Glucagon without an IV

[spenac]

I think our lot would prefer us to steer clear of the EJV unless for cardiac arrest. I.O is much more preferable. If I cant get a line & glucagen doesn't work then I opt for ez-io every time.

But why it is still just a vein? Please someone help me out. Was I improperly educated in this matter?

[akroeze]

SAY WHAT ? You prefer an IO site over a venous site ? Please explain the rationale for that.

Explain the rationale for avoiding IO in favour of EJV?

[hertzvanrental]

But why it is still just a vein? Please someone help me out. Was I improperly educated in this matter?

You can't use the EJV for major trauma with a c-collar applied. If I have some one screaming in agony I can use the EZ-IO and give em morphine. If you f*ck up a EJV then that's your lot, shouldn't be going for another go or on the other side. I.O is pretty much a guaranteed success. I've never missed.

[hertzvanrental]

In fact in seriously unwell kids the I.O route is the prefered choice. Such as meningococcal septacemia etc.

[JakeEMTP]

You can't use the EJV for major trauma with a c-collar applied. If I have some one screaming in agony I can use the EZ-IO and give em morphine. If you f*ck up a EJV then that's your lot, shouldn't be going for another go or on the other side. I.O is pretty much a guaranteed success. I've never missed.

true, but we're talking about a hypoglycemia pt. here.

[crotchitymedic1986]

In fact in seriously unwell kids the I.O route is the prefered choice. Such as meningococcal septacemia etc.

It is the preferred route for medics who are too scared to start an IV on a kid. Poking a hole in a bone should be the last choice, not the first.

And if I am bleeding to death internally from trauma, please dont try to bolus me through an IO, when my jugulars are working fine. And yes, you can apply a c-collar over an EJ.

[spenac]

true, but we're talking about a hypoglycemia pt. here.

Some c-collars have openings that allow access.

[hertzvanrental]

Too scared! Try telling that to top consultant paediatric DRs. Don't get me wrong, I would far prefer to get an IV in a kid than have to go IO but I bet I can get my EZ-IO in far quicker than some one pissing around, wasting precious time digging for a vein on a shut down kid.

And if a medic is too scared to start an IV in a kid then do you really think they are gonna have the balls to go IO, I doubt it. (TBH they shouldn't be a medic at all)

http://www.ich.ucl.ac.uk/clinical_informat...uideline_00049/

And if you are bleeding to death internally, unless your systolic pressure is less than 90, you wont be getting fluids off me. I'll rapidly be transporting you to the room of bright lights and shiny steel aka the OR and you'll thank me for it later. What you wouldn't thank me for is filling you full of fluid and making the bleeding worse.

Going back to EJVC in trauma, I was taught to turn the head and tilt the head down, surely if you are applying a c-collar you are suspecting a c-spine injury turning the head is the last thing you should be doing.

As for flow rate IO I've never had a problem pushing fluids or meds, it's just like pushing them through a 16g in the AC. If it's slightly off target that might explain why some people feel it slightly harder. Again I've never had any problems, I've done enough of them.

As

[Laura Anne]

If it was up to me, I'd opt for the intranasal glucagon if IV access wasn't an option. I'd follow this up with oral glucose. These two combined should give you enough time to get where you need to go. 8)

As far as IO in peds as opposed to IV, if the Pt is sick enough to warrant IV access, I'd go for the IV twice, then I'd do the IO. I learned from the wonderful people on this site that IO is actually less traumatic in a severely ill/injured patient than the IV......less painful.

In regards to Glucagon being lethal for patients with an extended transport time.... well you just bought the patient and yourself some time to think of what else can be done to treat the patient. I've never heard of it 'killing' someone. Then again, my local doesn't these extended transport times that you all may have. Good luck....

[spenac]

Too scared! Try telling that to top consultant paediatric DRs. Don't get me wrong, I would far prefer to get an IV in a kid than have to go IO but I bet I can get my EZ-IO in far quicker than some one pissing around, wasting precious time digging for a vein on a shut down kid.

And if a medic is too scared to start an IV in a kid then do you really think they are gonna have the balls to go IO, I doubt it. (TBH they shouldn't be a medic at all)

http://www.ich.ucl.ac.uk/clinical_informat...uideline_00049/

And if you are bleeding to death internally, unless your systolic pressure is less than 90, you wont be getting fluids off me. I'll rapidly be transporting you to the room of bright lights and shiny steel aka the OR and you'll thank me for it later. What you wouldn't thank me for is filling you full of fluid and making the bleeding worse.

Going back to EJVC in trauma, I was taught to turn the head and tilt the head down, surely if you are applying a c-collar you are suspecting a c-spine injury turning the head is the last thing you should be doing.

As for flow rate IO I've never had a problem pushing fluids or meds, it's just like pushing them through a 16g in the AC. If it's slightly off target that might explain why some people feel it slightly harder. Again I've never had any problems, I've done enough of them.

As

Discussion is about low blood sugar levels. None of us hesitate to go IO if needed, but we also do not use it when we can safely go IV.