Category Archives: Hypoglycemia

What is our responsibilities once a patient has been arrested under the mental health act? Is it considered implied consent? Are we responsible for vital taking, blood sugar and treatment if the BG is below four? Can the patient refused treatment with a decreased BG and a GCS of 14(confusion)?

Question: How fast can a pediatric Pt. burn through glucose stores? Scenario: Called for a 13y/o unconscious. Consumption of unknown amount of alcohol & unknown drugs or amount. AOx0, GCS 4=E2V1M1. Eyes open to pain as only response. Pt stable vital signs on Primary & throughout transport & BGL 5.8mmol/L on scene. Transport to appropriate children's hospital code 4 CTAS 2with a 25 min transport time. On ED assessment Pt. was given an amp of dextrose as ED found BGL to be "low".... or not able to read on meter, so possibly less than 1.6mmol/L. Crew's service meter DID pass daily test procedure as per manufacturer's guidelines. Thank you

I am an PCP IV certified paramedic, working with a non IV medic. If we have a hypoglycemic patient do I need to attend & consider D10/D50 or can my non IV partner treat the patient with Glucagon instead?” Same question for Gravol; do they need to get it IV or can non IV certified medic give it IM?

I was told during my I.V. course that it is O.K. to give dextrose immediately after Glucagon if an I.V. was achieved after Glucagon administration (failed I.V. attempts - give Glucagon - try another I.V. and succeed - give dextrose). Is this true? If so, would I have to record a new sugar reading prior to dextrose administration even if I’m prepared to give dextrose immediately after glucagon? Would there be any changes to the number of max doses of either drug I could administer in this case.

Question: I’m a recent graduate from the paramedic program and was wondering if I can get some feedback regarding the hypoglycemia treatment. The new protocol that came into play that now includes D10, I was curious what the reasoning was for choosing D10 over D50? Is there anything specific separating the 2 options of treatment?

Question: A couple questions with regards to D10. We have used D10 a few times now to treat hypoglycemia and have noticed some issues. It seems that for anyone with a BLG that is very low (say less than 2.0 for argument sake) the max dose of 10g will not get them over 4.0 mmol/L. Is there plans in the future to increase the dose? Perhaps something like if the patient is < 2.0 mmol/L then a 20g max or 4ml/kg loading dose followed by a 10g or 2ml/kg maintenance dose if necessary?

Second, with regards to Buretrol administration of D10, the process is very slow. Both the setup of the Buretrol and the infusion take quite a bit of time obviously more so if a second dose is required. Is there any reason a 60ml syringe can't be used (draw up and push 60cc and follow up with 40cc) as a push administration instead of the Buretrol? For most situations the slow drip is okay but in the case of an agitated or aggressive patient the quicker option would be nice. I realize the benefits of D10 over D50 in not sky rocketing BGL but the way it is laid out now seems that we have gone too far the other way in not raising BGL enough.

Question: Can we draw up D10 in a 50cc syringe and administer it that way instead of going through the Buretrol?

Question: In a situation where we are unable to get a blood glucose reading from the patient's finger due to patient being combative/handcuffed, are we allowed to get it from the toes of the patient?

Question: If a patient is presenting with signs and symptoms of hypoglycemia (confusion, diaphoresis, pallor, tachycardia, etc.) and you find them with a BG of 4.5mmol/L, but family on scene states their normal BG is over 12mmol/L, and that they are presenting as they typically do when their blood sugar is low, AND you cannot identify from assessment/history any other reason for their current presentation, is it advised to give them oral glucose at this point if they are able to swallow?

Question: Trauma and BGL. Is it imperative, at a traumatic event, when no signs of hypoglycemia where evident (e.g. guy on a bike hit by a car) to do a blood glucose reading even when a decreased LOA is present. Generally, does stressful events such as this not trigger a sympathetic response which would elevate the reading anyway? I understand if someone was acting different prior to such events. If BGL reading is to be done, when would the MAC feel it most appropriate to obtain, immediately or after package and in the truck? Thanks.

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