Hypo or Hyperglycemia - Revision history

Treloars: /* 5.10 HYPO / HYPERGLYCEMIA */

2020-04-24T00:23:03Z

5.10 HYPO / HYPERGLYCEMIA

← Older revision		Revision as of 00:23, 24 April 2020
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	** Administer [[Dextrose_50%25\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.		** Administer [[Dextrose_50%25\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
	*** If [[Dextrose_50%25\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;		*** If [[Dextrose_50%25\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
	**** Administer [[Dextrose_10%25\|~~Dextrose~~ 10%]] (D10) mixed in a 250 ml bag of solution IV Bolus.		**** Administer [[Dextrose_10%25\|DEXTROSE 10%]] (D10) mixed in a 250 ml bag of solution IV Bolus.
	***** The entire contents of this bag equal 25 gms of glucose.		***** The entire contents of this bag equal 25 gms of glucose.
	***** Administer the entire bag or as much as possible while transporting.		***** Administer the entire bag or as much as possible while transporting.

Treloars at 00:22, 24 April 2020

2020-04-24T00:22:35Z

Treloars at 01:51, 31 January 2018

2018-01-31T01:51:49Z

← Older revision		Revision as of 01:51, 31 January 2018
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	* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;		* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;

	[[Category:Medical\|~~5.10~~]]		[[Category:Medical\|0510]]

Treloars at 01:48, 31 January 2018

2018-01-31T01:48:43Z

← Older revision		Revision as of 01:48, 31 January 2018
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	* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;		* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;

	[[Category:Medical]]		[[Category:Medical\|5.10]]

Treloars at 01:45, 31 January 2018

2018-01-31T01:45:05Z

← Older revision		Revision as of 01:45, 31 January 2018
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	:'''AND'''		:'''AND'''
	* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;		* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;

			[[Category:Medical]]

Treloars: /* 5.10 HYPO / HYPERGLYCEMIA */

2016-04-25T19:00:37Z

5.10 HYPO / HYPERGLYCEMIA

← Older revision		Revision as of 19:00, 25 April 2016
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	* If LIMITED or NO response after initial [[Antidiabetics\|DEXTROSE 50%]] only:		* If LIMITED or NO response after initial [[Antidiabetics\|DEXTROSE 50%]] only:
	** [[Antidiabetics\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.		** [[Antidiabetics\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.
	** For pediatric administration refer to the Handtevy System
	* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.		* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.

Treloars: /* 5.10 HYPO / HYPERGLYCEMIA */

2016-04-25T18:57:56Z

5.10 HYPO / HYPERGLYCEMIA

← Older revision		Revision as of 18:57, 25 April 2016
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	* If patient awake with an intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.		* If patient awake with an intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.
	* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):		* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):
			** For pediatric administration refer to Handtevy System.
	** Administer [[Antidiabetics\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.		** Administer [[Antidiabetics\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
	*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;		*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
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	***** Administer the entire bag or as much as possible while transporting.		***** Administer the entire bag or as much as possible while transporting.
	***** If the patient responds quickly to D10, follow treat and release guidelines below.		***** If the patient responds quickly to D10, follow treat and release guidelines below.
	** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] if available and refer to Broselow® Tape.
	*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available then administer [[Antidiabetics\|Dextrose 10%]]% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).
	** If unable to obtain IV access, [[Antidiabetics\|GLUCAGON]] 1 mg IM or IN.		** If unable to obtain IV access, [[Antidiabetics\|GLUCAGON]] 1 mg IM or IN.
	*** If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN.
	*** Call for dosage order in pediatrics < 10 kg (22lb).
	*** [[Antidiabetics\|GLUCAGON]] onset of action in 8-10 minutes.		*** [[Antidiabetics\|GLUCAGON]] onset of action in 8-10 minutes.
	* If LIMITED or NO response after initial [[Antidiabetics\|DEXTROSE 50%]] only:		* If LIMITED or NO response after initial [[Antidiabetics\|DEXTROSE 50%]] only:
	** [[Antidiabetics\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.		** [[Antidiabetics\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.
	** For pediatric administration ~~dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] if available and~~ refer to ~~Broselow® Tape.~~		** For pediatric administration refer to the Handtevy System
	* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.		* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.

