View Full Version : Anybody carry Glucagon on their trucks??
SLIDER in KY
02-23-2006, 19:56
OK...I'm trying to convince our management that we need to carry Glucagon on the ambulance. I mean, why not?? Isn't Glucagon the "go to" option if you have a patient with low blood sugar that you cannot get an IV on? From what I have seen with Glucagon, it's just an IM injection that will bring the blood sugar up for approx. 30-45 minutes. Right now, if we have a hypoglycemic patient and we cannot get an IV anywhere, we can use the tibial ADULT IO. The main drawback to that is when the patient comes around, that IO in their leg hurts them like crap!!! Anyway, I'm looking for opinions from you folks that carry Glucagon. Thanks!!
We carry Glucogone here in Wisconsin. It is approved for all levels of care except First Responders. It works well for pt's with bad veins. You can usually see results in 10-15 minutes. The only drawback is with "frequent flyers". Glucogone causes the liver to release enzymes. If a person recieves Glocogone on a regular basis their liver might not have enough enzymes to reverse the hypoglycemia. So don't write off IO's yet.
Glkster19
02-24-2006, 15:36
We carry it. My experience with it is that it is slow to act. Only used it once and it took close to 30 mins before pt came around. If you're closer to hospitals than we are it may/may not be beneficial. Our nearest facility is 20 mins on a good day, generally closer to 30.
Most of the agencies here in South Florida carry it. My experience is that it works, real slow. Too slow for my taste personally. I have known some people, not me of course, to just give their D50 drop by drop between the bottom lip and gums and have it absorbed that way. I have been told, because I would never do that, that the blood sugar usually gets back to normal quicker than had they just given the Glucogon. But again I wouldn't know, I have never done that, not even 10 or 15 times.
;f
Right now our EMS System does not allow us since they have no way of checking our accu check machines for QA. I hear that it is about to change though.
Glkster19
02-25-2006, 17:26
Originally posted by hotpig
Right now our EMS System does not allow us since they have no way of checking our accu check machines for QA. I hear that it is about to change though.
Unless you have some archaeic glucometer, all manufacturers make test solution to make sure it reads within the parmeters set forth by the manuf.
Don't they?
EMS System wants something that they can check to make sure the test are done each day. The accu check machines at my other job are checked by the Lab at the end of the month. They just download all of the accu check readings into their computer. This accu check machine probably costs a lot more than the little palm sized ones that we hopefully will get to use soon.
TerraMedicX
02-26-2006, 12:07
One of the services I work for carries Glucagon and I've used it in the past. It does work really slowly, but if you have no other option (or your other options are not good) it works. The problem mentioned earlier about the liver is a little more complex, its not that Glucagon releases enzymes from the liver (Glucagon IS an enzyme, or more accurately a hormone). The problem is that Glucagon releases glucose from the liver that is stored as glycogen, but if a diabetic has been hypoglycemic for a long period of time, their body may have already used all of its glycogen stores, in which case Glucagon will do nothing. That said, I've never had this problem in my experience. Also, if you don't want to use the IO (my service has the sternal ones), you might want to consider using an EJ. Not very comfortable for medics who don't do a lot of them, but if done properly there's no more risk than a peripheral IV.
Nate.
As others have said, it's slow to act, won't work on malnourished/ long down time folks, plus, it is really expensive for something that just doesn't get used.
SLIDER in KY
02-27-2006, 09:24
Thanks for all the info, guys. I've learned something from this. Apparently Glucagon doesn't work as fast as what I thought. I was thinking 2-3 minutes, but I guess not. Thanks!!
hirundo82
02-27-2006, 15:49
Originally posted by SLIDER in KY
Thanks for all the info, guys. I've learned something from this. Apparently Glucagon doesn't work as fast as what I thought. I was thinking 2-3 minutes, but I guess not. Thanks!!
I was a medic on a volunteer squad in Virginia. We carried glucagon as a second line intervention if unable to get a line in hypoglycemia. The practice among our ALS providers was to try once for an IV, give the glucagon IM if unsuccessful, then try again for the line. The EMS council where I volunteered was actually starting to train EMT-B's in the use of glucagon, a policy which I support, around the time that I left EMS.
