Blood Glucose Measuring Devices in the Pre-hospital Setting

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Blood Glucose Measuring Devices in the
Pre-hospital Setting
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Indications for BG Measuring

• Signs and Symptoms consistent with
• Acute Stroke
• Altered Mental Status

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Hypoglycemia

• Blood glucose level of 80 or less
• Most calls for diabetic emergency
• Signs and symptoms
• Hunger
• Nervousness or shakiness
• Perspiration
• Dizziness or light-headedness
• Sleepiness or weakness
• Confusion
• Difficulty speaking
• Unresponsiveness

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Hyperglycemia

• Blood glucose level of 120 or higher
• Most common but least calls to EMS
• Signs and symptoms
• Frequent urination
• Increased thirst
• May lead to Ketoacidosis

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Procedures

• Careful attention to BSI safety
• Insert Glucometer test strip into device
• 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

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Step 1
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Step 2

• Get out a lancet (prepare the lancet as needed)
• Locate the place for the finger-stick
• Choose a finger any finger (usually not the
  thumb)
• Use the side of the pad of the finger, between
  the knuckle and the finger tip
• If the patient has callused fingers or thick skin
  it maybe difficult to get blood, try to find a
  place with thinner skin
• As EMT providers we are not authorized to use
  alternate site testing (IV starts, toes, arms,
  etc.) if fingers are not available, medical
  control must be contacted for orders to test an
  alternate site

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Step 3

• Clean the finger tip that you will be performing
  the finger-stick on with an alcohol prep pad
• Be sure the area dries completely, use a sterile
  gauze pad to dry the area if needed
• Note un-dried alcohol may skew the reading so
  make sure it dries completely

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Step 4

• Lance the finger with the lancet
• Lower the hand and squeeze the finger gently (if
  needed) to assist with producing a small droplet
  of blood

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Step 5
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Step 6

• When the blood glucose reading appears, document
  it immediately on the ePCR
• Ex blood glucose 100 at 1357
• Continue to treat the patient per Maryland
  Medical Protocol

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Troubleshooting

• What could go wrong when using the glucometer?
• Dead batteries
• Always carry spare batteries in the ambulance and
  check the unit regularly
• Error reading appears
• Insert a new strip, re-test, check batteries
• Unable to get enough blood from finger-stick
• Lance a different finger, if skin is cold-try
  warming with a hot pack wrapped in a towel
• Inaccurate reading
• Why do you think it was inaccurate? Was the
  alcohol dried? Was the strip contaminated? Try
  re-testing.

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Results
80-120

• Normal blood glucose range is typically
• If it reads LO lower than 20 mg/dl
• If it reads HI higher than 500 mg/dl
• If it reads E-3 may be too low to read
• If it reads E-4 may be too high to read

Any of these readings could also indicate that
there is a problem with the test strip. Remember
to treat the patient and not the number on the
meter.
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Maintenance Calibration

• Techniques
• Frequency
• Batteries
• Care Storage
• Device
• Test strips
• Documentation