Glucagon without an IV

[spenac]

Just out of curiosity, are you this dramatic and exaggerating in real life?

I know a medic that trys and makes every stubbed toe seem like a major life threatening trauma.

[triemal04]

Sure you can give D10 to your 300lb unconscious hypoglycemic patient who is circling the drain. Lets see:

1. you have to find your IO needle (pray you remember how to use it).Don't have to, see, I'm a good paramedic; I know how to use the equipment I'm given.

2. Then you have to find his tuberosity under all that fat. Yes...and? A better point would be to consider if you'll even be able to penetrate through all that fat and into the bone.

3. Then you have to clean the site. Oh wow...that's going to take forEVER.

4. Then you have to hope the needle is long enough, and you have to place it in the right site. Hmm. Actually, I would have considered this long before I stuck him with a needle.

5. Then you have to spike a bag, hang it, dilute your D50, let it run in over 30 minutes. If he isnt dead bythen, you now have to transport him to get antibiotic therapy for the wound you made in his leg and bone (diabetic sores heal real well). Or you can use D25, or dilute your own D50 to a lower concentration and still give it IVP, use a pressure bag, or just take your time and push the D50.

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.

I suppose. Granted I don't have all the experience you do your majesty, but I have yet to see a pt that was "circling the drain" because of hypoglycemia.

[crotchitymedic1986]

Really ? run a few more calls then, because I have had several that were. Usually found by someone else after being down for god knows how long. The body can only last so long.

[triemal04]

Really ? run a few more calls then, because I have had several that were. Usually found by someone else after being down for god knows how long. The body can only last so long.

Ok. Sure. Not going to dispute that it couldn't happen. Or that other factors may have been involved. Or that if they where "circling the drain" they might be getting transported as well. But I am curious though, since you are such a proponent of rectal D50, did you do that with all your hypoglycemics? After all, starting an IV takes time (and in your case you might have to pray that you remember how to start one), you have to sometimes search for the veins (and may not find one, in which case you just wasted some time), and the D50 may still cause damage to the veins. So wouldn't it be easier to just pop that ET tube up their ass each time? Faster and safer, which is the way to go. Right?

[akroeze]

In fact IO tends to be quicker for gaining access than IV.

I guess crotch is advocate rectal D50 in all cases. :shock:

How did we ever manage to treat patients who are hypoglycemic before he showed us the light??

[hertzvanrental]

Sure you can give D10 to your 300lb unconscious hypoglycemic patient who is circling the drain. Lets see:

1. you have to find your IO needle (pray you remember how to use it).

2. Then you have to find his tuberosity under all that fat.

3. Then you have to clean the site.

4. Then you have to hope the needle is long enough, and you have to place it in the right site.

5. Then you have to spike a bag, hang it, dilute your D50, let it run in over 30 minutes. If he isnt dead bythen, you now have to transport him to get antibiotic therapy for the wound you made in his leg and bone (diabetic sores heal real well).

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.

On the EZ-IO needles there are markers so it may not be possible to use on a 300lb porker, why not go for a vein in the foot? Or worst case EJV. If the I.O needle is sited properly and flushed after use then there should be no problem with regards to infection, I've never had any problems.

[crotchitymedic1986]

The conversation is regarding when you could not find a vein, and glucagon did not work. Obviously if you had a vein anywhere, you would go that route first (unless the only vein was the vein in the penis, but due to homophobia, you wouldnt attempt that one). So you are left with:

Drinking D50 or other sugar substitute PO if conscious enough.

D50 rectally.

D50 via IO.

[spenac]

Or worst case EJV. .

Why worst case? I go EJ before I go IO. It is a vein. Easy good access. I have done many and pushed D-50 as well as other meds. I always feel like I am missing something as so many avoid EJ's with a passion or at least that is what it seems like.

[hertzvanrental]

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.

[crotchitymedic1986]

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