Treloars: /* Section 5 -MEDICAL */

2014-08-07T01:18:36Z

Section 5 -MEDICAL

← Older revision		Revision as of 01:18, 7 August 2014
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	'''BLOOD GLUCOSE LEVEL > ~~250~~ WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:'''		'''BLOOD GLUCOSE LEVEL > 400 WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:'''
	* Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.		* Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.
			'''''NOTE: Prehospital treatment of HYPERGLYCEMIA is not indicated when only an elevated blood glucose level is present without any other signs and symptoms.'''''

Treloars: /* 5.10 HYPO / HYPERGLYCEMIA */

2013-05-22T14:51:42Z

5.10 HYPO / HYPERGLYCEMIA

← Older revision		Revision as of 14:51, 22 May 2013
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	***** The entire contents of this bag equal 25 gms of glucose.		***** The entire contents of this bag equal 25 gms of glucose.
	***** Administer the entire bag or as much as possible while transporting.		***** Administer the entire bag or as much as possible while transporting.
	***** ~~Do not wait on scene for a response. Begin transport immediately~~.		***** If the patient responds quickly to D10, follow treat and release guidelines below.
	** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] if available and refer to Broselow® Tape.		** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] if available and refer to Broselow® Tape.
	*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available then administer [[Antidiabetics\|Dextrose 10%]]% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).		*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available then administer [[Antidiabetics\|Dextrose 10%]]% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).
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	:'''AND'''		:'''AND'''
	* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;		* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;
	~~:'''AND'''~~
	* The patient was not placed on a D10 glucose infusion. ALL PATIENTS being treated with a D10 glucose infusion SHALL be transported to the hospital.

Treloars: /* Section 5 -MEDICAL */

2013-03-18T13:46:43Z

Section 5 -MEDICAL

← Older revision		Revision as of 13:46, 18 March 2013
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	===5.10 HYPO / HYPERGLYCEMIA===		===5.10 HYPO / HYPERGLYCEMIA===

	[[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01): ~~Provide [[Medical Gases\|~~OXYGEN]] or assist ventilations as appropriate for patient condition.		[[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE (2.01)]]: Open the airway, provide OXYGEN or assist ventilations as appropriate for patient condition.
	* Obtain history of time of patient's last medication dosage and patient's last meal.		* Obtain history of time of patient's last medication dosage and patient's last meal.
	* Obtain and record blood sugar level.		* Obtain and record blood sugar level.
	* Draw blood tubes, if available.


	~~====~~BLOOD ~~SUGAR~~ < 100 OR SIGNS ~~AND~~ SYMPTOMS OF INSULIN SHOCK / HYPOGLYCEMIA:~~====~~		'''BLOOD GLUCOSE LEVEL < 100 OR SIGNS & SYMPTOMS OF INSULIN SHOCK / HYPOGLYCEMIA:'''
	* If patient awake with intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.		* If patient awake with an intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.
	* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):		* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):
	**[[Antidiabetics\|DEXTROSE 50%]] ~~25 gm~~ IVP for adults		** Administer [[Antidiabetics\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
	** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] and refer to ~~Broselow~~ Tape.		*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
	** If unable to obtain IV access, [[Antidiabetics\|GLUCAGON]] 1 mg IM or IN. / If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN. Call for dosage order in pediatrics < 10 kg (22lb). [[Antidiabetics\|GLUCAGON]] onset in 8-10 minutes.		**** Administer [[Antidiabetics\|Dextrose 10%]] (D10) mixed in a 250 ml bag of solution IV Bolus.
	* If LIMITED or NO response after initial [[Antidiabetics\|DEXTROSE 50%]]:		***** The entire contents of this bag equal 25 gms of glucose.
	**~~Repeat~~ [[Antidiabetics\|DEXTROSE 50%]] 12.5 gm IVP for adults.		***** Administer the entire bag or as much as possible while transporting.
	** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] and refer to		***** Do not wait on scene for a response. Begin transport immediately.
	~~Broselow~~ Tape.		** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] if available and refer to Broselow® Tape.
	* If the patient is a ~~Trauma~~ patient or a ~~Stroke~~ is suspected: Consider administration of ½ dose of D50 following ~~Blood Sugar~~ monitoring.		*** If [[Antidiabetics\|DEXTROSE 50%]] (25gm) is not available then administer [[Antidiabetics\|Dextrose 10%]]% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).
			** If unable to obtain IV access, [[Antidiabetics\|GLUCAGON]] 1 mg IM or IN.
			*** If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN.
			*** Call for dosage order in pediatrics < 10 kg (22lb).
			*** [[Antidiabetics\|GLUCAGON]] onset of action in 8-10 minutes.
			* If LIMITED or NO response after initial [[Antidiabetics\|DEXTROSE 50%]] only:
			** [[Antidiabetics\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.
			** For pediatric administration dilute [[Antidiabetics\|DEXTROSE 50%]] to [[Antidiabetics\|DEXTROSE 25%]] if available and refer to Broselow® Tape.
			* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.


