When To Use Glucagon IN

[mobey]

Just pulling from my head here, but also, doesn't Glucagon make the in hospital management of IDDM patients much more complex by burning their entire store of glycogen? No idea if that is true, or where I may have come to believe it..but it's the reason I've always considered Glucagon to be the ugly, illegitimate stepchild of Glucose. I've always questioned EVER using Glucagon in a system that allows I/Os. Am I completely off in the ditch?

I can't really comment about the in-hospital complications, as I have never had too care for a post Gucagon pt in-hospital before. However, anecdotally, my uncle is a fragile diabetic on sliding scale insulin says any competent diabetic should be able to adjust his/her dosages to accomodate. Anecdote though....

As far as your thoughts on Glucagon vs I.O. I am hardly interested in trying to tell you what is "right" or "wrong", but I will tell you my opinion.

When I am making the decision to use Glucagon, it is on a hard IV start (after 2 attempts) or a combative pt. These are the factors between my 3 choices; Glucagon, IO, Multiple IV attempts.

Which is safer for me?

Which has less complications for the pt?

Are thier other life threatening issues?

I am pretty quick to go with Glucagon if I miss my IV's because of it's peripheral arteriole and venous dilation properties. Even if the Glucagon does not work 100%, suddenly there is veins!

Although I do not see IO as a dangerously invasave procedure as some others do, I do see it as more invasive than venipuncture and IM injection, therefore I go Glucagon 1st.

There is the idea of pt comfort too.... Waking up with a small IM wound is quite different than waking with a needle in your bone. When going IO I always have to use some form of analgesia and that is a step I can skip with IM.

Just my opinion

[DwayneEMTP]

Yeah, I get that Mobey...I guess that I've not really given it a terrible lot of thought...

And I should have made clear that 'never' in my previous post was italics so that it would be marked as added in the edit and not for emphasis...

Great thread...I'll have to do some more looking on the Glycogen issue and see if it has merit in the non glycogen challenged hypoglycemic patient...

Thanks all...

Dwayne

[Johnboy]

As Dwayne should have learned before his dumb ass got fired, glucagon, is not such a bad thing.... Again, if you IO a patent prior to a trial of Glucagon, you are an IDIOT. Period, end of sentence!!!!!

Edited April 15, 2011 by Johnboy

[Johnboy]

Are people using Glucagon regularly?

Part of the reason that I didn't use it on the case from the other thread is that I've never used it and was afraid that my inexperience with it might cloud my stroke exam if in fact I'd had faith it would have worked in the time frame I wanted.

Other than that, I don't think I've ever even considered it before, tell the truth.

Does anyone have significant experience with it? Why?

Dwayne

Your INEXPERIENCE, is your own worse enemy.... You need to learn more about pharmacy brother! We all make mistakes , the real man will admit them and LEARN from them.... My suspicions were absolutely correct! Learn this lesson from your prior boss!!! It would behove you....

[Bieber]

Yeah, I get that Mobey...I guess that I've not really given it a terrible lot of thought...

And I should have made clear that 'never' in my previous post was italics so that it would be marked as added in the edit and not for emphasis...

Great thread...I'll have to do some more looking on the Glycogen issue and see if it has merit in the non glycogen challenged hypoglycemic patient...

Thanks all...

Dwayne

Well, besides being new to the field, I've only ever given dextrose once throughout my entire internship and during the last several months as a paramedic. Never, ever given glucagon, so I don't know how quick I'll be to use it when the day comes I can't get an IV on a hypoglycemic patient.

[paramedicmike]

Dude! Seriously! Can you just not let it go?

Just stop. You've made your point. You disagree with what Dwayne did. We get it. You've said your piece. Repeatedly. Give it up. Let it go. Move on.

[Johnboy]

You ARE right. I DID make my point, a long time ago........

[mobey]

Well, besides being new to the field, I've only ever given dextrose once throughout my entire internship and during the last several months as a paramedic. Never, ever given glucagon, so I don't know how quick I'll be to use it when the day comes I can't get an IV on a hypoglycemic patient.

3 Rules of glucagon administration as I tell my students.

1) Don't shake the vial when reconstituting (But if you do it foams up something fierce. Just set it down and don't look at it foe a minute or two and it will go back to liquid state)

2)Once administered, start moving the pt. it will take a full 3-5 min to take any effect.

3) Use it when it is necessary

BTW; Cudos to dwayne for never running into a hypoglycemic pt that you cannot start a line on. You are obvioustly stronger at IV's than me!

Fricken diabetics and thier small vasculature

You need to learn more about pharmacy brother!

Ya Dwayne.... learn more about the pharmacy!

Did you know they have a special on arthritis ointment? Bet not

Do you even know where they keep the get well soon cards??

How about the medical terminology for dummies book?

You ARE right. I DID make my point, a long time ago........

So in the words of a great influential leader in my life "Take care then, Bye bye now"

free + to whoever guesses my reference!

Edited April 15, 2011 by mobey

[Just Plain Ruff]

Would you just shut the hell up.

Sent from my SPH-D700 using Tapatalk

Not you mobey. I'm sure you know that wasn't directed at you

Sent from my SPH-D700 using Tapatalk

[Johnboy]

3 Rules of glucagon administration as I tell my students.

1) Don't shake the vial when reconstituting (But if you do it foams up something fierce. Just set it down and don't look at it foe a minute or two and it will go back to liquid state)

2)Once administered, start moving the pt. it will take a full 3-5 min to take any effect.

3) Use it when it is necessary

BTW; Cudos to dwayne for never running into a hypoglycemic pt that you cannot start a line on. You are obvioustly stronger at IV's than me!

Fricken diabetics and thier small vasculature

Ya Dwayne.... learn more about the pharmacy!

Did you know they have a special on arthritis ointment? Bet not

Do you even know where they keep the get well soon cards??

How about the medical terminology for dummies book?

So in the words of a great influential leader in my life "Take care then, Bye bye now"

free + to whoever guesses my reference!

Really mobey? That's it??

Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek: φάρμακον (pharmakon), meaning "drug"

Anything else??

Ruff, tuck your string in, and stop crying like bitch....