hypoglycemic episode; rather these patients vomited so much that their blood sugar level dropped to hypoglycemic numbers.

[Guest partyrock]

I have to stress the fact that they are not necessarily diabetics having a hypoglycemic episode; rather these patients vomited so much that their blood sugar level dropped to hypoglycemic numbers.

Where these patients severely hypoglycemic or the numbers made them hypoglycemic? What I'm getting at is in my times ridding the back of the bus I never had a glucometer and I never had a patient that was severely hypoglycemic upon presentation to the ER. The were a few who got D50 that didn't need it but any time you get a drunk who appears "off" give them the glucose. Clinical judgment is key.

[NYMedic37 22]

I think we should train and give the EMT's glucometers and glucogen (IM). With proper training, a caveman can do it!

Paul

[Guest partyrock]

Now that idea scares me.

[Oswegowind 17]

Once again, as was said already....blah blah blah...

A Glucometer is a "tool" to aid someone in doing their job. Once an EMT has determined that the situation is hypoglycemia, they can simply verify this by doing a so called fingerstick. Just as the Police recognize that someone is speeding and approximately how fast they are going, they use the Radar gun to verify this condition. Or as firefighters do with Thermal Imaging Cameras, they see smoke, know there is fire, but verify its location and amplitude by using their "tool" or "gadget".

If an EMT cannot recognize or decipher hypoglycemia then the tool is useless and they should not be able to use it.

Technology is awesome, but should not take the place of the individuals brain!

[firemoose827 324]

I have one thing to add to this discussion, more of a QUESTION realy than an opinion...what about LEGAL ISSUES? Would a prosecuter and a judge be satisfied with the response from a witness of " Well its simple realy, Ive been doing EMS for 10 years now and I KNOW what a pt should like like when hypoglycemic."

Or would they be more inclined to respect this answer, "Your honor, upon arrival I noticed immediately the signs of hypoglycemia and confirmed it with the Blood Glucose Monitor and proceeded to treat the pt according to NYS BLS Diabetic protocols."

Just my thoughts on this topic which has been covered numerous times on this forum. Id rather back up my actions with clinical data than personal observations. BUT!!!!!!!! I also agree with everyone that the use of mechanical devices to obtain vital signs is getting out of hand. Its rediculous now-a-days to see this happening. I told a new EMT at work who was doing her ride time with us to go and assess the PT. She grabbed the PULSE OXIMETER and put it on the PT's finger and sat there and looked at me..................After the PT was delivered to the ED I pulled her aside and explained what a Pt Assessment was and that it had nothing to do with a Pulse Ox. On the other hand, at work I see experienced Medics throwing the automatic BP cuff on the pt and not grabbing one MANUALLY first....WHY?? Has everyone gotten that Lazy? I mean, I went to do a rig spec at work the other night and there were NO BP CUFFS in the jump bag, the medic simply said "Oh well we have the monitor anyway." Machines are here to AID us, and used to CONFIRM things...not DISCOVER them. Everyone must practice good pt assessment with just a few BASIC tools; Sight, Sound, Sensation, and smell.

By the way, to answer the original question........yes, we all do the BLS Glucometer skill in our region. In order to participate you must receive Training from your medical director including a written test, than they will aprove/disaprove of your ability to perform the skill. It is used ONLY as an aid to the county ALS who sometimes takes 15-20 minutes to get to certain areas of our county, so if they have all of the info possible before they even arrive on scene they can just TREAT the pt upon arrival. I perform the skill routinely at work for my medic partner as well as spiking bags, applying the monitor, getting the drugs ready for administration, and securing IV's. And that is why I think it should be a BLS skill...while the ALS provider draws bloods and hooks up the line the EMT could be performing the BG check for the medic.

Team Effort to arrive at a joint goal...get the pt to the hospital alive.

Happy Halloween everyone!!

Moose

[Goose 188]

Fact is, the EMT program in New York is far too basic in nature.

[Guest alsfirefighter]

I have one thing to add to this discussion, more of a QUESTION realy than an opinion...what about LEGAL ISSUES? Would a prosecuter and a judge be satisfied with the response from a witness of " Well its simple realy, Ive been doing EMS for 10 years now and I KNOW what a pt should like like when hypoglycemic."

