Hypo
The other day I had one of those calls where I was on scene so long, I felt like exchanging Christmas cards with the patient and calling him on his birthday. It started out as a simple diabetic, but when we got there the patient was more or less awake and oriented. He had had a syncopal episode which led to our being called.
We checked his sugar and it was something like 42. Not good. So I looked around the room, and there were some muffins on the kitchen table. We had him eat one of those, and drink some OJ. Wanting to give those enough time to work, we waited a few minutes and checked his sugar again. 41. What?! So, to plan B. We had him eat a tube of glucose. And some more juice too. We waited a while in hopes that his sugar would be more normal. In this time, though, his wife said that he was acting more normally, which is always good. We were having a nice chat, I learned about all their children and grandchildren, what they both used to do for a living, and we all joked around like old friends. We took it again, 59. Not good enough for a refusal. We had certainly established by then that the patient had no interest in going to the hospital, and his wife was quite satisfied he had made a full recovery. Unfortunately, in the bizarre system I work in, we cannot "treat and street" without informing a doctor of what's going on. No doc is going to let a blood sugar of 59 refuse. So, to plan C. (or I could say plan D as in dextrose) We started a little line in him and gave half an amp. We waited a few, just to make sure it would take effect. I carefully took his sugar again. 181! Fantastic. Good enough for government work, good enough to refuse, good enough to satisfy my worries.
As we left, he was eating another muffin, and we gave the wife all of the standard post hypoglycemic care and advice. Our scene time was over 45 minutes! Finished in time to raise our own blood sugars with a now, late dinner.
We checked his sugar and it was something like 42. Not good. So I looked around the room, and there were some muffins on the kitchen table. We had him eat one of those, and drink some OJ. Wanting to give those enough time to work, we waited a few minutes and checked his sugar again. 41. What?! So, to plan B. We had him eat a tube of glucose. And some more juice too. We waited a while in hopes that his sugar would be more normal. In this time, though, his wife said that he was acting more normally, which is always good. We were having a nice chat, I learned about all their children and grandchildren, what they both used to do for a living, and we all joked around like old friends. We took it again, 59. Not good enough for a refusal. We had certainly established by then that the patient had no interest in going to the hospital, and his wife was quite satisfied he had made a full recovery. Unfortunately, in the bizarre system I work in, we cannot "treat and street" without informing a doctor of what's going on. No doc is going to let a blood sugar of 59 refuse. So, to plan C. (or I could say plan D as in dextrose) We started a little line in him and gave half an amp. We waited a few, just to make sure it would take effect. I carefully took his sugar again. 181! Fantastic. Good enough for government work, good enough to refuse, good enough to satisfy my worries.
As we left, he was eating another muffin, and we gave the wife all of the standard post hypoglycemic care and advice. Our scene time was over 45 minutes! Finished in time to raise our own blood sugars with a now, late dinner.
Comments
thanks for a great blog!
tracy wannabe