Glucagon Protocol

[mark440]

What is your protocol for Glucagon? Here, right now, only EMT-I's can administer the drug. The reasoning is that Medics can get a line started no matter what and Glucagon is a "last ditch" effort. What do you all do?

Stay safe,

Mark

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If in doubt - Call us out

[mike m]

there are times when even the best trained medics with great iv skills cant get a line on am ams patient.i think glucagon should never be considered a last ditch effort.i have given the drug to a number of diabetics where i couldnt get a line and with good results.thats one of the reasons why medical control puts the drug in our protocols.

[mark440]

I agree, great drug. I have administered this to patients before with great results. Other than the price tag on it, I think it is easier and less painful (depending on how many times you get stuck for a line) and overall quicker and cleaner to administer than D25/D50. I think it all ought to depend on the situation at hand. Not the IV line situation. We have a "different" way of doing things here. Not bad, just different.

Stay safe,

Mark

*Opinions are mine and no one else's that I am associated with

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If in doubt - Call us out

[Rescue 21]

We use Glucagon on standing order for diabetic/ hypoglycemic patients that we are unable to gain IV access on after 2 peripheral sticks.

[Youngmedic]

Just gave it a couple of weeks ago, on a seizing hypoglycemic. It worked pretty good especially since we couldn't get a line after sticking her a bunch of times. We can give it on SO after we can't get vascular access...

[cfr3504]

In Virginia of course the names of certifications are a little different. But for Shock Trauma (sort of like intermediate),Cardiac Technician(same as paramedic, except fewer standing orders), and Paramedic glucagon is to be used when IV access cannot be established. At least that how it works in my region.

[ALSfirefighter]

We also utilize it if peripheral access cannot be obtained. Which as I've seen posted here usually after 2 venipuncture's are attempted. I have seen it work very well other than severly chronic alcoholics and/or malnourished patients because they lack glycogen, which is what the glucagon breaks down to form glucose. I wuld be be weary of using this as a first line drug for hypoglycemia because of the IM route, it will take longer to use, and I have had patients who's insulin dose was making their blood sugar levels plummet rapidly, and eat away the first amp of dextrose I gave.

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The above is just my opinion and does not reflect that of any dept./agency I work for, am a member of, or deal with. It is also not intended to and doesn't say anyone elses opinion is wrong. http://www.firehouse.com/forums/biggrin.gif

[Michael Day]

Our protocols allow for standing order use of Glucagon by medics if no IV access in adults and peds patients. No clause about # of IV attempts before going to Glucagon. We also use oral glucose and will give pt's juice with sugar added if they can maintain their own airway.
MLDay

[Medic328]

I got orders the other day to give Glucagon to a pt in respiratory distress who was allergic to EVERYTHING!!! Sounded weird to me but the Doc explained that it worked as a smooth muscle dialator. Whatever the process it worked.

[fyrmedik]

We use Glucagon as a second line drug for hypoglycemia, when we are unable to start an IV for D50. BLS providers use it as a first line drug, to be given SQ.

[BFD847]

The service I work part time for have protocols for using Glucagon if unable to gain IV access in a resonable time. No specific # of attempts.
They are now using the F.A.S.T. one adult sternal intraosseous unit. These have been very useful in these situations. Check them out.

[EMTGodess]

EMT-D's in the state of New York are not allowed to start IV's....we depend more on ALS.

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Michele

I save lives....what do you do?

[CanadianMedic]

Here in Ontario, we have 3 levels of certification. Primary Care Paramedic, Advanced Care Paramedic and Critical Care Paramedic. Primary Care is BLS plus SAED and 5 Symptom Relief Medications. Advance Care includes Primary plus ET tubes, medication admin via IV's etc....

In the symptom relief medications Primary Care Paramedics administer Glucagon to any Insulin Dependant Diabetic who has an acute onset of any of the following: altered level of consciousness, agitation, syncope, confusion, seizures or symptoms of a CVA and a blood sugar of less than/equal to 4.0 mmol/L. Oral glucose is then administered as a patient becomes more oriented.

We have been using this very sucessfully for several years.

[rchildress]

Diabetic pts never have good veins to begin with so iv access is not a given, that is why cental lines are placed. Our protocol is give Glucagon after two iv attempt or or 90seconds of trying, the lesser of the two. Glucagon has a leaves a pt feeling a little rough afterwards, but it's better than being unconscious.

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[emtwannabe]

Our protocols state that if we are unable to establish an IV(no specific # of attempts mentioned in this section of protocols), we are to administer 1mg glucagon IM. In the IV access section of our protocols, it is stated that an Intermediate(which I am in training for) is to limit IV attempts to 2 for a hemodynamically stable patient. No clue what hemodynamically stable means, but it must be okay. Haven't gotten that far in class yet. Wish me luck. http://www.firehouse.com/forums/biggrin.gif

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GOD is my Medical Director and JESUS is my EMS crew chief.

[ALSfirefighter]

I just wanted to add that when we use Glucagon here after 2 IV attempts, that is a unwritten guide that most medics use to go to Glucagon. If I look and do not see a vein screaming for a catheter, I sometimes give the Glucagon beforehand, so I have some means of reversing the hypoglycemia. If I get the vein and they still haven't improved, then they get the 100 of Thiamine, and an Amp.

Also, Medic328, I can see how that would help. Just like when we use Benadryl for Thorazine OD's.