I have seen glucagon work faster than is usually quoted. Most of the time, there was not a significant change by the time we got to the hospital (our transport times were almost never longer than 20 minutes), but there were a few times that it was noticeable. I can think of a few patients where within 10 minutes the patients blood sugar went from about 20 to 50 with a noticeable improvement in mental status. This was one of the reasons we usually got it on board relatively early.
There are a number of patients in whom glucagon tends to not work. Since it depends on glycogen release from the liver, it will not work well in liver failure patients because they tend to not store glycogen. I do not imagine it would work well in malnourished patients--glycogen is the first store of energy that the body liberates, and is used up within the first 24 hours of a fast. I imagine it would not be of much use in profound hypoglycemia, like in OD of insulin of of oral hypoglycemics--there is only a limited amount of glycogen that can be liberated, usually about the equivalent of 2 amps of D50.
But anyhow, I am firmly convinced of the benefits of carrying glucagon. I've seen it work well a number of times in patients where we could not get IV access.
Also, glucagon is one of those rare drugs that is very safe--no real side effects to speak of. So even if the patient is not hypoglycemic, you are not going to hurt them by giving glucagon. Don't become to dependent on your glucometer--use your clinical judgement. However, even if you do end up giving glucagon incorrectly, it is not going to raise their blood sugar enoough to cause problems.
sgtwunder
03-01-2006, 23:38
We carry and use Glucagon where I work. I personally like it. It works well and is a nice option when you can't start a line or cant give D50
DScottHewitt
03-02-2006, 10:02
Originally posted by SLIDER in KY
OK...I'm trying to convince our management that we need to carry Glucagon on the ambulance. I mean, why not?? Isn't Glucagon the "go to" option if you have a patient with low blood sugar that you cannot get an IV on? From what I have seen with Glucagon, it's just an IM injection that will bring the blood sugar up for approx. 30-45 minutes. Right now, if we have a hypoglycemic patient and we cannot get an IV anywhere, we can use the tibial ADULT IO. The main drawback to that is when the patient comes around, that IO in their leg hurts them like crap!!! Anyway, I'm looking for opinions from you folks that carry Glucagon. Thanks!!
Heck, I can give glucogon, and I'm an EMT-B. ;f Some of our FDs are putting "BLS" boxes on their response vehicles. All the local protocol meds we would have to break an ALS box to give. Well, all three of them.....
Plus Epi-pens and such.
Cool thing is you can fit it all in a (lockable) glove compartment if you use a little box.....
Scott
;b
DScottHewitt
03-02-2006, 10:07
Originally posted by hirundo82
The EMS council where I volunteered was actually starting to train EMT-B's in the use of glucagon, a policy which I support, around the time that I left EMS.
Where were ya? I'm in CSEMS. Just took the full LP class this January. Only the County employees had to stick each other. So we all stayed to watch them practice!!!!
Scott
;b
hirundo82
03-03-2006, 00:26
Originally posted by DScottHewitt
Where were ya? I'm in CSEMS. Just took the full LP class this January. Only the County employees had to stick each other. So we all stayed to watch them practice!!!!
Scott
;b
Yeah, I was in CSEMS; volunteered with Harrisonburg Rescue for almost six years. I took EMT at 16, then went through Shock Trauma, Cardiac Tech, and then bridged to EMT-I when the council started that.
I went to JMU so volunteered the entire time during college and a while after, spending way too much time at the squad. Quit end of April 2005, moved to Houston to start medical school in July.
How is that working out with the expanded drug list? Are you cracking ST boxes to get at the glucagon and aspirin (they added that too, right? I was pushing for ASA for EMT-B's for years) or are you just carrying it locked up in the trucks? They are letting you pull up epi too instead of using epi pens, right?
Sorry about all the questions; they were literally doing the class for those at HRS the week before I quit, so I didn't get to ask many questions.
Westicle
03-04-2006, 22:09
Work as industrial paramedic and the way our medical director has it set up we give oral glucose after secondary, take blood sugar level if it is below 4 then we IM the glucagon.
plain and simple protocol....
