Clinical Judgment and Protocols

[Johnboy]

Paramagic- I understand what you mean, however in this case, this diabetic with snoring respirations would not benefit from lidocaine, they are usually comatos, without the ability of feeling pain. I have been there numerous times with this type of pt.

Neuroglycopenic symptoms include weakness, tiredness, or dizziness; inappropriate behavior (sometimes mistaken for inebriation), difficulty with concentration; confusion; blurred vision; and, in extreme cases, coma and death.

Above--(coma, and death)

JB-

[Paramagic]

Sorry, I'm having a bit of a brain fade today. Can you explain what it is about hypoglycemia that renders the body unable to mount a physiological response to noxious stimuli? It seems counter intuitive given that one only needs intact spinal nerves to mount a response normally. Even patients with spinal cord transection will manifest pain even though they are completely unaware of it themselves thanks to spinal reflexes.

But I beg your indulgence, I'm struggling a little today (not enough coffee I think)

[Johnboy]

Hypoglycemic symptoms are related to the brain and the sympathetic nervous system. Decreased levels of glucose lead to deficient cerebral glucose availability (ie, neuroglycopenia) that can manifest as confusion, difficulty with concentration, irritability, hallucinations, focal impairments (eg, hemiplegia), and eventually, coma and death. Stimulation of the sympatho-adrenal nervous system leads to sweating, palpitations, tremulousness, anxiety, and hunger.

The adrenergic symptoms often precede the neuroglycopenic symptoms and, thus, provide an early warning system for the patient. Studies have shown that the primary stimulus for the release of catecholamines is the absolute level of plasma glucose. The rate of decrease of glucose is less important. Previous blood sugar levels can influence an individual's response to a particular level of blood sugar. However, one must appreciate that a patient with chronic hypoglycemia can have almost no symptoms.

Hope this helps..

JB

[DwayneEMTP]

...

The adrenergic symptoms often precede the neuroglycopenic symptoms and, thus, provide an early warning system for the patient. Studies have shown that the primary stimulus for the release of catecholamines is the absolute level of plasma glucose. The rate of decrease of glucose is less important. Previous blood sugar levels can influence an individual's response to a particular level of blood sugar. However, one must appreciate that a patient with chronic hypoglycemia can have almost no symptoms.

Hope this helps..

JB

http://www.positivea...t-Methods/28548

There you go man...I helped you out. In the future you should cite your sources so that people don't think that you making the limp dick mistake of quoting other peoples thinking as your own. That would have been really bad form...if you had done such a thing...just sayin'...

Dwayne

Edited to quote the above instead of just cut/paste. No other changes made.

Edited April 5, 2011 by DwayneEMTP

[Johnboy]

Yep D- it was from Medscape. A great website, you should read it more. You might learn something.... As a matter of fact reading articles like that one prior to your screw up might have changed things for the better for your pt, that you put an unnessesary hole in their leg and administered a potential toxic medication to...

Maybe you should frequent this site less, and go job hunting .

JB

[Bieber]

D. You gave Lidocaine to an UNCONSCIOUS pt. That is NOT indicated. This right here proves my beliefs about your judgements. That is for concious people. What don't you understand? You or nobody else on this site knew if she had addequate glycogen stores. YOU or nobody else did not know if it would have worked. It might have. I am glad you were fired , you deserved to be. You know everything, right? Your boss is a saint. What you did , you did outside the box alright, so outside, it was stupid. You need to read more about Lidocaine buddy. I am finished waisting my time with you. You were wrong in placing the IO prior to Glucagon, and you were wrong in giving a bolus of Lidocaine to an unconscious person... Again, what don't you understand?

JB

You're ridiculous. If the solution to the patient's problem is to pump them up with sugar, and if pumping them up with sugar will (see, Wonder Drug Advertising) take them from obtunded to alert in a matter of moments, then how do you think they're gonna feel when they wake up with an amp of sugar in their bone? Think it might be a little painful? Think a little prophylactic lidocaine while they're unconscious so when they return to consciousness shortly thereafter might not be not only reasonable, but good patient care?

