A Question about Hypoglyemia

[itku2er]

Here is the scenario:

This takes place in long term care facility, You have a hypoglycemic patient...

vital signs: b/p 50/pal.... resp 10 and shallow. pulse 60 and thready.....BBS clear pulse ox 95% on RA..BS 47.. the nurse supervisor has given 1ml glycogen Im per protocol and BS is now 44 after 10 minutes... the supervisor now has an order from the patients own MD to start a line and give 1 amp of D50 and a 500 cc bolus of of D5 ...if in 10 minutes the BS is below 60 push another amp of D50...you arrive on scene and have all your als procedures done for you accept placed on a monitor and NRB ..........(you arrive on scene 20 minutes after being dispatched) and the BS on your arrival is only 54 after all the interventions above have been done.....here is the question ....do you question the 500 cc bolus of D5 being given and the second amp of D50 (which was not given).......

[ERDoc]

What exactly are you questioning?

PS I had a pt come in yesterday with a FS of 11 and was still partially mentating (is that a word?). Got a call from the lab 2 hours later, "We have a critical value. Her glucose was 13." Yeah, thanks, we'll get on that right away. Thanks for the rapid notification.

[Ghettomedic351]

Is this MD planning on joining you at the LTC facility before you transport that patient, accept responsibility for the orders he's giving you and ride with you to the ER? If the answer is no, and I'm sure it is, it seems once you assume care of the patient, you should begin to treat the patient according the protocols set forth by YOUR medical director. After all, they decide if you're practicing or not. If all else fails, consult medical control, it's what they are there for.

[itku2er]

Doc here i am gonna amend the post

here is the full story

I work in a long term care facality as a nursing supervisor ........i was on the phone with the md getting the orders for all the interventions when the first amp of d50 was given followed by the 500cc bolus and i was getting ready to push the second when the squad arrived to transport the patient to the ER...when they arrived on scene 20 mins later they were questioning why i gave the medications and didnt wait on them to arrive. I was wondering if anyone else would question that or not ......hope thait makes it clearer

[ERDoc]

Makes more sense. As a former EMT, I would not question you for anything you did. Just because you called an ambulance does not mean you don't treat the pt. I think it would be malpractice not to (especially if they had a 20 minute response time). They pt is yours until they arrive on scene, so you do what your orders/physicians dictate. Would you not do CPR on someone in cardiac arrest because you called the ambulance? I think that crews needs to check the attitudes.

[MedicRN]

I agree with Doc..... just like in EMS, the patient is yours until you turn them over to the next care provider.

Personally, I would have looked cross-eyed at the 'ambulance driver' :tongue2: ](*,) , taken a deep breath and said something to the effect of 'I didn't know I needed your permission to follow my doctor's orders.' And then point them down the hall to the patient's room. Since they seem to know so much about what has already transpired, they can continue to use their ESP (tongue planted firmly in cheek). :pottytrain2:

[Ridryder 911]

I agree, in ER when medics question the treatment and try to insinuate something .. I tell them hold on.. I get the physician and ten tell them . here.. now, you tell the physician how "wrong his/her treatment was"... You know it is amazing.. some reason or another they seem to get amnesia.. or get tongue tied... hmmmm

I suggest next time dial the M.D. up and had the phone to them and tell the Doc here, they want to question your tx... I am sure they will never repeat it.

Be safe,

R/R 911

[Nate]

Sounds like you could use a new ambulance service, 20 minutes on a hypoglycemic patient is to long. It is cool that you were able to start treatment, most of the nusring homes here in Houston just look at the patient, they don't actually start IV's and give medications.

[JoelEMT]

Itku2er: You said 1ml of glycogen IM

I assume that you had meant 1 mg Glucagon IM correct????

[Medic2588]

1ml usually works out to be 1mg of Glucagon.

Devin