WELCOME BACK

Before we start….Updates to GFR BG Kits New Med Pouches PPE Bags (Gowns, Shoe Covers, N95 Masks) Vomit Bags If you are looking to start the clearing process, please email esquad and see me about taking the medical test. Before we start….Updates to GFR

Summary Sheets will be sent out 2 Weeks from now Elections

Scheduling

Glucometry

Vital Signs- Blood Glucose Normal Range for Blood Glucose? 80-120 mg/dL Considerations- patient’s baseline Vital Signs- Blood Glucose

Hypoglycemia

Oral Glucose Dosage: 1 tube  15-24 grams (adult and pediatric) Route: Oral/Buccal Only if the patient can maintain their own airway and swallow on command, have the patient suck on the tube of oral glucose. You can also administer the oral glucose to the patient between their tongue and cheek using a popsicle stick. When do we give oral glucose? When the patient is symptomatic and the BG is less than 60 mg/dL Be aware that oral glucose is short lasting (~30 minutes) so be aware of possible crashes in the future Oral Glucose

ALS and Hypoglycemia Necessary if… The patient cannot maintain their own airway or swallow on command (no oral glucose)/ unconscious patients The patient does not improve with oral glucose (altered mental status persists) ALS and Hypoglycemia

Sign offs and Hypoglycemia PER PROTOCOL: If the patient wishes to refuse transportation to a hospital and you have administered any medications, including oral glucose, regional procedure requires you to contact medical control prior to leaving the patient or completing the refusal of care, particularly if you know or suspect the patient may be on oral glycemic medications, or for any other worrisome concerns. Patient should be instructed to eat a meal if they are refusing transport because simple sugars are quickly metabolized (One of the only times we should be encouraging patients to eat on calls). Even if the patient is a known diabetic, they should be encouraged to go to the hospital  something could be off with their medications, there could be an underlying medical issue, etc. (we don’t know the reason why the incident occurred) The patient can not be signed off if they have an altered mental status that does not improve Sign offs and Hypoglycemia

Hyperglycemia

Diabetic Ketoacidosis Develops when the body cannot produce enough insulin The body begins to break down fats Acids build up in the bloodstream  Ketones This can lead to diabetic ketoacidosis if not treated Symptoms: fruity scented breath, excessive thirst, nausea and vomiting, weakness/fatigue, shortness of breath, altered mental status This can be triggered by an illness, issues with insulin therapy, trauma, heart attack, drug issues (cocaine), certain medications such as corticosteroids. You are at a high risk for ketoacidosis if you have type 1 diabetes. Diabetic Ketoacidosis

Our Interventions ABCs Appropriate Oxygen Therapy Make the Patient Comfortable NO ORAL GLUCOSE Our Interventions

ALS and Hyperglycemia Necessary if… The patient has an altered mental status Seizure Loss of Consciousness ALS and Hyperglycemia

Signing off and Hyperglycemia The patient can NOT sign off if they have an altered mental status Even if the patient is a known diabetic, they should be encouraged to go to the hospital  something could be off with their medications, there could be an underlying medical issue, etc. (we don’t know the reason why the incident occurred) BLS EMTs can not do anything in the field to improve hyperglycemia. ALS can provide IV fluids to dilute blood glucose concentrations, but this is not a permanent solution. Signing off and Hyperglycemia

Other Reasons to Take a BG Per Protocols For Both Pediatric and Adult Patients Agitated Patient/Excited Delirium Altered Mental Status Opioid/Narcotic Overdose Organophosphate Exposure Overdose/Toxic Exposure Seizure Suspected Shock Suspected Stroke Loss of Consciousness Lightheadedness/dizziness Cardiac Arrest (not a first priority) Other Reasons to Take a BG Per Protocols **Glucometry is a clue that can help us learn more about patients in the field BUT we do not need to be unnecessarily taking a BG on every single patient** - Dr. Farney brought this topic up

GFR’s Blood Glucose Kit GFR’S BG kit looks IDENTICAL to BG kits from other agencies. Double check that you put ours back in the bag after each call- Let us know right away if there is a mix up BG kit will be kept in the medicine pouch on the AEDs

Parts of the BG Kit Glucometer Lancet Test Strips Alcohol Wipes & Band-Aids

Glucometer Settings Do not press any buttons on the glucometer Once you push the test strip into the glucometer, it will turn on and a flashing drop of blood will appear indicating that the test strip is ready for blood Once enough blood fills up the strip, the BG reading will appear on the screen Take the test strip out and the glucometer will automatically shut off Glucometer Settings

Best Places to Prick the Finger Ask the patient first- don’t pick a finger that they regularly use It will feel like a small pinch – don’t lie to the patient if they are nervous/ask if it will hurt. The side of the finger is best (fingertips are sometimes rougher and have thicker skin) Alternative places (less than ideal)- palm of the hand, earlobe, toe Best Places to Prick the Finger

BG Steps Put on Gloves (BSI, Scene Safety) and Open the Glucometry Kit Wipe the patient’s finger with an alcohol wipe and let it dry (don’t let it touch anything between wiping and pricking) Pull out a test strip and insert it into the glucometer (not all the way or the glucometer will time out) Pull out a lancet, twist the end off, press firmly onto finger, and push the button on the end to prick the finger Squeeze finger gently to form a blood drop if necessary Push the test strip all the way into the glucometer. When the blood drop is flashing, it is ready to collect the blood. Scoop up the blood drop from the finger with the test strip inserted into the glucometer Wait and then read the glucometer Engage the Band-Aid Place lancet into sharps shuttle (place in sharps container when back in the squad room) Collect all other garbage and fold it up in your gloves when you take them off . If lots of blood- consider a biohazard bag. BG Steps

Glucometry Video

Practice with Glucometers You MUST practice with the glucometer before leaving today or you will not be able to use it on calls Please let me know if you have any questions Practice with Glucometers