Pushing D50

[RomeViking09]

I've got to agree. By getting the sugar up you've won the battle but not the war. The important thing here is, why are they hypoglycemic. Most pts don't require much more of a workup but there are those that do. I feel it is completely inappropriate/malpractice to make someone sign the form. If they don't want to go, that is a different situation.

Ture, but even if they don't want to go you should first try to talk them into going. If you have a patient with a history and chest pain who does not want to go do you just hand them the clipboard? I think many EMS providers take hypoglycemia as a non-emergency and overlook what can go wrong. Treat for the worse (within reason) and hope for the best until you have reason to do other wise.

[ERDoc]

Ture, but even if they don't want to go you should first try to talk them into going. If you have a patient with a history and chest pain who does not want to go do you just hand them the clipboard? I think many EMS providers take hypoglycemia as a non-emergency and overlook what can go wrong. Treat for the worse (within reason) and hope for the best until you have reason to do other wise.

Couldn't agree more.

[EMT Foose]

Lets say a fluid bolus is out of the question. Only thing available is 10cc flushes.

On an AC, it's pretty difficult if not impossible to note any edema from 10-20cc of saline, especially on large patients. What's the best option at that point?

There's a reason I'm asking these questions..

[stcommodore]

Starting an IO to administer D50, dear god.

[speedygodzilla]

Starting an IO to administer D50, dear god.

Lol so I'm not the only one still thinking this!

[fiznat]

What is the general consensus of pushing D50 through a line that will not aspirate?

I think it is a good general rule that if you feel your line is sketchy you probably shouldn't try to push any drugs through it.

Just because a line won't aspirate, though, doesn't mean it isn't good. Like everything else in medicine, you should use every method you have available to verify a finding:

-Try infusing some fluid and watch for extravasation

-Try to tamponade the vessel at a proximal location and see how that affects fluid flow

-Drop your bag down low and see if you get backflow blood

-Watch for flash when you start the line, and subjectively judge how the lumen "feels" when you catheterize.

These are just a few methods you can use to evaluate a questionable line.

Sometimes good lines won't aspirate, but I think it is pretty rare that a bad line will pass ALL of those tests completely undetected. And if it does, well, mistakes happen, but at least you did your due diligence in properly evaluating your IV access.

Edited September 10, 2009 by fiznat

[DartmouthDave]

Hello,

I agree with Fiznat.

Also, if you are stilled worried about pushing D50 through a line just dilute it in a 500 or 250 cc bag of NS. Heck, some services do not even use D50W for the very reason we are discussing. The just hand a bag of D10W.

In the end, the results will be the same.

Cheers,

DD

[hertzvanrental]

Lol so I'm not the only one still thinking this!

So if the patient also has Liver cancer or some other severe liver problem and you can't get a line. Glucagon hasn't (and probably wont of) worked. Are you still not going for the IO?

[rock_shoes]

Lets say a fluid bolus is out of the question. Only thing available is 10cc flushes.

On an AC, it's pretty difficult if not impossible to note any edema from 10-20cc of saline, especially on large patients. What's the best option at that point?

There's a reason I'm asking these questions..

True you are not going to see much pushing 10-20mL into a botched AC. The odds of you failing to get good flash from an AC are also very low however. If you blow out an AC altogether it's unlikely you will miss the blood going interstitial. PCP's (EMT-I roughly) in my service don't even use D50W. We use D10W in 100mL boluses until BGL returns to an acceptable range with a 50mg slow IV push of thiamine during the first 100mL bolus. In my experience it has worked extremely well for two reasons. First. Grandma's papery thin veins aren't such a big deal because you can run it through a 22 guage if need be. Second. It allows you to maintain a person's BGL on a glucose drip should there be any reason the patient will not be able to eat for any amount of time following.

Personally I hate using glucagon. I will only ever use it if I can't get a line. Using glucagon depletes a person's emergency stores and running down someone's emergency stores when there is an alternative seens fool hardy to me.

Edited September 14, 2009 by rock_shoes

[speedygodzilla]

So if the patient also has Liver cancer or some other severe liver problem and you can't get a line. Glucagon hasn't (and probably wont of) worked. Are you still not going for the IO?

In this case an IO would may warranted but I would still probably provide ABC's load and go obtaining medical control authorization/orders. Giving the the Glucagon on scene should give enough time while loading and all that I can see if it is helping (onset of 5 to 20minutes). Would giving Glucagon to a pt with Liver cancer or liver failure etc cause harm to the pt? Might as well try it and give it time to work until you go to the next step of placing an IO. What do you think?