Hypoglycemia Directive Flashcards
(11 cards)
What are the indications under this directive?
Suspected hypoglycemia
Altered LOA/LOC
Seizure
Symptoms of CVA
Agitation
What are the conditions for dextrose?
Age- ≥ 2 years
LOA- Altered
HR- N/A
RR- N/A
SBP- N/A
Other- Hypoglycemia
What are the contraindications for dextrose?
Allergy or sensitivity to dextrose
What are the conditions for glucagon?
Age- N/A (≥4 years for IN
powder)
LOA- Altered
HR- N/A
RR- N/A
SBP- N/A
Other- Hypoglycemia
What are the contraindications for glucagon?
- Allergy or sensitivity to glucagon
- Pheochromocytoma
What is the treatment for administering glucagon IM to a patient <25 kg?
Dose? Max. single dose? Dosing interval? Max. # of doses?
Dose- 0.5 mg
Max. single dose- 0.5 mg
Dosing interval- 20 min
Max. # of doses- 2
What is the treatment for administering glucagon IM to a patient ≥25 kg?
Dose? Max. single dose? Dosing interval? Max. # of doses?
Dose- 1 mg
Max. single dose- 1 mg
Dosing interval- 20 min
Max. # of doses- 2
(If authorized and available)
What is the treatment for using intranasal powder?
Age- ≥4 years
Weight- N/A
Route- IN
Dose- 3 mg
Max. single dose- 3mg
Dosing interval- 20 min
Max # of doses- 2
What are clinical considerations under this directive?
- If the patient responds to dextrose or glucagon, he/she may receive oral glucose or
other simple carbohydrates. - If only mild signs or symptoms are exhibited, the patient may receive oral glucose or other simple carbohydrates instead of dextrose or glucagon.
- If a patient initiates an informed refusal of transport, a final set of vital signs including
blood glucometry must be attempted and documented. - IV administration of dextrose applies only to PCPs authorized for PCP Autonomous IV.
- Intranasal glucagon is a powder that is supplied in a commercially available single-dose
intranasal device.
What are considerations for treat and discharge?
(if authorized)
All of the following criteria must be met:
□ the patient is ≥18 AND <65 years old;
□ the patient has a diagnosis of diabetes;
□ the hypoglycemia can be explained by insulin administration with inadequate
oral intake;
□ the hypoglycemia promptly responded to a single administration of dextrose or
glucagon as per the Medical Directive and/or consumed oral glucose or other
complex carbohydrates;
□ this was a single isolated episode of symptomatic hypoglycemia within the past
24 hours;
□ the blood glucose is ≥4.0mmol/L after treatment;
□ the patient has a return to their normal level of consciousness and is
asymptomatic;
□ a complete set of vital signs are within expected normal ranges;
AND
□ not an intentional overdose;
□ the hypoglycemia must not be related to alcohol or substance abuse or
withdrawal;
□ no seizure or reported history of seizure prior to paramedic treatment,
□ not on an oral hypoglycemic medication;
□ hypoglycemia is not considered to be related to an acute medical illness, and;
□ the patient is not pregnant.
In addition to the above criteria, if all of the following requirements have been met, the
patient can be discharged by paramedics:
□ the patient has access to appropriate carbohydrates;
□ a responsible adult agrees to remain with the patient for the next 4 hours;
□ all of the patient or substitute decision makers questions were answered
and a care plan was developed;
□ the patient or substitute decision maker has been advised to follow up with their
primary health care team or provider;
□ clear instructions to call 911 were provided should symptoms redevelop;
□ patient or substitute decision maker has the ability to access 911
should symptoms redevelop, and;
□ patient or substitute decision maker consents to the discharge.
What is the clinical consideration for treat and discharge?
Patch to BHP for consultation if you are unclear if the patient meets all of the discharge criteria.
