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

2. 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.

3. 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

4. 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

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

6. 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

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

8. 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

9. 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

10. 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?

11. 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.

12. 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

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

14. 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

15. Device & Accessories Glucometer Test Strips Lancet

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

17. Glucose Measuring Steps, cont. Step #4 Confirm Codes

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

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

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

21. Step #8 Document Results

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

23. Results Normal blood glucose range is typically 80-120 (fasting) Treat the patient, not the numbers

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

25. 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

26. 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

27. 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)

28. Questions? Ask your training officer Consult your service Medical Director Call your Regional office or visit their website Contact OEMS at (617)753-7300 or visit http://www.mass.gov/dph/oems/oems.htm http://www.mass.gov/dph/oems/oems.htm