Pretty simple one this week for a cool-down, folks. Not a ton for EMS to do for patients with hyperglycemia other than to recognize it. Recognize that EMS should be equipped with blood glucometers starting at the BLS level; if, for any reason, an EMT tells you they do not have a BGM for a patient, remind them that obtaining blood glucose is necessary for their practice, and they should report any malfunctioning equipment to the necessary supervisor.
Once the patient is confirmed to be hyperglycemic, BLS has a low threshold to request ALS backup, ultimately as a means to support the airway and start fluid resuscitation while transporting. By Standing Order, ALS will bolus up to a liter of crystalloid (weight-based for pediatrics), and they will contact OLMC for permission to give up to an additional liter (again, weight-based for peds). Given that many of these patients often have extraordinary fluid deficits, this is likely a good place to start, but as with all OLMC requests, use your discretion and ask for as much info as you need to make the decision. Just remember that there is a potentially critical patient in front of the crew while you deliberate, so be prompt about it!
See you all next week! www.nycremsco.org and the protocol binder for more.
Dave