Would you take a blood sugar here?

[Acosell]

Situation 1:

Pt. complaining of sharp 4/10 chest pain worsening on inspiration which completely resolves with oxygen admin. He then complains of dizzyness and general weakness in his arms. Would you take a sugar?

Situation 2:

Pt. was at work and began to feel very light headed. Pt. sat down and rested immediately, but still feels a little bit dizzy. Would you take a sugar?

Neither patient has a Hx of diabetes, either personal or family.

[jjcapo]

I would do a Blood Glucose on both. Anyone can have new onset>

Have a great day. JC

[Medic2588]

I take blood sugars whenever I can. Hyperglycemia can be an indicator of a lot, including MI. So yes, I would take a BGL on both of them.

Devin

[Dustdevil]

Anything that is not clearly, obviously, and absolutely diagnosed by my exam will get a blood glucose level (BGL) determination. Almost all medical patients will receive a BGL. A fair number of trauma patients will also get a BGL's.

• Broken leg from motorcycle crash = no BGL.

Broken leg from a fall of undetermined cause = BGL.

• In the first situation you gave, while the symptoms point to some specific diagnostic possibilities, it does not clearly and positively point to any one specific condition. Consequently, they would receive a BGL. The second situation you gave is a given. Any altered mental status or weakness or diminished coordination abilities gets a BGL.

A history of diabetes might prompt me to do a BGL on a patient with isolated illness or injury that I might not otherwise check. However, a lack of diabetic history would never discourage me from checking BGL on any patient with possibly associated symptoms or conditions.

[Ridryder 911]

I would not.. on patient 1. If the patient does not have a hx of such. Even if the readings are high, this does not mean much other than report it..a fasting glucose is necessary to determine any true DM.

Number 2: I might it all depends on the situation. Personally, EKG , 0[sub:108a9d7c7a]2[/sub:108a9d7c7a] sat reading and a better history. I rather focus my assessment and history and perform a nuero assessment and maybe a tilt test.

Be sure to focus on patient assessment and history and use tools to add to your diagnosis. Performing BGL routinely may be allowable but not appropriate on every medical call.

R/R 911

[Acosell]

I forgot to mention with Pt. 1, he claimed he had not eaten in 2 days.

Anyway, the reason I ask is because I took a blood glucose on both of these patients, as is allowed in my protocol. The problem is Base hospitals right hand doesn't know what it's left hand is doing. This creates a situation in which I can take a blood sugar if I have any reason whatsoever to suspect it may be low, but base hospitals other hand says no CBG unless the GCS is less then 15.

I plan on following my protocol and checking CBG on patients that are exhibiting signs that could possibly be related to a glucose problem, but many of these patients have a GCS of 15. My dilemma is this.

I can A: follow my protocols, take the sugar, document it on my ACR, then get dinged on the BH audit, or

I can B: follow my protocols, take the sugar, and falsify the ACR and live life happy, or

I can C: not take the sugar, not follow my protocols, and get screwed anyway.

I choose path A because I WILL NOT falsify a form, and as for witholding a test that could reveal additional info on my patients condition doesn't jive with me.

Any advice? From my point of view, I get screwed no matter what.

[N.S. ACP]

You are saying that you can not check a blood sugar unless there is a drop in the pt's GCS, or you will be nailed for a protocol violation? :shock:

WOW, my advice would to try and get that particular protocol changed, it's stupid.

[Dustdevil]

You are saying that you can not check a blood sugar unless there is a drop in the pt's GCS, or you will be nailed for a protocol violation? :shock:

Yes, I am more than a little confused on that point too. Is that indeed your protocol, or did we misunderstand you?

That is simply asinine. Significant and progressive hypoglycemia can present in a multitude of ways that would not affect the GCS. Why would we wait until their brain starts malfunctioning before identifying their problem?

[Acosell]

It's NOT my protocol, sorry for the confusion. My protocol says that I can take a blood sugar for any patient that is exhibiting signs or symptoms that MAY be related to a POSSIBLE glucose problem.

For some reason though, if I take a blood sugar on a patient with a GCS of 15, I get a "Minor Error" on my ACR and that goes on my record.

[strippel]

We have protocols that state when we must get a BGL. But, it is company policy at my full and part time to get a BGL with any IV start. We take the blood off of the retracted angio.

Any POSSIBLE diabetic gets a BGL all of the time, IV or not.

(Meaning if they are alert enough to eat or suck glutose.)