Glucagon without an IV

[hertzvanrental]

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.

totally agree, sorry for going off topic.

[crotchitymedic1986]

Well once you stick your 5th or 6th kid, and your 2nd trauma patient (forgot how many rookies are here), you will realize: Kids veins are basically in the same places adults are, if you know your vein anatomy, there is no reason that you shouldnt be able to get a saphenous stick on any kid.

As far as trauma, less than 10% of multi-system trauma patients have a c-spine injury, and i doubt anyone was there to hold c-spine during the immediate 5-10 minutes after the accident. With that being said, an EJ can be started with c-spine being held.

As far as waiting until my b/p hits 90, you might want to read up on compensatory shock. At the point, my b/p hits 90, i will no longer have good venous access, which is probably why you have started so many IOs.

An IO is not less painful or less dangerous than an IV. Obvioulsy, if you do not have the skills or confidence to get an IV, then you should go to IO, before your patient dies. But you will learn later in your career that difficult IV sticks and intubations are all about confidence, not skill. I was the one the hospital called when they couldnt get an IV or intubation, and I never went to a special class that they didnt take. I was trained the same as everyone else.

[hertzvanrental]

I've got many IVs in patients with their pressure as low as 60 or 70 systolic thank you. The last two being anaphylaxis patients again both of these were last week! As for waiting till your pressure is lower than 90, I didn't say that I wouldn't have fluids up and running, it's that they would be at KVO rate. I think it's you that needs to read up on prehospital fluid resuscitation as it can cause more harm than good. Try looking at the references which seem to come from North America.

If I can get an IV I will but I wont piss around making several attempts to get one when time is of the essence. I'll have two attempts then go for the IO. if a kid has bacterial menningitis I'll go IO so that I can get my glucose, benzylpenicillin, diazepam and fluids in as needed while someone is poking around looking for a suitable IV site. The parents/ED Docs will and have thank/ed me for it later. HMMM getting a IV in the saphenous on an 18month old with septacemia, I'd love to see that.

[hertzvanrental]

What! Never heard of glucagon being lethal with extended transport times. Crikey what do they teach you? Give the patient IM glucagon and follow it up with oral sugars and carbs. It's rare that some one wont wake after glucagen. Please don't tell me you rush around like a headless chicken initiating transport becuase your patient is unconscious due to hypoglycemia. Do you not wait for the meds (whether it be glucagon or IV D50/glucose 10%) to take effect first before coming up with a differential diagnosis. Don't you treat these patients at home?

[Arkymedic]

It also relaxes smooth muscle and can help with a FBAO.

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

[Mateo_1387]

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

It also relaxes smooth muscle and can help with a FBAO.

I was thinking it was more of an esophageal smooth muscle relaxer. I'd be more apt to try a heimlich maneuver for FBAO than to give glucagon.

[Arkymedic]

A few services I have worked for required us to be in the ambulance before giving D50 and a couple of others did not carry glucagon.

What! Never heard of glucagon being lethal with extended transport times. Crikey what do they teach you? Give the patient IM glucagon and follow it up with oral sugars and carbs. It's rare that some one wont wake after glucagen. Please don't tell me you rush around like a headless chicken initiating transport becuase your patient is unconscious due to hypoglycemia. Do you not wait for the meds (whether it be glucagon or IV D50/glucose 10%) to take effect first before coming up with a differential diagnosis. Don't you treat these patients at home?

[spenac]

I hate that policy. It is just a way to bill more because many refuse transport once awake. So services now want you to wait till in the ambulance and enroute before pushing D-50.

A few services I have worked for required us to be in the ambulance before giving D50 and a couple of others did not carry glucagon.

[Arkymedic]

Yep especially since medicare and medicaid do not pay...was not one of my favorite policies either.

I hate that policy. It is just a way to bill more because many refuse transport once awake. So services now want you to wait till in the ambulance and enroute before pushing D-50.

[crotchitymedic1986]

I agree with mandatory transport of these patients:

1. You are making an assumption as to what caused the hypoglycemia, it could just as easily be due to overdosage of insulin, an infectious process, or a metabolic problem.

2. You are administering a medicine to a patient and then leaving them behind with untrained personnel to monitor the patient. I doubt that you routinely leave a chest pain patient at home whose symptoms were relieved by 1 ntg tab that you administered. Why not give 5mg of Valium to a seizure patient and then leave them at home, or give 5mg of morphine to that chronic back pain patient and leave them at home ?

3. At best, the patient is mildly altered while signing your refusal.

4. You have no guarantee that their blood sugar will not drop again.

5. Most services are operating at loss or razor thin profit margin, and it is expensive to send a crew to the scene, administer meds, and wait with that patient for 30-45 minutes. Insurance does not pay for no transports, and most patients do not pay if you do bill them some minimal charge.