Glucagon without an IV

[crotchitymedic1986]

Look at it from this perspective: List from start to end, all the things that occur to various body parts and organs during a hypoglycemic event. Think about what has just happened to that patient over the past 15-20 minutes.

[ERDoc]

It does not matter what might or might not happen. If you have a person who has the capacity to make their own decisions and you take them to the hospital you have kidnapped them, no matter how good your intentions. You had better be able to prove that they did not have the ability to make their own decisions in a court of law. The same applies to people who have been drinking. People who drink everyday may be stone cold sober with a BAL of .15. If they have the capacity to make their decisions at that point you cannot take them. However, you could involve law enforcement and make the arguement that because their BAL was so high they were incapacitiated, but again, be ready to prove it in court. Not all hypoglycemics require a CBC or a chem and not all hyperventilating pts need an ABG (almost none need it unless you are cruel and trying to punish them for bothering you).

[crotchitymedic1986]

It does matter what might or might not happen, as I am sure you have ordered a Head CT on a patient who you knew would be negative, but did it to cover your butt. No one is suggesting kidnapping, the person just stated that their policy was to load the hypoglycemic patient in the ambulance before administering D50.

[Arizonaffcep]

It does matter what might or might not happen, as I am sure you have ordered a Head CT on a patient who you knew would be negative, but did it to cover your butt. No one is suggesting kidnapping, the person just stated that their policy was to load the hypoglycemic patient in the ambulance before administering D50.

IMHO, that policy is dick. If the D50 works and you watch them eat something...and they still want to refuse, fine. At that point, you are trapping them into paying for an unnecessary transport. A**hole thing to do.

[spenac]

IMHO, that policy is dick. If the D50 works and you watch them eat something...and they still want to refuse, fine. At that point, you are trapping them into paying for an unnecessary transport. A**hole thing to do.

I also think it is negilgence as you are with holding care in order to get a bigger payment.

[Arizonaffcep]

I also think it is negilgence as you are with holding care in order to get a bigger payment.

I would think that's more fraud than negligence...

[spenac]

I would think that's more fraud than negligence...

Could be both as you are bilking the patient finacially and you could be causing harm by delaying medical care.

[crotchitymedic1986]

OK guys pick a side, when we were discussing rectal D50, you claimed there was no need to hurry, as you had never seen a critical hypoglycemic patient. Now that someone wants to move them to the ambulance first, it is delaying life-saving care --- cant have it both ways.

[Arizonaffcep]

OK guys pick a side, when we were discussing rectal IV, you claimed there was no need to hurry, as you had never seen a critical hypoglycemic patient. Now that someone wants to move them to the ambulance first, it is delaying life-saving care --- cant have it both ways.

I have not weighted in on that-the "no need to hurry." The problem is...definitive care is food. None on the ambo (the Pt is NOT getting my lunch/dinner!!!!). My personal preference is to stabilize and see if they want to be transported. The only exception on that...if I can't get the D50 onboard (post glucagon) for lack of IV/IO, etc. So...in theory, should never happen. I just think it's horrible customer service to push D50 in the back of a moving ambo, the Pt "wakes up," says "I don't want to go to the hospital," so you are stuck pulling over and letting them pull out without ensuring they eat anything...which could border on abandonment.

[triemal04]

Or you could of stuck an ETT up his ass 20 minutes ago, got your refusal, and been on the way back to the station, while the patient is unglueing his booty hole.

Does anyone even realize that this jackass likes to argue both sides of the issue over and over again? Playing devils' advocate is one thing, but constantly changing your stance just to pick fights is ridiculous and maybe indicative of a bigger problem.

And moving someone to an ambulance isn't delaying life-saving care, it's delaying care period. Treat them where you find them, and then after they are awake, continue to treat them with the appropriate tool: FOOD. Idiot.