	~~====~~BLOOD ~~SUGAR~~ LEVEL > 250 WITH SIGNS ~~AND~~ SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:~~====~~		'''BLOOD GLUCOSE LEVEL > 250 WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:'''
	* Administer a fluid bolus of 200 - 300 ml. Continue IV infusion KVO.		* Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.


	~~====~~PATIENT ~~REFUSALS====~~		'''PATIENT TREATED AND RELEASED'''
	If a patient has been ~~treated~~ for hypoglycemia ~~or seizures~~, transport is not required if:		If a patient has a KNOWN history of Diabetes or Hypoglycemia that has been evaluated by a physician and EMS personnel provided treatment for the hypoglycemia, transport is not required if:
	* The ~~patient~~ is stable		* The patient’s blood glucose is stable;
	AND		:'''AND'''
	* The patient has a competent adult that will remain with the patient for hours		* The patient has a competent adult that will remain with the patient for hours;
	AND		:'''AND'''
	* The patient understands and agrees to eat, re-check blood ~~sugar~~ and call back if necessary.		* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;
			:'''AND'''
	~~[[Category:Medical]]~~		* The patient was not placed on a D10 glucose infusion. ALL PATIENTS being treated with a D10 glucose infusion SHALL be transported to the hospital.

← Older revision		Revision as of 00:22, 24 April 2020
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	* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):		* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):
	** For pediatric administration refer to Handtevy System.		** For pediatric administration refer to Handtevy System.
	** Administer [[~~Antidiabetics~~\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.		** Administer [[Dextrose_50%25\|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
	*** If [[~~Antidiabetics~~\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;		*** If [[Dextrose_50%25\|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
	**** Administer [[~~Antidiabetics~~\|Dextrose 10%]] (D10) mixed in a 250 ml bag of solution IV Bolus.		**** Administer [[Dextrose_10%25\|Dextrose 10%]] (D10) mixed in a 250 ml bag of solution IV Bolus.
	***** The entire contents of this bag equal 25 gms of glucose.		***** The entire contents of this bag equal 25 gms of glucose.
	***** Administer the entire bag or as much as possible while transporting.		***** Administer the entire bag or as much as possible while transporting.
	***** If the patient responds quickly to D10, follow treat and release guidelines below.		***** If the patient responds quickly to D10, follow treat and release guidelines below.
	** If unable to obtain IV access, [[~~Antidiabetics~~\|GLUCAGON]] 1 mg IM or IN.		** If unable to obtain IV access, [[Glucagon\|GLUCAGON]] 1 mg IM or IN.
	*** [[~~Antidiabetics~~\|GLUCAGON]] onset of action in 8-10 minutes.		*** [[Glucagon\|GLUCAGON]] onset of action in 8-10 minutes.
	* If LIMITED or NO response after initial [[~~Antidiabetics~~\|DEXTROSE 50%]] only:		* If LIMITED or NO response after initial [[Dextrose_50%25\|DEXTROSE 50%]] only:
	** [[~~Antidiabetics~~\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.		** [[Dextrose_50%25\|DEXTROSE 50%]] 12.5 gm IVP for adults if available.
	* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.		* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.