Or would they be more inclined to respect this answer, "Your honor, upon arrival I noticed immediately the signs of hypoglycemia and confirmed it with the Blood Glucose Monitor and proceeded to treat the pt according to NYS BLS Diabetic protocols."

Why would you be in front of a prosecutor or judge and have to use either answer? Unless you didn't do any of the above.

I have a question for your question...how many are going to be able to answer this question if sitting in a deposition or trial?

When was the last time you calibrated the glucometer you were using?

How would you respond to the following statement?

So perhaps then that could have led to the possibility why you got a false high reading...when the patient was showing overwhelming symptoms of hypoglycemia but you chose not to treat it because the glucometer gave you a normal reading.

I'd rather answer the following:

The patient presented as being cool, pale, diuphortetic, uncoordinated in movement and fairly lethargic with slurred speech. After questioning a family member about the patient's past medical history it was learned that he was a type II diabetic who takes insulin. Based on that I then decided the best action to take was to administer oral glucose (D50) etc. The patient then showed signs of improvement, motor/nuero function improved significantly and the patients speech returned to normal.

Who is going to argue with you or find fault in you with just simple facts and good quality care. I do not always take a glucometer reading on patients I treat with D50.

Even so...what if you have the above symptoms in my statement and the glucometer reads "70"? That's a normal reading isn't it?

[ny10570 745]

Or would they be more inclined to respect this answer, "Your honor, upon arrival I noticed immediately the signs of hypoglycemia and confirmed it with the Blood Glucose Monitor and proceeded to treat the pt according to NYS BLS Diabetic protocols."

Instead you would say..."Your honor, upon arrival I noticed immediately the signs of hypoglycemia and proceeded to treat the pt according to NYS BLS Altered Mental Status protocols."

Not too long ago I went to court concerning a fatal MVA where my patient, the driver, was claiming his hypoglycemia was the cause of the accident. The ADA wanted to know first what we would do for hypoglycemia, then what we did for the patient, and finally how we knew he wasn't hypoglycemic. Apparently there was a problem where the hospital's blood glucose measurement were being contested. My partner and I explained hypoglycemia, the protocols, and our observations. Our observations and treatments were all well documented and in the end he was convicted. You don't need glucometers you just need to do your job.

[firemoose827 324]

Why would you be in front of a prosecutor or judge and have to use either answer? Unless you didn't do any of the above.

Anything could happen and anyone in EMS should know that. I was using it as an example to state that I would rather argue what I "DID" do rather than explain why I "DIDNT" do it. There are peope out there who will call an ambulance just to find a reason to sue you...and there are people who actually think they have been victimized because of any trivial little thing they can think of. It takes very little time to check BG levels.

I have a question for your question...how many are going to be able to answer this question if sitting in a deposition or trial?

Me, because I treat the patient and not the machine and I do a thorough assessment, and I would have no problem answering basic questions presented to me in court, as I have done so before.

When was the last time you calibrated the glucometer you were using?

At the beginning of every shift at work, and once a month in my vollie squad...its a routine thing.

So perhaps then that could have led to the possibility why you got a false high reading...when the patient was showing overwhelming symptoms of hypoglycemia but you chose not to treat it because the glucometer gave you a normal reading.

I treat the patient, not the machine....as I stated I use them to confirm things. If a patient shows true signs of hypoglycemia I treat them. Im not one of the morons looking at a flatline ekg yelling "CLEAR" with the patient staring at him with the electrodes in his hands looking shocked. (forgive the pun )

I'd rather answer the following:

The patient presented as being cool, pale, diuphortetic, uncoordinated in movement and fairly lethargic with slurred speech. After questioning a family member about the patient's past medical history it was learned that he was a type II diabetic who takes insulin. Based on that I then decided the best action to take was to administer oral glucose (D50) etc. The patient then showed signs of improvement, motor/nuero function improved significantly and the patients speech returned to normal.

good for you, I was asking a question. But I will still do what I feel is right and let others do what they feel is right.

Who is going to argue with you or find fault in you with just simple facts and good quality care.

Just about every lawyer alive...You should know that when someone sues their lawyer will try and find fault in just about anything and everything and will pick you apart...regardless of what you think, preach, teach or practice they will try and make you look foolish.

I do my job, and I strive to learn more every day. Part of my job is to be aware of the legal issues as well. In the case you mentioned ny10570, the prosecuter was going against the hospital and would naturally use your testimony to prove their point to the courts...had the case been against your agency I doubt it would have had the same results.

