The glucagon discussion

[whit72]

I realize the typo. Thanks

And you are a MEDIC/EMT

Do you use Glucagon?

[whit72]

I was looking for a discussion, if you dont have anything to add please dont post.

Thank you

[AZCEP]

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.

[Ace844]

DELETED - ADMIN

[whit72]

Thanks for screwing up the thread again. much appreciated.

As far as it being a standing protocol, whats the difference I call him give him report, he says give it. I'm still painting the picture for him. And I cant recall any time them disagreeing Stating no, no ,no don't give it something terrible will happen.

[AZCEP]

Whit,

Have you even stopped to read any of the volumes of information that we have provided for you?

Do you honestly not know what a standing order is? You used the Brady paramedic text. I remember seeing this discussed in the chapter on medical/legal issues. Go look it up. We will wait for you.

Ace,

Please, for the love of all that is holy. Limit yourself to one high-quality reference embedding in your posts. This particular individual isn't taking the hint anyway. The rest of us can follow the links. Thanks.

[paramedicmike]

Sure you paint a picture, but what picture are you painting? What you think the doc wants to hear? What is actually presenting to you with no embellishment on your part? Or something else?

And again, we'll go back to the reading comprehension issue that keeps coming up. Have you read anything that's been put out here for you? Is any of it sinking in?

And Ace:

I'll echo AZCEP's request. Please go easy on the embedded links/references! We got it man! We got it! Thanks!

-be safe.

[Ace844]

Whit,

Have you even stopped to read any of the volumes of information that we have provided for you?

Do you honestly not know what a standing order is? You used the Brady paramedic text. I remember seeing this discussed in the chapter on medical/legal issues. Go look it up. We will wait for you.

Ace,

Please, for the love of all that is holy. Limit yourself to one high-quality reference embedding in your posts. This particular individual isn't taking the hint anyway. The rest of us can follow the links. Thanks.

"Az,"

Duely noted, will do, thanks for the suggestion...

Out here,

ACE844

[stream:da1aacdb5a]http://www.favewavs.com/wavs/misc/endww2.wav[/stream:da1aacdb5a]

[Asysin2leads]

Okay, so maybe this has been answered, maybe it hasn't, I didn't read the entire debate. However, I did read through RI's protocols and if I'm reading them correctly, they state that a BLS provider can give Glucagon 1 mg IM after contacting medical control. Which is too bad, because of up until that point I was really enjoying them, what with the cool anchors and teddy bears for pediatrics. My protocols only have, like words and stuff.

Which, of course, begs the question, why did I have to be tested and cleared by state certified ALS instructors before I could administer IM injections, not to mention being cleared on pharmacology and medication administration, and basics in RI get to do it with only a can-do attitude and a call to the doc?

That's it, I'm going to find something really bad that happened when an IM injection was messed up. Well, there was that case in Florida I think it was where a doctor was going to give a routine local injection of lidocaine to a 10 year old boy for a minor corrective surgery, and accidently drew up a vial of epinephrine that was there for bleeding control, and gave him an injection of a massive dose of epi and killed him. That was a bad one.

So, what are the chances of some basic in Rhode Island someplace, sometime, meaning to inject Glucagon and accidently giving something like a 1 mg of 1:1000 epinephrine? I don't know, but bad things happen. The point is that administering medications is nothing to be taken lightly. As one of my instructors once said, "Medications are like a gun. In the right hands, they can be a life saving tool. In the wrong hands, they are a deadly weapon."

Oh, and by the way, if somehow one of these medications does harm to the patient, I hope your malpractice insurance is paid up. Wait, do most basics even carry malpractice insurance? If you're poking people with needles and pushing stuff into them, you definitely should, unless you'd like to see a mean lawyer take all of your possessions away. Good luck!

[SuperKoopa]

I'm surprised that this thread has stayed alive this long. Wow.