Glkster19
03-05-2006, 05:16
Originally posted by Westicle
below 4
Meaning 4mg/dl? At that level they're just about dead. Or do you measure the levels differently being in Canada?
DScottHewitt
03-06-2006, 11:03
Originally posted by hirundo82
Yeah, I was in CSEMS; volunteered with Harrisonburg Rescue for almost six years. I took EMT at 16, then went through Shock Trauma, Cardiac Tech, and then bridged to EMT-I when the council started that.
I went to JMU so volunteered the entire time during college and a while after, spending way too much time at the squad. Quit end of April 2005, moved to Houston to start medical school in July.
How is that working out with the expanded drug list? Are you cracking ST boxes to get at the glucagon and aspirin (they added that too, right? I was pushing for ASA for EMT-B's for years) or are you just carrying it locked up in the trucks? They are letting you pull up epi too instead of using epi pens, right?
Sorry about all the questions; they were literally doing the class for those at HRS the week before I quit, so I didn't get to ask many questions.
Glucagon
Nitro
ASA
We use the Epi-pens. (I remember the discussion of pulling it up, though.) Heck, in TJEMS, Dr. Lindbeck would write us a script for Ani-kit after we took the class. Could buy our own to carry and use in the field.....
Scott
;b
DScottHewitt
03-06-2006, 11:04
Originally posted by Glkster19
Meaning 4mg/dl? At that level they're just about dead. Or do you measure the levels differently being in Canada?
Some different "per"?
4mg/cl=40mg/dl?!?!?
Scott
;b
hirundo82
03-06-2006, 21:24
Originally posted by Glkster19
Meaning 4mg/dl? At that level they're just about dead. Or do you measure the levels differently being in Canada?
Pretty sure that it is millimolar. If I'm doing the calculations right, 4mM glucose = 72mg/dL.
obxprnstar
03-23-2006, 23:33
Originally posted by hotpig
Right now our EMS System does not allow us since they have no way of checking our accu check machines for QA. I hear that it is about to change though. Kinda big brotherish, eh?
Our system, after we download our LP12 into our PCR program, managment can see EVERYTHING...
Going back to glucagon, after trying two or three times for an IV on a hypoglycemic, I fire in the glucagon. From admin to "full" conc averages about 20 min.
akulahawk
03-25-2006, 23:40
When I worked as a medic, we carried Glucagon for 2 reasons. The primary reason was for hypoglycemia, the other was for CCB? OD. (It's been a while...)
Navy HMC
03-26-2006, 04:54
We've carried Glucagon since we had stagecoaches for ambulances here in KS. This is a good second line drug for Hypoglycemia.
IRT the QA question about ensuring that the glucometer is within specs, most of the glucometers have an available test solution that can be used to ensue that the readings are accurate. I know for certain Accuchecks have them-we check the things every shift. The contained for the test strips has the values written on them. Good enough for our folks.
I also agree with the limiting it on the frequent fliers. It does indeed rely on the available glycogen in the liver for glucogenesis.
Keep it safe.
Yes. And I'm surprised to hear that you don't have it. No offense, but are you in a fairly rural EMS system? I'm a medic in a volunteer department in Richmond, and we've had it for at least 10 years. It's great, and you're exactly right in your thought process.
And before a tibial IO I'd go for the EJ. Works like a charm!
obxprnstar
03-26-2006, 16:01
Originally posted by mclark
And before a tibial IO I'd go for the EJ. Works like a charm! Plus the look on their face is priceless when they realize you put a needle in their neck.
akulahawk
03-26-2006, 17:53
Originally posted by obxprnstar
Plus the look on their face is priceless when they realize you put a needle in their neck.
Yeah, but the look on the new ER RN is to die for... it's usually somewhere between shocked, freaked, and outraged because THEIR facility considers EJ's to be central lines... and they can't do them!:supergrin:
SLIDER in KY
03-26-2006, 23:17
The main problem with EJ's is the fact that ALOT of our hypoglycemic pt's will get the Thiamine/D50 in the house. Once they come around, they don't want to be transported. I'm sure that when they realize that there is a needle in their neck, they'll freak!!
hirundo82
03-27-2006, 00:13
Originally posted by akulahawk
When I worked as a medic, we carried Glucagon for 2 reasons. The primary reason was for hypoglycemia, the other was for CCB? OD. (It's been a while...)
