Blood Glucose Measuring Devices in the Pre-hospital Setting Created by Boston EMS Edited by Central Mass EMS Corp. 2005

NOTE Information within this presentation should be tailored to the Blood Glucose Measuring Device used by the service and should include a review of the manufacturer’s instructions.

Purpose To prepare currently certified EMT-Basics and Intermediates to utilize a Blood Glucose Measuring Device when operating under a licensed ambulance service and in accordance with A/R 5-520: “Requirements for Basic and Intermediate EMT Use of Glucose Monitoring” and the Massachusetts EMS Pre-Hospital Treatment Protocols

Objectives State when blood glucose measuring is indicated Describe the importance of a full patient assessment in conjunction with test results Demonstrate accurate calibration Demonstrate appropriate procedures for measuring blood glucose Explain proper maintenance, care & storage

Indications for BG Measuring Signs and Symptoms consistent with Acute Stroke Altered Mental Status

Acute Stroke Refer to the Acute Stroke Protocol Utilize the Boston Operation Stroke Scale (BOSS) Transport patient in accordance with the Stroke Point of Entry Plan

Altered Mental Status (Common Causes) AEIOU-TIPS AlcoholismTrauma EpilepsyInfection InsulinPsychiatric OverdoseStroke Underdose

Pre-Hospital Care (FOLLOW THE PROTOCOLS) 1. Scene Safety/Survey 2. Perform initial assessment May require airway control, definitely oxygen 3. Ensure cervical spine immobilization as indicated 4. Activate ALS if necessary & available

Pre-Hospital Care 5.Perform focused history and physical exam (a). SAMPLE history 1.Signs/Symptoms (when did they start?; how long did they last?) 2.Allergies 3.Medications (When last taken?) 4.Prior Medical History (diabetes?, seizure disorder?) 5.Last oral intake (When did patient last eat)? 6.Events leading to illness/injury

Pre-Hospital Care 5.Focused history & physical exam, cont. (b). Take base line vital signs (c). Determine blood glucose level (d). Evidence of hypothermia/hyperthermia? (e). Can the patient swallow normally?

Pre-Hospital Care Do not administer anything orally if the patient does not have a reasonable level of consciousness and normal gag reflex. Contact medical control prior to administering glucose to patients suspected of Acute Stroke.

Pre-Hospital Care 6.If patient is unconscious or seizing, transport on left side. 7.If patient’s BP drops below 100 systolic; treat for shock 8.Monitor VS every 5 minutes if unstable; every 15 minutes if stable. 9.Notify receiving hospital as soon as possible

Glucose Measuring Devices Used to Check Blood Sugar Levels Many different types and models

Procedures Careful attention to BSI & safety Select Finger Massage blood into distal end Clean finger with alcohol & allow to dry Use lancet or Auto-lancet device Wipe first drop of blood off Apply drop of blood onto test strip and follow individual glucometer instructions Dispose of sharps and soiled supplies

Device & Accessories Glucometer Test Strips Lancet

Glucose Measuring Steps Step #1Step #2 Locate Glucometer Open Up Case Step #3 Turn Power On

Glucose Measuring Steps, cont. Step #4 Confirm Codes

Glucose Measuring Steps, cont. Step #5 Insert Test Strip

Glucose Measuring Steps, cont. Step #6 Obtain Blood Sample

Apply Drop of Blood If inadequate up to 15 secs., add additional blood Step #7 Glucose Measuring Steps, cont.

Step #8 Document Results

Some glucometers turn on automatically. Know the features of the glucometer your service uses. Device Variations

Results Normal blood glucose range is typically (fasting) Treat the patient, not the numbers

Maintenance & Calibration Techniques Frequency Batteries Care & Storage –Device –test strips Documentation

BSI & Cleansing Issues Dispose of all sharps and blood contaminated materials properly Cleanse only outside of monitor with general disinfectant (manufacturer approved) Do not immerse/ inject/spray any liquid into device

Summary Indications for blood glucose measuring Importance of a full patient assessment in conjunction with test results Accurate calibration procedures Appropriate blood glucose measuring procedures Proper maintenance, care & storage procedures

Practice Session Students should complete a calibration procedure and test sequence under the direct supervision of an instructor Students may practice obtaining a blood sample on each other or a thin skinned fruit (e.g., apple)

Questions? Ask your training officer Consult your service Medical Director Call your Regional office or visit their website Contact OEMS at (617) or visit