Blood Glucose Measuring Devices in the Prehospital Setting

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Blood Glucose Measuring Devices in the
Pre-hospital Setting

• Created by Boston EMS
• Modified by SEMAEMS

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NOTE

• Information within this presentation should be
  tailored to the Blood Glucose Measuring Device
  used by the service and should include a review
  of the manufacturers instructions. SEMAEMS
  encourages its providers to use the Accu-Chek
  Compact Meter to allow for economy of scale
  purchases of testing supplies. Please contact
  the Regional Office for more Details.

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Purpose

• To prepare currently certified EMT-Basics and
  Intermediates to utilize a Blood Glucose
  Measuring Device when operating under a licensed
  ambulance service and in accordance with A/R
  5-520 Requirements for Basic and Intermediate
  EMT Use of Glucose Monitoring and the
  Massachusetts EMS Pre-Hospital Treatment Protocols

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Objectives

• State when blood glucose measuring is indicated
• Describe the importance of a full patient
  assessment in conjunction with test results
• Demonstrate accurate calibration
• Demonstrate appropriate procedures for measuring
  blood glucose
• Explain proper maintenance, care storage

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Indications for BG Measuring

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

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Acute Stroke

• Refer to the Acute Stroke Protocol
• Utilize the Boston Operation Stroke Scale (BOSS)
• Transport patient in accordance with the Stroke
  Point of Entry Plan

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Altered Mental Status(Common Causes)AEIOU-TIPS

• Alcoholism Trauma
• Epilepsy Infection
• Insulin Psychiatric
• Overdose Stroke
• Underdose

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Pre-Hospital Care

• (FOLLOW THE PROTOCOLS)
• 1. Scene Safety/Survey
• 2. Perform initial assessment
• May require airway control, definitely oxygen
• 3. Ensure cervical spine immobilization as
  indicated
• 4. Activate ALS if necessary available

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Pre-Hospital Care

• Perform focused history and physical exam
• SAMPLE history
• Signs/Symptoms (when did they start? how long
  did they last?)
• Allergies
• Medications (When last taken?)
• Prior Medical History (diabetes?, seizure
  disorder?)
• Last oral intake (When did patient last eat)?
• Events leading to illness/injury

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Pre-Hospital Care

• Focused history physical exam, cont.
• Take base line vital signs
• Determine blood glucose level
• Evidence of hypothermia/hyperthermia?
• Can the patient swallow normally?

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Pre-Hospital Care

• Do not administer anything orally if the patient
  does not have a reasonable level of consciousness
  and normal gag reflex.
• Contact medical control prior to administering
  glucose to patients suspected of Acute Stroke.

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Pre-Hospital Care

• If patient is unconscious or seizing, transport
  on left side.
• If patients BP drops below 100 systolic treat
  for shock.
• Monitor VS every 5 minutes if unstable every 15
  minutes if stable.
• Notify receiving hospital as soon as possible.

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Glucose Measuring Devices

• Used to Check Blood Sugar Levels
• Many different types and models

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Procedures

• Careful attention to BSI safety
• 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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Device Accessories
Test Strips
Glucometer
Lancet
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Glucose Measuring Steps
Step 1
Step 2
Step 3
Locate Glucometer
Open Up Case
Turn Power On
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Glucose Measuring Steps, cont.
Step 4
Confirm Codes
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Glucose Measuring Steps, cont.
Step 5
Insert Test Strip
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Glucose Measuring Steps, cont.
Step 6
Obtain Blood Sample
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Glucose Measuring Steps, cont.
Step 7
Apply Drop of Blood
If inadequate up to 15 secs., add additional blood
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Glucose Measuring Steps, cont.
Step 8
Document Results
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Device Variations
Some glucometers turn on automatically. Know the
features of the glucometer your service uses.
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Results

• Normal blood glucose range is typically
• 80-120 (fasting)
• Treat the patient, not the numbers

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Maintenance Calibration

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

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BSI Cleansing Issues

• Dispose of all sharps and blood contaminated
  materials properly
• Cleanse only outside of monitor with general
  disinfectant (manufacturer approved)
• Do not immerse/ inject/spray any liquid into
  device

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Summary

• Indications for blood glucose measuring
• Importance of a full patient assessment in
  conjunction with test results
• Accurate calibration procedures
• Appropriate blood glucose measuring procedures
• Proper maintenance, care storage procedures

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Practice Session

• Students should complete a calibration procedure
  and test sequence under the direct supervision of
  an instructor
• Students may practice obtaining a blood sample on
  each other or a thin skinned fruit (e.g., apple)

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Questions?

• Ask your training officer
• Consult your service Medical Director
• Call your Regional office or visit their website
  http//www.semaems.com
• Contact OEMS at [phone] or visit
  http//www.mass.gov/dph/oems/oems.htm