Glucagon can be used for beta blocker OD and calcium channel blocker OD, but it takes much more than would be used in hypoglycemia. The dose used is usually 5-10 mg IV; I am not aware of any agency that carries that much.
Glkster19
03-27-2006, 09:30
Originally posted by akulahawk
Yeah, but the look on the new ER RN is to die for...:supergrin:
Amen. Used to work at this facility part time and they'd call the medic to assist with arrests. Called me for an 80'ish y/o guy circling the drain. Nursing supervisor had blown all 2 of his peripheral veins. Took a look, saw no veins and asked respiratory to scoot around to the other side of the head. Slipped in an EJ on this guy and the RN's jaws hit the floor. I'm going "What, his BP is 40/syst and you (the supervisor) blew his only peripheral veins you could see."
We've carried Glucagon for many years but (knock wood) I've never had to use it, as others have said, i'll go for the EJ if all else fails. Typically for us though these pt.s are non transports, as long as they come around fully A & O, have a BS greater than 70, demonstrate that they understand that they need to eat and manage their condition and have a responsible family member or friend on scene, we dc the iv, contact med control, have them sign a non transport form (not a refusal) and finish the report back in quarters.
I do sort of miss the look on the nurses faces though when they see the EJ, although the same dinosaurs still give us grief about not backboarding all MVA's.
FirNaTine
05-22-2006, 10:27
Glucagon for beta blocker overdose gets 1 mg IV every 5-10mins max of 3.... In MD at least. We use calcium chloride for calcium channel blocker overdose.
lexmedic157
05-22-2006, 10:39
I've started an EJ for a hypoglycemic patient, and yes I do carry Glucagon (wait time of 10 minutes). And usually once I've give the D50 I'll flush it and cap it (removing the tubing). I've seen them freak, and flail while coming around but at least they won't get tangled up and pull the line. Once they come to, they seem to be pretty understanding why you stuck a needle in their neck, they know they didn't veins to begin with. The weirdest is to start one on a conscious patient (in my case it was a doctor) as she really didn't have anything short of a veinous cutdown.
I take back my poo pooing of Glucagon. Used it yesterday and it worked in about 9 min. After the 180 kg. guy was normoglycemic (form 60 to 115) and stopped trying to kill me, and I could assess the 2 lines that I started and the danged things were both good! I could have used D50, but I couldn't be sure that either line was good.
D50 is quite necrotic! One EMS system had a lot of medics doing direct venipuncture rather then start a line!
I take offense to medics that think that just cause they can perform EJ's in their scope of practice vs the ED RN being limited by facility limitations. I know some ED RN's that know the EMS protocols better then the medics, and they are not afraid to make notes to medical directors. Some facilities allow RN's place lines as long as the tip of the catheter does not lie in the SVC. So, it is all a wash!
Originally posted by D25
I take back my poo pooing of Glucagon. Used it yesterday and it worked in about 9 min. After the 180 kg. guy was normoglycemic (form 60 to 115) and stopped trying to kill me, and I could assess the 2 lines that I started and the danged things were both good! I could have used D50, but I couldn't be sure that either line was good.
Originally posted by P0832177
D50 is quite necrotic! One EMS system had a lot of medics doing direct venipuncture rather then start a line!
I take offense to medics that think that just cause they can perform EJ's in their scope of practice vs the ED RN being limited by facility limitations. I know some ED RN's that know the EMS protocols better then the medics, and they are not afraid to make notes to medical directors. Some facilities allow RN's place lines as long as the tip of the catheter does not lie in the SVC. So, it is all a wash!
Huh?
Originally posted by D25
I take back my poo pooing of Glucagon. Used it yesterday and it worked in about 9 min. After the 180 kg. guy was normoglycemic (form 60 to 115) and stopped trying to kill me, and I could assess the 2 lines that I started and the danged things were both good! I could have used D50, but I couldn't be sure that either line was good.