And coincidentally, I dont use any machines in my assessment. When I am done with my assessment I will use them sparingly if time permits to use an additional tool...like if the patients CC is dyspnea I will grab a quick Room Air SPO2 and than another after O2 therapy has been started. Likewise, in the hypoglycemic pt I will grab the BG levels whilel the medic is attempting a line prior to administering D50. But ultimately the patients signs are what get treated...not the monitors.

[Guest alsfirefighter]

Jonesy:

I apologize if you think I was pointing those comments towards you I was speaking more in general. I enjoyed your previous post and got the jist of it. Again I apologize I'm not questioning you at all, I respect your comments and your abilities from what you have posted on here.

There are a couple of things that I want to point out that are my own beliefs and experience based on your comments directed towards me in your last post however:

Anything could happen and anyone in EMS should know that. I was using it as an example to state that I would rather argue what I "DID" do rather than explain why I "DIDNT" do it. There are peope out there who will call an ambulance just to find a reason to sue you..

Anything can happen in any walk of life. My point was you would be more apt to be in civil court then be in criminal court with a prosecutor. Anything can happen...to a point. Things happen when people make dumb decisions based on stupid mistakes or preconcieved notions. As far as people who will call an ambulance just to sue. That's fine but BS is BS and if you still do your job they will have no reason or merit. If you have any documentation that this has occurred by all means please post it so I can use it when I instruct. Not checking a blood glucose isn't something you are going to get sued for, or criminally prosecuted on a BLS level unless you do something extremely stupid. The brunt of liability really falls on ALS providers. The biggest question I would have to ask if a BLS provider was pulled into court based on a hypoglycemia case would be more geared toward did they immediately begin transport when the patient was unconscious or close to it and did they request ALS?

Oral glucose isn't going to kill anyone. If you are a BLS provider and you suspect the patient is hypoglycemic...administer the O.G. Have them drink OJ or any other food with sugar in it that will be metabolized quickly.

As far as your calibration comments...its nice to see other do. I know for a fact many are not. And trust me bro, I highly doubt I would surmise you yelling "clear" in your example. Then again if anyone I know of did that, I'd have to recommend them to remedial training. After all asystole is the most stable complex to work from.

Just about every lawyer alive...You should know that when someone sues their lawyer will try and find fault in just about anything and everything and will pick you apart...regardless of what you think, preach, teach or practice they will try and make you look foolish.

Yes if there is merit to the case and it goes beyond the intial phases. While most lawyers are (a word for oral sex that I cannot use on here anymore) they still have limits of where they can go. Solid assessment + solid treatment + solid documentation= no case. And even if they want to further the issue they can only make you look at that point as silly as you make yourself. I don't live every tour thinking I'm going to get sued or have the possibility to get sued. I never will. There are not that many lawsuits flying around the EMS world and those that are....the highest percentage of cases involve RMA's of all else.

[firemoose827 324]

Jonesy:

I apologize if you think I was pointing those comments towards you I was speaking more in general. I enjoyed your previous post and got the jist of it. Again I apologize I'm not questioning you at all, I respect your comments and your abilities from what you have posted on here.

There are a couple of things that I want to point out that are my own beliefs and experience based on your comments directed towards me in your last post however:

Anything can happen in any walk of life. My point was you would be more apt to be in civil court then be in criminal court with a prosecutor. Anything can happen...to a point. Things happen when people make dumb decisions based on stupid mistakes or preconcieved notions. As far as people who will call an ambulance just to sue. That's fine but BS is BS and if you still do your job they will have no reason or merit. If you have any documentation that this has occurred by all means please post it so I can use it when I instruct. Not checking a blood glucose isn't something you are going to get sued for, or criminally prosecuted on a BLS level unless you do something extremely stupid. The brunt of liability really falls on ALS providers. The biggest question I would have to ask if a BLS provider was pulled into court based on a hypoglycemia case would be more geared toward did they immediately begin transport when the patient was unconscious or close to it and did they request ALS?

Oral glucose isn't going to kill anyone. If you are a BLS provider and you suspect the patient is hypoglycemic...administer the O.G. Have them drink OJ or any other food with sugar in it that will be metabolized quickly.

