IV Catheter -v- Finger Stick Blood Glucose

[jwiley40]

No, Captain we have our own little "dutchy." Fair example of fuedal life in modern times.

[Just Plain Ruff]

You have to be talking about maybe St Johns?????? Or Cox???

Or could it be Rolla EMS?

Edited September 23, 2013 by Captain ToHellWithItAll

[jwiley40]

Nope, nope and nope! I'm local. It very well could have the Fort but nope there too.

[Just Plain Ruff]

Damn, so you have the ability to affect change from within which you probably ought to before someone catches hepatitis or HIV or some other nasty. I see you being the one to do it.

[iFester]

For what it's worth I typically go by this rule in the field and it hasn't let me wrong YET.

If it's a routine ALS, I get my BGL via IV hub.

If my clinical treatments will be based off my findings (diabetic emergencies or possible CVA) I go by fingerstick.

My other question for you is... Was she bradycardic prior to the D50? If so maybe you could have done a fluid bolus with D10 vs a D50 IVP? But I was not there, your the quarterback =)

[Brandon Oto]

I would actually make a controversial recommendation here. Although strictly speaking, using a venous source for your capillary-calibrated glucometer is incorrect, the difference is rarely more than a few points (maybe a little more if they've recently eaten). On the other hand, sick patients will usually have a MORE reliable venous than capillary reading, and this far outweighs that small inaccuracy. In other words, for any patient where it really matters, I would actually prefer a venous reading.

I talk about this a bit more here and I can provide sources if anybody wants, but basically, there's plenty of research showing that patients in shock, or sepsis, or cardiac arrest, or really any acute illness inducing a classic stress response (with peripheral vasoconstriction and so forth), your capillary blood is going to be the "last to hear" about any changes in the circulating plasma. Readings can be grossly elevated or depressed -- and yes, it can be either one, so there's no back-of-the-envelope correction you can make. For sick people, venous blood is better.

I realize there's a legitimate safety concern regarding needlesticks, to which I'd let everybody make their own reasonable decisions. (It blows me away that anybody is still using non-safety needles.)

[Just Plain Ruff]

For what it's worth I typically go by this rule in the field and it hasn't let me wrong YET.

If it's a routine ALS, I get my BGL via IV hub.

If my clinical treatments will be based off my findings (diabetic emergencies or possible CVA) I go by fingerstick.

My other question for you is... Was she bradycardic prior to the D50? If so maybe you could have done a fluid bolus with D10 vs a D50 IVP? But I was not there, your the quarterback =)

Hang on a second, can you clarify what you mean. How do you know which instance will simply be routine ALS versus a situation where your clinical treatments will be based on your findings? I don't really understand that statement. Shouldn't you always be working towards a clinical treatment versus just "a routine als call"??????

[jwiley40]

And what justifies being called a "routine ALS call?" I have thought all ALS calls were more than routine. At least that's the way I do it. Having seen the back of an ambulance from the cot, I think if a transport is treated as "routine," something may be missed. I try to treat all calls as if whatever I have to do, is in the best interest of the patient and is not based off of something that might seem "routine." That just might come back to bite you.