LMAO, They can be mean after glucagon. Anyone here able to explain that one. I have always wondered why.
And good call on the IV's, D50 does real damage when you screw up the IV. Compounded with the circulation problems of the pt that never control their NIDDM, Next thing you know they lost the hand or something that all you did is speed up the process by a year because your vein blew. Then you are in court with a lawsuit......Sorry sore point with me.
Originally posted by P0832177
D50 is quite necrotic! One EMS system had a lot of medics doing direct venipuncture rather then start a line!
I take offense to medics that think that just cause they can perform EJ's in their scope of practice vs the ED RN being limited by facility limitations. I know some ED RN's that know the EMS protocols better then the medics, and they are not afraid to make notes to medical directors. Some facilities allow RN's place lines as long as the tip of the catheter does not lie in the SVC. So, it is all a wash!
WTF? Where did this come from?
I take offense to nurses that second guess medics Skills and Standing orders. Take it up with the Medical Director. Next.
Glkster19
10-22-2006, 19:17
Originally posted by P0832177
D50 is quite necrotic! One EMS system had a lot of medics doing direct venipuncture rather then start a line!
I take offense to medics that think that just cause they can perform EJ's in their scope of practice vs the ED RN being limited by facility limitations. I know some ED RN's that know the EMS protocols better then the medics, and they are not afraid to make notes to medical directors. Some facilities allow RN's place lines as long as the tip of the catheter does not lie in the SVC. So, it is all a wash!
I've worked with RN's that I've watched mainline drugs also.
And I know some medics that know the RN's job in the ER better than they do.
Guess it's a wash. ;)
So it is slow. So what. If you cant get a line then it is a good drug. I have very short transport times where I work. But if I cant get a line then more than likely the hospital wont be able to get one quickly. So if glucagon takes 20 min and I have a 10 min transport time then the pt is 10 min ahead of the ball when I give it. That being said I have never given it in over 10 years. I guess I find a vein or some how it always works out. Me or my partner can some how get a vein or oral glucose on board. It is not always very “nice” but the pt with a glucose in the 50-20 range can some times be “harassed” into using oral glucose. I assume you guys understand the need for having the proper gag/ swallowing reflex when you do this. But a good sternum rub and some verbal encouragement can often persuade people to swallow oral glucose.
Just a note on EJs. I hate to admit it but sometimes they can be hard to get. I have had several that are right in your face, but when you stick them it just doesn’t happen. As you know you don’t always get a good flash back which is OK with them. But then you go to flush them and it just isn’t happening. It is just one of those things that reminds you that nothing is 100%.
I just read over some of the page and feel the need to comment on the ER nurse vs. medic thing brewing. There are idiots in both fields. Some nurses get mad that P-EMTs can do some things that they cant. But there are also many nurses that are better educated and extremely capable in areas that most EMS personnel will never touch. It is also the poor pt care of many of our coworkers that causes the nurses to question some of what we do. I am friends with many ER doctors and nurses. If you talk honestly with them they will tell you things that our pears do that will shock you. This simply perpetuates the poor image of EMS. On the same note they are well aware of how bad many of their fellow RNs and MDs are. The point of this is that there are idiots all over. Work to the best of your ability and remember that the ER staff is on your team. If you show them that you are competent then you will get the respect you deserve. If you cant show them that you are competent then you still get the respect you deserve, none.;)
Really guys, there are dumb asses all over. The ER staff knows that some of their staff is sharp and some is worthless just like we know it about our co-workers.
Rinconjoe
01-05-2007, 00:11
Dana how true you are right on the spot!!
Well I can tell you with much certainly that most the major ems systems in NC carry it. As a back up, work times will vary from person to person. The average I think is 14-25 minutes at least the survey we did a couple yrs ago for state came back to that time frame. Personally I used it one time, 12minutes later we were ok of course by then we was enroot to hospital. It a good back up source we have protocols for EJ, we have to try 4 peripheral attempts first and then only under certain situations. Can we do the ej?