"Nah, Bieber, shut up you silly newbie. That's just crazy talk. Go back to driving the ambulance."

[Johnboy]

Justin beiber, let me shed some light for ya....the IO should not even have been placed, unless the the useful hormone that we have in a siringe did not work!!

Brain child you are buddy!!!

Please do, go back to driving the ambulance, and better yet make it a transport company so you are not presented with critical patients Justin Beiber....

[Happiness]

un·con·scious (n-knshs)

adj.

1. Lacking awareness and the capacity for sensory perception; not conscious.

2. Temporarily lacking consciousness.

3. Occurring in the absence of conscious awareness or thought: unconscious resentment; unconscious fears.

4. Without conscious control; involuntary or unintended: an unconscious

Here ya go Ruff, In case you were not aware, Lidocaine is not indicated for unconscious persons. I have provided you with the definition of unconsciousness. I agree with you, Lidocaine IS, infact given to reduce pain. When your unconscious, guess what.... you feel no pain.

Well Johnboy you should be aware on the fact that you have now just become the entertainment for many with your ridiculas posts. What are you 12 with all the name calling. You should really try to get to know some of the people on this site as they are very good at what they do and will call a spade a spade, but best of all if they are proven wrong with facts they will admit they were wrong. (Crap were is dustbunny when you need him or squint for that matter) You should take a look around and actually read some of the posts that Annie, Dwayne and P-mike have made. You seem to really be focusing in on Dwayne, why is that could it be that you are suffering from Quote above 3. Occurring in the absence of conscious awareness or thought: unconscious resentment and my favorite unconscoius fears, that have arisen because some people have the ability to think outside of the box and you sir do not have that ability, or is it because maybe you actually know Dwayne personally and joined this site to hide under a screen name. (Dwayne maybe Johnboy is some one you poked with a big needle) Before you start name calling and throwing stones you better research who you are doing it to because with the above mentioned group you will loose everytime.

Now to the statement When your unconscious you feel no pain. In my earlies of training I was always taught that be careful of what you say around the unconscious as they can still hear you. In other words don't ever say OMG they are going to Die, just incase you didnt understand the first statement. So with that being said if I can hear someone when I'm unconscious I'm pretty confident that I will have awareness of my suroundings and I will in fact be able to feel pain. So me being the big pain baby that I am If someone is going to pain meds because they are thinking out side of the box then so be it. So it is know to you all if I am ever in need of a medic I would certainly want people like Annie, Ruff, P-Mike and of course the prickly Dwayne to take care of me and the reason why is that they have to ability to make conscious life decissions even if it is outside of the box.

Just a thought Johnboy are you that boss that fired Dwayne as you seem to think that guy is pretty groovy. Oh ya so you know being the entertainment will not make you a movie star here.

Oh I would like to comment on the glucogon but your protocols are much differnt than mine so No Comment.

[usalsfyre]

Maybe I'm an idiot, but to me your article citation (which you attempted to pass of as your own) fails to adequately explain how hypoglycemia prevents reaction to noxious stimulus. All it does is explain the effects of hypoglycemia on the CNS, which I'm fairly certain most here discussing this are aware of.

Literally anyone can randomly cite crap off of medscape and pub med. I fail to see a true understanding of the sources your citing and the clinical significance behind them. There's a hell of a lot of smart people here trying to hit you with a clue bat. You might want to heed that. Like Dwayne said, your either trolling or very, very new to EMS, as anyone with REAL clinical experience doesn't speak in absolutes. I feel sorry for you the day your wrong.

[Johnboy]

I wouldn't Dwayne take care of my dying guinea pig......and, although I am not dwaynes boss, I would definitely buy his former boss a beer!!

Cheers...