Determination of prehospital blood glucose: a prospective, controlled study.
ABSTRACT To determine if emergency medical personnel can effectively rule out hypoglycemia in the prehospital setting.
During a 10-week period, emergency medical personnel determined the fingerstick glucose on all prehospital patients with altered mental status using the Chemstrip bG. Statistical comparisons were made to serum glucose levels performed by hospital laboratory personnel on blood samples obtained prior to glucose administration. A serum glucose level less than 60 mg/dL was considered a positive test for hypoglycemia.
170 consecutive patients with altered mental status (AMS) ranging in age from 13 to 90 years were enrolled.
Of these patients, 158 were normal or hyperglycemic, 12 were hypoglycemic, and one patient was hypoglycemic but had only a borderline negative fingerstick test. Thus, a sensitivity of 91.7% and a negative predictive value of 99.3% were obtained. The specificity was 92.4%, and positive predictive value was 47.8%.
The Chemstrip bG may be used safely in the prehospital setting to rule out hypoglycemia.
SourceAvailable from: secure-xp.netAnnals of Emergency Medicine 06/1999; 33(6):735–761. DOI:10.1016/S0196-0644(99)80039-0 · 4.33 Impact Factor
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ABSTRACT: In emergency cases, finger stick testing is primarily used to check the blood glucose value of patients since it takes longer to obtain the venous value. In critical patients, under conditions that cause an increase in metabolic state and level of stress, there occurs considerable difference in glucose levels between capillary and venous measurements. This study aimed to investigate the comparability of capillary and venous glucose values, according to the perfusion index level obtained with the Masimo Radical-7(®) device, in critical patients aged 18 years and over. We conducted this prospective and observational study in the emergency department of the Eskisehir Osmangazi University hospital between November 3, 2008 and February 2, 2009. The blood glucose of 300 critical patients was checked by finger stick in the emergency unit. The participants with normal vital signs had perfusion index between 0 and 5; the results obtained by the two methods were more consistent for perfusion index values of 6 and over. The results were most consistent in aged participants with normal vital sign findings and low perfusion index and in young patients with high perfusion index. In the cases where at least one of the vital signs was abnormal, the glucose values obtained by the two methods were more consistent when the perfusion index was 6 or over. In this group, independently from the perfusion index value, the consistency was higher in younger patients compared with aged patients. In the emergency department, perfusion index value measured by Masimo Radical-7 and capillary blood glucose levels can serve in blood sugar management in critically ill patients.Therapeutics and Clinical Risk Management 01/2014; 10:985-991. DOI:10.2147/TCRM.S73359 · 1.34 Impact Factor
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ABSTRACT: Abstract Objective. The objective of this guideline is to recommend evidence-based practices for timely prehospital pediatric seizure cessation while avoiding respiratory depression and seizure recurrence. Methods. A multidisciplinary panel was chosen based on expertise in pediatric emergency medicine, prehospital medicine, and/or evidence-based guideline development. The panel followed the National Prehospital EBG Model using the GRADE methodology to formulate questions, retrieve evidence, appraise the evidence, and formulate recommendations. The panel members initially searched the literature in 2009 and updated their searches in 2012. The panel finalized a draft of a patient care algorithm in 2012 that was presented to stakeholder organizations to gather feedback for necessary revisions. Results. Five strong and ten weak recommendations emerged from the process; all but one was supported by low or very low quality evidence. The panel sought to ensure that the recommendations promoted timely seizure cessation while avoiding respiratory depression and seizure recurrence. The panel recommended that all patients in an active seizure have capillary blood glucose checked and be treated with intravenous (IV) dextrose or intramuscular (IM) glucagon if <60 mg/dL (3 mmol/L). The panel also recommended that non-IV routes (buccal, IM, or intranasal) of benzodiazepines (0.2 mg/kg) be used as first-line therapy for status epilepticus, rather than the rectal route. Conclusions. Using GRADE methodology, we have developed a pediatric seizure guideline that emphasizes the role of capillary blood glucometry and the use of buccal, IM, or intranasal benzodiazepines over IV or rectal routes. Future research is needed to compare the effectiveness and safety of these medication routes.Prehospital Emergency Care 12/2013; 18(Supplement 1). DOI:10.3109/10903127.2013.844874 · 1.81 Impact Factor