I hate to admit it but I don’t know our exact protocols for a EJ either. I know that some times between my partner and I it looks like we have stuck some one a half dozen times looking for a vein in the arms. Other times I look and you just know there isn’t crap and I will just stick a EJ. You just have to work with what you have.
Glucagon can also be given IN with a quicker absorption rate than IM. We use it with a MAD (mucosal atomization device) with good success.
And speaking of EJ and IO's.... we have recently changed from the FAST 1 sternal IO to the EZ-IO drill. Now only our SWAT medics are carrying the FAST 1.
FirNaTine
01-05-2007, 21:30
For me EJ is just another peripheral IV. What our medical directors prefer is the following progression of access. Arm vein, lower extremity, EJ, then IO. Generally I don't go through the whole list before I am en route or at the hospital, but if I have a long time or absolutely need it that is how we handle it.
DepChief
01-06-2007, 23:53
Originally posted by mclark
And before a tibial IO I'd go for the EJ. Works like a charm!
Yes it does!
Fiery Red XIII
01-08-2007, 00:35
We carry it, We can sign pt's w/D50 per a doc's order via radio, but if they get glucagon, they get a trip to the hospital. Glucagon needs the enzymes mentioned before, so there is a chance it may not work.
Red
uselessmedic
01-08-2007, 10:55
We carry Glucagon and use it often, some of our diabetics have central lines and our protocols will not let us access them. Some of our pts don't have an ej to stick.
medic8350
01-18-2007, 01:44
My EMS system carries Glucagon. I have found it to react in about 10 minutes and be very useful when you can't establish an IV. It is well worth having as a backup to D)
john19718
02-14-2007, 16:38
we have a new handy IO drill called the ez IO. It has a magnetic tip..the needles come in individually sealed cups. Tear the lid off take your magnetic tip ...stick in cup..the needle attatches to the drill...find your land mark...insert needle till you feel resistance off tibial tuberocity..depress switch..needles drills in in about 1/2 seconds and stops. If pts awake..after you aspirate to confirm placement flush with 2% lidocaine to reduce discomfort when that fluids starts to infuse....awesome piece if you dont already have one. By the way nobody mentioned glucagon for beta blocker OD?
john19718
02-14-2007, 16:41
OOPS...didnt read page 2 before the beta blocker od thing..sorry.
john19718
02-14-2007, 16:42
glucagons alright..i have seen it work fast and slow...i would rather have than not.
indigent
02-18-2007, 18:36
We carry it on our medics. I haven't ever used it.
Well, I'm jumping in and adding my own $0.02 here
I'm sidestepping whatever debate about nurse vs. medic... its not worth my time.
I'm a paramedic, and I'm also a daughter of a type I diabetic.
One thing I have not seen mentioned, is the mechanism of action of glucagon and its downfalls. No bright lightbulbs turning on and I'm not teaching anyone anything they don't know, but it acts on the glycogen stored in the liver. In some instances when a diabetic has been pretty out-of-whack, their glycogen stores are depleted, and the glucagon is essentially useless.
When I can't get immediate venous access, IM the glucagon, and then rush like all civilized hell to the hospital while attempting to access circulatory system... Sternal IO is never a bad thing, and I'm not above inserting a line in the penile veins or an EJ... I'd rather have overkill and manage to D50 him 5 minutes before the glucagon would kick in, than to have my fingers crossed on the glucagon working and **** hitting the fan...
-AuroraRose
Greenglock21
04-03-2007, 09:26
No discussion about the "other" site to administer D50? You know, where the sun doesn't shine. It works when other methods fail. Not pleasant, but effective.
FirNaTine
04-03-2007, 22:42
Originally posted by Greenglock21
No discussion about the "other" site to administer D50? You know, where the sun doesn't shine. It works when other methods fail. Not pleasant, but effective.
'Round here we only give diazepam that way, but I see how D50 could work that way too.
Originally posted by Greenglock21
No discussion about the "other" site to administer D50? You know, where the sun doesn't shine. It works when other methods fail. Not pleasant, but effective.