As far as your calibration comments...its nice to see other do. I know for a fact many are not. And trust me bro, I highly doubt I would surmise you yelling "clear" in your example. Then again if anyone I know of did that, I'd have to recommend them to remedial training. After all asystole is the most stable complex to work from.

Yes if there is merit to the case and it goes beyond the intial phases. While most lawyers are (a word for oral sex that I cannot use on here anymore) they still have limits of where they can go. Solid assessment + solid treatment + solid documentation= no case. And even if they want to further the issue they can only make you look at that point as silly as you make yourself. I don't live every tour thinking I'm going to get sued or have the possibility to get sued. I never will. There are not that many lawsuits flying around the EMS world and those that are....the highest percentage of cases involve RMA's of all else.

Hey ALS, I wasnt mad at all, I respect everyones input in everything I do, especially someone like you who is as involved with the Fire/EMS world as you are. I was simply addressing the questions you had about my post, nothing more than adding to the conversation. Thanks for your acknowledgements, they mean a lot to me.

Yah, youre right, I used the wrong kind of example for that one answer....cant very well shock asystole, can you?

I was using a personal experience of mine when I used to work with a certain Medic from another paid outfit I used to work for. He always treated the monitor....till one day, one of the electrodes fell off and it resembled course V-Fib on the monitor, without looking at the pt he grabs the paddles (Yes, paddles, shows how long ago it was) and yells to me to charge them up...I looked at the pt, who by now was truly HAVING an MI and hiding under the sheets, and said "Too late, shes already converted, Good Job."

He didnt like me very much.

My last comment was for the other guy, ny10570. Im just terrified of getting sued by some un-gratefull, sue happy relative of a donkey. I guess its all due to the fact that Legal issues were beaten into me from day one, my instructor loved discussing legal stuff, so, like a straight guy in a gay bar, Im always trying to cover my a**.

Have a Great day everyone.

Moose

[ckroll 101]

Fear of litigation should not be driving our health care decisions. If it is that big of an issue, then those individuals need a career path with less jeopardy. Doing right by the patient will be infinitely more effective at avoiding bad outcomes.

The 4 treatment scenarios are: needs glucose, gets it; doesn't need glucose, gets it; needs glucose, doesn't get it; doesn't need glucose, doesn't get it. The only killer one is not giving glucose when its needed. What we should be concerned about is not missing opportunities to give needed glucose. A glucometer doesn't help with that in the EMS setting. The standardization of 70-120 is referenced to symptoms for the average person. The body adjusts to its circumstances. Someone who lives with routinely low BG may tolerate a reading of 40 well and a person who has routinely very high BG [ I was told, haven't searched it] can have personal 'hypoglycemia' in the 70-120 range if sugar drops precipitously [ fever, sepsis, extreme exercise ] So a glucometer is much less useful for patients at the extremes.

I got called for chest pains, 8/10. Alert, oriented, not well. The older patient had a long history: cardiac, renal failure, needed to be dialyzed, was warm to touch. About the only thing the patient didn't have was diabetes. I did a 12 lead EKG which was unremarkable for ischemia. 30 minutes after arriving at the hospital the blood work came back with a BG of 40. Nobody had anticipated that. It also wasn't the primary problem.

The take home lessons, for me are: I didn't give glucose and it didn't change outcome on a person who was not symptomatic. No one ever has just one problem. Hypoglycemia can be anywhere and as the population gets older and fatter, diabetes related issues and renal issues will be more common.

So now I check BG on lots of patients, not so much to catch the life threats, but to isolate secondary issues. That is more an ALS role than a BLS one, though.

I also remember a wild day with a heat wave and a power failure. The ER, the only AC in town, was long past capacity with patients with difficulty breathing. We were asked to treat as much as we could in the field. That day, OJ and a glucometer and a call to MC kept several of people out of the ER.

So a glucometer really has a place in overall treatment, but perhaps not as a first line of defense under normal circumstances.

[NYMedic37 22]

Fact is, the EMT program in New York is far too basic in nature.

===== I AGREE.... Thank you!

[NYMedic37 22]

Everybody seems to be way too paronoid about glucometers. It is a tool that will help you do your job and ultimately help the patient. Add a simple Glucagon IM injection and you could help a hypoglycemic patient. Aren't we here to help people? Or are we just ambulance drivers? As I said before, Its so easy a caveman could do it!