Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-06-28T02:20:28.937Z Has data issue: false hasContentIssue false
  • English
  • Français

Development and Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia: A Retrospective Study

Published online by Cambridge University Press:  28 June 2012

Randy H. Thompson  and
Robert W. Wolford
Randy H. Thompson
Affiliation:
University of IllinoisCollege of Medicine at Peoria, Peoria, Illinois
Robert W. Wolford*
Affiliation:
University of IllinoisCollege of Medicine at Peoria, Peoria, Illinois Department of Emergency Medicine, Saint Francis Medical Center, Peoria, Illinois
*
Department of Emergency Medicine, Saint Francis Medical Center, 530 N.E. Glen Oak Avenue, Peoria, Illinois 61637, USA
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

A retrospective study of patients transported by paramedics to a community teaching hospital was conducted to: 1) determine the response of hypoglycemic patients to prehospital treatments, 2) develop criteria to identify patients who safely could be released without transport to a hospital, and 3) evaluate the prehospital release criteria.

Methods:

Patients presenting to EMT-paramedics with an altered level of consciousness were identified retrospectively. Pre- and post-treatment blood glucose levels were measured and response to treatment noted (Phase 1). Criteria were established using these data and a second sample was evaluated using these criteria (Phase 2).

Results:

During a 12-month period, 60 patients with an altered level of consciousness (ALOC) were encountered. Of the 60 patients, 27 (45%) were documented to be hypoglycemic (blood glucose [BG] <80 mg/dl, mean 27±13 mg/dl). Of the 27 hypoglycemic patients, 24 (89%) were discharged from the emergency department (ED) and three patients (11%) were admitted. Criteria were developed to identify patients who could be treated and released safely without transport to a hospital: 1) history of insulin (IDDM) or non-insulin (NIDDM) dependent diabetes mellitus; 2) pre-treatment BG <80 mg/dl; 3) post-treatment BG >80 mg/dl; 4) return to normal mental status within 10 minutes of treatment; and 5) absence of complicating factors (renal dialysis, chest pain, arrhythmia, dyspnea, seizures, alcohol intoxication, focal neurological signs/symptoms). The criteria were applied retrospectively to 27 hypoglycemic (mean BG=28±14 mg/dl) patients during a different 10-month period. Of the 27 hypoglycemic patients, 23 (85%) were discharged from the ED, and prehospital release criteria correctly identified 19 of 23 (83%). The prehospital release criteria did not select for release any patient who required an additional, major intervention or who was admitted.

Conclusion:

This study demonstrates that there is a group of hypoglycemic patients who respond favorably to paramedic interventions. Retrospectively, the prehospital release criteria were successful in selecting patients who did not require additional interventions. A larger prospective study must be conducted before prehospital treatment and release can be recommended for general practice.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 6 , Issue 3 , September 1991 , pp. 309 - 313
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1991

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Brodows, RG, Williams, C, Amatruda, JM: Treatment of insulin reactions in diabetics. JAMA 1984;252:3378–3381.CrossRefGoogle ScholarPubMed
2. Collier, A, Steedman, DJ, Patrick, AW, et al. : Comparison of intravenous glucagon and dextrose in treatment of severe hypoglycemia in an accident and emergency department. Diabetes Care 1987;10:712–715.Google Scholar
3. Goldstein, DE, England, JD, Hess, R, et al. : A prospective study of symptomatic hypoglycemia in young diabetic patients. Diabetes Care 1981:4:601–605.Google Scholar
4. Daneman, D, Frank, M, Perlman, K, et al. : Severe hypoglycemia in children with insulin-dependent diabetes mellitus: Frequency and predisposing factors. J Pediatr 1989;115:681–685.Google Scholar
5. Casparie, AF, Elving, LD: Severe hypoglycemia in diabetic patients: frequency, causes, prevention. Diabetes Care 1985;8:141–145.CrossRefGoogle Scholar
6. Hogya, PT, Yealy, DM, Paris, PM, Stewart, RD: The rapid prehospital estimation of blood glucose using Chemstrip bG. Prehospital and Disaster Medicine 1989;4:109–113.Google Scholar
7. Hevesy, GZ: Peoria area MIC paramedic protocol, 1989.Google Scholar
8. Adler, PM: Serum glucose changes after administration of 50% dextrose solution: Pre- and in-hospital calculations. Am J Emerg Med 1986;4:504–506.CrossRefGoogle ScholarPubMed
9. Susler, S, Dougherty, J: Utility and accuracy of glucose reagent strips in an active, physician-supervised EMS System. Prehospital and Disaster Medicine 1989;4:64. Abstract.Google Scholar
10. Herr, RD, Richards, M: Chemstrip reliability declines with ambulance storage. Prehospital and Disaster Medicine 1989;4:64. Abstract.Google Scholar
11. Brooks, KE, Rawal, N, Henderson, AR: Laboratory assessment of three new monitors of blood glucose: Accu-Chek II, Glucometer II, and Glucoscan 2000. Clin Chem 1986;32:2195.Google Scholar