Oral glucose

[EMTBgirl]

Are we allowed to give oral glucose to an unconscious patient???? According to my nutrition teacher, if someone is unconscious and you suspect low blood sugar, you should always give them oral glucose or sugar in some form through their mouth. I though that we were only allowed to give oral glucose to a conscious patient? Who is right?

[emt322632]

[align=left]Your teacher should know better. Feeding an unconscious person a sticky gel is not really conducive to a patent airway. I had one call at a nursing homes for an unconscious diabetic, to find out that when I got there they'd given not 1 but 3 tubes of oral glucose to the guy. Suctioning that stuff is hard.

In short, no you are not supposed to give oral glucose to an unconscious patient, only if the patient is awake and alert enough to swallow. Sometimes though, people feel they need to do SOMETHING to help the person, and feel helpless. My advice is to ask your teacher about possible airway problems that could result from giving oral glucose to an unconscious patient, see what she says.

[FormerEMSLT297]

[align=left]Your teacher should know better. Feeding an unconscious person a sticky gel is not really conducive to a patent airway. I had one call at a nursing homes for an unconscious diabetic, to find out that when I got there they'd given not 1 but 3 tubes of oral glucose to the guy. Suctioning that stuff is hard.

In short, no you are not supposed to give oral glucose to an unconscious patient, only if the patient is awake and alert enough to swallow. Sometimes though, people feel they need to do SOMETHING to help the person, and feel helpless. My advice is to ask your teacher about possible airway problems that could result from giving oral glucose to an unconscious patient, see what she says.

REALLY.??? be careful with the "always and never" statements,, Oral Glucose for "unconscious or Altered Mental Status patients" with known diabetic history, is in a lot of protocols.

Even if the patient is unconscious.

I know for a fact that it is in the MD Protocol for 10-15 Grams paste between gum and cheek.

So, don't tell him "your teacher should know better." That may be directly out of the protocol book from the state or county they they are in.

Now you may not agree with it, and being an ALS provider you may have a better way of doing it, and it can be a airway problem if you are not careful, but Glucose paste is protocol for Unc. Pt's.

Thank you

[FormerEMSLT297]

opps,,, sorry, her teacher

[paramedicmike]

Just because it's in a protocol doesn't mean it's right. That only goes to show that protocol monkeys shouldn't be operating prehospitally (not calling anyone here a protocol monkey...just an observation). Sure, your protocols may allow something. But we're supposed to be smart enough to know better. And this is one of those cases where we should know better.

The absorption rate of oral glucose is not fast enough to affect any realistic change in a diabetic patient who is unresponsive. Plus, as was mentioned, placing substances in the mouth of an unresponsive patient only invites disaster.

What's more, it was a NUTRITION teacher who said this. It wasn't someone who has been presented as having any credential to teach people how to deal with unconscious diabetics. Didn't that strike anyone else?

There are better ways to address an unresponsive diabetic. They usually involve transporting to the ED (from a BLS perspective) and/or ALS intervention. They do not involve stuffing oral glucose into the patient's mouth.

-be safe

[medic001918]

Just because it's in a protocol doesn't mean it's right. That only goes to show that protocol monkeys shouldn't be operating prehospitally (not calling anyone here a protocol monkey...just an observation). Sure, your protocols may allow something. But we're supposed to be smart enough to know better. And this is one of those cases where we should know better.

The absorption rate of oral glucose is not fast enough to affect any realistic change in a diabetic patient who is unresponsive. Plus, as was mentioned, placing substances in the mouth of an unresponsive patient only invites disaster.

What's more, it was a NUTRITION teacher who said this. It wasn't someone who has been presented as having any credential to teach people how to deal with unconscious diabetics. Didn't that strike anyone else?

There are better ways to address an unresponsive diabetic. They usually involve transporting to the ED (from a BLS perspective) and/or ALS intervention. They do not involve stuffing oral glucose into the patient's mouth.

-be safe

+1. Well said. There really isn't much more to add to this.

Shane

NREMT-P

[FormerEMSLT297]

I didn't catch that she (the original poster was a girl),, you expect me to catch that the teacher was a nutritionist and not an EMT? LOL

I do not advocate blindly following protocol, however, if something is in protocol and you feel it should not be, isn't it better to have an educated discussion with you Protocol committee or Med Director and fix the problem.????????

The other question/comment I will proffer is this. If oral glucose in in protocol for an Unc. patient between the cheek and gum, and you don't do it, I think you open yourself up to litigation especially if the patient has a bad outcome.

