The glucagon discussion

[medic001918]

Whit,

I am all for educating the uninitiated, but the information that you have given seems to be from a handout provided for family members of newly diagnosed diabetics.

Let's go on a little journey to see how this "simple" drug works, shall we?

The patient's body burns up the available sugar, and because the brain needs a constant supply of sugar, the patient quickly loses cognitive function, personality changes, control of voluntary muscles becomes more difficult, and ultimately the patient loses consciousness.

Now, assuming this individual is well-nourished, the body would have released glucagon from where? That's right! From the pancreatic alpha cells. The glucagon then moves to the liver and signals the breakdown of stored GLYCOGEN through the process of glycogenolysis.

Now, at the same time, the brain is sending signals to the remainder of the endocrine system to do what? That's right again! Release hormones to increase perfusion to the brain of what little bit of sugar is still available. Which hormones would that be? Why the sympathomimetics from the adrenal medulla. Our friends epinephrine and norepinephrine. Now it would be nice if these two agents could pick and choose where they want to work, but unfortunately they can't. So, widespread vasoconstriction, increased cardiac output, smooth muscle relaxation, pupillary dilation, and emesis to empty the stomach. All because the body realizes that it needs to find food, kill it, and eat it.

So, now we have released the little amount of GLYCOGEN , and the body is preparing for a fight. In the event the patient is malnourished, guess what will happen. Right again! Absolutely nothing on the level of consciousness front. The adrenal response will still happen, but due to the lack of available GLYCOGEN they will remain unresponsive.

The BLS provider is poorly prepared to evaluate the consequences of administering this drug. In the event of any of the other causes of altered mental status, glucagon can, and will, make a bad situation worse. Stroke patients will be the most drastically affected, due to the sudden sympathomimetic deluge that the brain is ill prepared for. Patients in shock from other causes, are already in hyperdynamic states, as such, they are already using their stored GLYCOGEN for fuel. A patient in a cardiogenic shock state, will not appreciate the sympathetic release on the damaged myocardium.

Is that enough for now, or would you like me to explain how Glucagon will also work to activate the cAMP in body cells in the event of a beta blocker toxicity?

Too much bad/not enough good. Very bad idea.

+1 for a well written post that clearly explains Glucagon, how it works and why it shouldn't be given by basics based on their current level of training.

Shane

NREMT-P

[AZCEP]

I'm all for increasing the scope of practice, but not under the current educational system.

Hopefully, those providers that feel drug administration is not a big deal will understand it a little better. Unfortunately, the original poster has yet to comment on why he thinks we are only holding basics back by not allowing them to use this drug.

[BEorP]

How do you guys feel about PCPs in Ontario giving glucagon?

[Ridryder 911]

The problem is we have a system in place, however they do not want to abide or feel they need to adhere to national standards. Again those in power be have degraded the system and the ones that suffer the most are not aware of it, the patients.

This would be like in comparison a nurses aide able to administer a medication solely based on sign and symptoms without proper education, the public would be outraged as we (EMS) and they the public should be. But alas, we are EMS. We think we should be special and exempt from all general medical practices.. (obviously, we do not demand college education either). But, hey what is the difference as long as they can attend a workshop and have step by step protocols... ( I hope they are not written in too big of words). Next thing you know, we will want to be excused of having a drivers license too...its part of the job.

R/r 911

[AZCEP]

How do you guys feel about PCPs in Ontario giving glucagon?

Honestly, I don't know enough about the Canadian system to intelligently discuss it.

[akroeze]

How do you guys feel about PCPs in Ontario giving glucagon?

I would just like to point out that fortunately (for the pts) in many areas in Ontario they are moving to D50 for PCPs

[Ace844]

Hello Everyone,

Here is some of the information which was lost when admin 'deleted' my thread for lack of "PRPG," style 'Koombyah'. For those who would like to learn I hope this information is helpful.

ACE844

I hold a lic. in one of the most progressive state in the country. R.I. Look up the protocols..

I am sick of hearing about studies WHAT DO YOUR PROTOCOLS STATE.I am saying my protocols state you work arrest pt's' date= without obvious signs of injuries non compatible with life. Why is this such a big problem for people to understand it has nothing to do with being aggressive. It has nothing to do with my emotions. Until the protocols change thats how they are handled regardless of my own personal opinions. The facts about intubation are true medics suck at it because they never perform the skill. If the rate for intubation was higher you would have more succesful tubes. I had to take and intubation class in a another state that I worked in, lets face it its not rocket science. But wouldnt you be more proficent at it if you did three a day rather then one a month.

[AZCEP]

It would appear that our friend from Mass. has decided he is no longer able to carry himself into unwinnable confrontations without the evidence that he was searching for.

I could care less, but I really wanted to make sure that he understood my description of this medication's actions.

I guess I will just have to go on about my business knowing that I helped to make the City safer for those that want true knowledge.

[kevkei]

Its a simple question man.

Yes or no, and why

If you think it is a simple question, then my answer is no.

If you can tell me why and how Glucagon affects cyclic AMP and why it is important in your patient (and prove it is tought in the program that affords you to utilize this medication), then I might say yes.

[AZCEP]

And still no response to come. Makes it seem that he became scared when presented with actual facts.

Yes whit72, I am calling you out. You are willing to bash those you don't know with your opinions. Respond to my post of facts about this drug that you think you should be able to administer.

I am ready for any response you can give. 8)