Glucagon without an IV

[Arizonaffcep]

Someone made a comment about not getting an IV, giving glucagen and then having another look for an IV coz they may have better luck, this is because glucagon is an inatrope therefore raising BP= good veins (sometimes anyway).

It's also got chronotropic properties as well...and works well for counteracting beta blocker OD's

[AnthonyM83]

Makes sense. If you have a shampoo bottle that's almost out, you can make it last a couple more days by using it slowly (as the body's own glucagon would be doing in hypoglycemia), but if you squeeze every last drop of shampoo out with force, then great you cleaned our hair well for that day, but now you're totally out of shampoo. You're not getting any more out now for tomorrow.

I don't know what the best course of action is, but the theory makes sense.

As mentioned, glucagon might potentially better your veins enough to get a line, so must consider that when deciding.

The other issue is if someone decides to sue you, will that thinking (even if smart) be a good enough defense? Or will they say the standard of care is to give glucagon? Don't know.

PS

Are there ever any problems giving dextrose by IO...clogging up or anything since there's not an enclosed vein...just a maze of bone matrix? Question just to came to mind...

[Arizonaffcep]

Are there ever any problems giving dextrose by IO...clogging up or anything since there's not an enclosed vein...just a maze of bone matrix? Question just to came to mind...

Not to my knowledge...anything that can be given IV can be given IO.

[crotchitymedic1986]

And I am sure your patient will appreciate you drilling into bone and giving them osteomyelitis, because you think the anus is yuck !

[akroeze]

And I am sure your patient will appreciate you drilling into bone and giving them osteomyelitis, because you think the anus is yuck !

They'll appreciate it as much as a perforated bowel....

I mean, we're talking doomsday scenarios here so it can go both ways

[crotchitymedic1986]

My guess is you have never actually started an IO in a real patient and attempted a fluid bolus. If you had, you would know that pushing D50 would nearly be impossible. The risk of infection, fracture/cracking of the bone, and or tissue infiltration (if you dont do it right, which is highly possible in a skill you do once or twice per year -- remember D50 has a necrotic issue) are far higher than that of puncturing bowel with an ETT, and even if you did, it is rarely life threatening in the last 6 inches of bowel. You have to put your patient above ego.

[Dustdevil]

They'll appreciate it as much as a perforated bowel....

I mean, we're talking doomsday scenarios here so it can go both ways

[ERDoc]

My guess is you have never actually started an IO in a real patient and attempted a fluid bolus. If you had, you would know that pushing D50 would nearly be impossible. The risk of infection, fracture/cracking of the bone, and or tissue infiltration (if you dont do it right, which is highly possible in a skill you do once or twice per year -- remember D50 has a necrotic issue) are far higher than that of puncturing bowel with an ETT, and even if you did, it is rarely life threatening in the last 6 inches of bowel. You have to put your patient above ego.

There have been several studies which have shown the IO route to be just as useful for D50 as IV. Though, if I was in a semiconscious state I don't think I would want someone drilling into my bones (though I'm not to keen on an ETT going in the out). I have never had to do this as I have some awesome nurses and when they miss I can get a central line in probably in less time than it would take to get an IO. Here are the studies:

http://www.ncbi.nlm.nih.gov/pubmed/3394678...Pubmed_RVDocSum

http://www.ncbi.nlm.nih.gov/pubmed/1688484...Pubmed_RVDocSum

[akroeze]

My guess is you have never actually started an IO in a real patient and attempted a fluid bolus.

You would guess wrong.

[reaper]

My guess is you have never actually started an IO in a real patient and attempted a fluid bolus. If you had, you would know that pushing D50 would nearly be impossible. The risk of infection, fracture/cracking of the bone, and or tissue infiltration (if you dont do it right, which is highly possible in a skill you do once or twice per year -- remember D50 has a necrotic issue) are far higher than that of puncturing bowel with an ETT, and even if you did, it is rarely life threatening in the last 6 inches of bowel. You have to put your patient above ego.

I have pushed D50 twice by IO. Once in the field and once in the ER(by request of the Dr.). It is a little harder to push, but not impossible. If you verify a patent IO and continue the flow, there is no problems with it.