After all you're not a Doctor, you operate under a Medical Directors license and he/she, the person with the highest medical training (your MD), advocates the use of oral glucose and placed it into your protocols.

We can argue all day about what treatments in our collective protocols are effective, and which ones are not, but until you get an MD behind your name, or until you get a particular protocol removed, or added to a list of "may" try instead of "must" administer, you are somewhat bound by your systems protocols.

In MD our protocols for BLS Altered Mental Status/Unresponsive Person state in part: "...Administer glucose paste (10-15 grams) Between the gum and cheek.."

I don't see anywhere where is says, "If you feel like it" or maybe give glucose that would give you any room for deviation.

Now do I agree with all the stuff posted about Glucose lack of rapid absorption, possibility of aspiration, etc. Yes they are all possible. If I had my druthers, I would start O2, Start a line, check glucose level and if appropriate give a D50....

BLS personnel do not have that option.

So to reiterate, I'm not a Protocol Monkey, or Cookbook medic or anything like that, I just was/am concerned with giving a NEW EMT direction that MAY be in direct contradiction to her protocols, and what the ramifications of that MAY be.

As to whether you, the original poster, in Minnesota can and should give oral glucose to an Unc. patient, diabetic or otherwise, check your Minnesota AMS Protocols, and follow them, I think we have beat the pro's and cons to death.

That is all; I AM done.

My thoughts are my own and do not represent my agency or dept.

Former

[medic001918]

I can understand where you're coming from about not the legal aspects of not following protocol. But the bigger thing to remember is that protocols are guidelines and not absolutes. Even as a paramedic, if a doctor gives me an order that I know is wrong but I choose to follow it anyway and harm is done to the patient, I'm just liable (if not more so) than if I didn't do it. We still have an obligation to do what's in the best interest of our patients. In the case of an unconcious diabetic, there is significant risk in placing a thick gel into their unprotected airway. The risk of aspiration becomes a very viable complication that needs to be considered. If you don't give the oral glucose, you might be answering questions to someone. If you give it you might be answering questions. I think that you're best option would be rapid transport or intercept with an ALS provider capable of correcting the situation. There's too much potentital to worsen the situation otherwise.

Shane

NREMT-P

[Just Plain Ruff]

i offer a different viewpoint as to your protocol

here is what you wrote:

In MD our protocols for BLS Altered Mental Status/Unresponsive Person state in part: "...Administer glucose paste (10-15 grams) Between the gum and cheek.."

This is from your BLS Altered mental status/unresponsive person protocol. I offer that the administration of glucose paste is given to the altered mental status and not the unresponsive person part.

I have never been taught that you put anything in the mouth of an unconscious patient and would never advocate or teach that.

Just because it's in the protocol, you have to read or think outside the box sometimes. Altered mental status/unresponsive person is a huge broad spectrum.

If given that protocol, I'd be on the phone with med control saying my protocol states yada yada yada but I don't feel comfortable giving the oral glucose in this unconscious patient and I'll bet that every physician you talk to would reem your rear end a new hole if you put a sticky substance inside the mouth of a unconscious patient.

That protocol needs to be rewritten to say something that oral glucose is only to be used in patients that can control their own airway and not otherwise.

you give that gel to a unconscious patient and they aspirate and arrest or whatever and their outcome could have been prevented by following sound medical guidelines and not just following protocol and your liability is greater than not giving the instaglucose.

[FormerEMSLT297]

Without starting the ALS/BLS debate, that is very true. AMS diabetics who are hypoglycemic is one area where rapid ALS intervention can help correct the situation. An experienced medic or EMT can make a judgement call and if questioned speak quite educatedly about why they did or did not do a procedure.

When I precept EMT and Medic students, I always debrief the call and ask them before they do something, if time permits, why what their rationale is. And we talk constructively about what if's and how to justify a particular procedure.

I hate cook book medics. When I was a new Medic my "senior" partner and I went on a call for an Unconscious Diabetic in an office building. Upon arrival we got a Dex stick of like 40. We gave her 25 Grams of Dextrose I.V. B. and as she began to come around, he whipped out 2 mg of Narcan and and started to give it to the patient. I stopped him and he said "we have to give it, it's in protocol", and he proceeded to give it over my objections. After the call we had a QA and the Medical Director said to him what was your rationale for the narcan. Well when he couldn't answer except that it was in protocol, the Doc was not pleased.

And before anyone asks, she had no signs of Narcotic O.D. Pupils midline, known diabetic, took insulin, and didn't eat breakfast, etc.

Thanks

Former