Ah yes, this reminds me of a story which includes a hypoglycemic, a fire chief, and a bag of candy corns.....:shocked:
We carry glucagon. It's a good alternative when IV access cannot be obtained on a hypoglycemic patient. It has a long action time and it also only works if liver glycogen stores have not already been depleted, so it's not as good as D50, but it usually works. Most hypoglycemics we deal with are diabetics who take insulin and then don't eat on schedule. Insulin causes glucose to be taken up from the blood, but is also causes activation of protein phosphatase I which stimulates glycogen synthesis (the body thinks it has a lot of sugar to work with so it stores it up) and inhibits glycogen breakdown (again body things is has a lot of sure, so why bother breaking down its emergency sotres?). So, most of the diabetic hypoglycemics we see in EMS rarely have depleted glycogen stores so glucagon, which binds to receptors and causes release of glycogen stores by activating glycogen phosphorylase, are very responsive to glucagon. That being said, D50 is definitely the gold standard for treatment of hypoglycemics, but glucagon is a GREAT alternative in patient's where IV access cannot be obtained.
I'll leave the nurse v. paramedic and the debate over IV sites for others. I will say this though, I've used glucagon when I couldn't get an IV, I'm not concky enough to sit here and say I never miss, but there are some patients (the 80 yo diabetic who's been on dialysis for the last 10 years, has PVD, and is a train wreck) who lack veins of any kind. In patients like these I'm glad I have glucagon on my truck.
DScottHewitt
05-06-2007, 13:10
Originally posted by hirundo82
Yeah, I was in CSEMS; volunteered with Harrisonburg Rescue for almost six years. I took EMT at 16, then went through Shock Trauma, Cardiac Tech, and then bridged to EMT-I when the council started that.
I went to JMU so volunteered the entire time during college and a while after, spending way too much time at the squad. Quit end of April 2005, moved to Houston to start medical school in July.
How is that working out with the expanded drug list? Are you cracking ST boxes to get at the glucagon and aspirin (they added that too, right? I was pushing for ASA for EMT-B's for years) or are you just carrying it locked up in the trucks? They are letting you pull up epi too instead of using epi pens, right?
Sorry about all the questions; they were literally doing the class for those at HRS the week before I quit, so I didn't get to ask many questions.
Glucagon and ASA is in the ST box. And we are ENCOURAGED to break the ST box, NOT the CT box. (Narcs, and the patient pays more)......
Scott
DScottHewitt
05-06-2007, 13:14
IF you have a progressive OMD when you call the hospital, there are places besides the cheek that have a mucosa.....
If you don't have Glucagon and you do have Oral Glucose, it is also able to be absorbed though the mucosa of the rectal lining.....
And probably would work quicker.....
Scott
billygoatpete
05-09-2007, 16:52
Anybody seen Glucagon used in a case of esophageal spasm???
Saw it in the ED onetime......it kicked ass!!
I have carried Glucagon with almost every service I have worked with and only used it 1 time...(400+ pt) and it worked fine.
BTW you folks brought me out of lurker hell with this subject...so kudo's to you!:thumbsup:
Parmaboy
05-22-2007, 20:06
I see lots of positive responses about glucagon. I love having it on my truck. There are some patients that we can just not find IV access on. As said earlier, glucagon doesnt always work if their stores are gone, but sometimes it does work on the patient. You best try glucagon on me, and an EJ, and a central line on me before you give me an IO lol. I have never had a patient so bad that they needed an IO. Sure you might have to bag a patient with your BVM till you get to the hospital, but that usually keeps them good till the hospital can get an IV.
You gotta have Glucagon. If you've ever fought a violent diabetic, you know what I mean. You're not safely getting an IV on the guy.
IM Glucagon's pretty much a "no - brainer."
:drillsgt:
DScottHewitt
05-24-2007, 05:38
Originally posted by Rora
I'm not above inserting a line in the penile veins
-AuroraRose
OUCH!!!!! BACK OFF!!!!!
Scott
Originally posted by DScottHewitt
OUCH!!!!! BACK OFF!!!!!
Scott
LOL better never get injured anywhere in Europe then. I learned about that from a French Paramedic he said they do it all the time.
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