Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 Another lesson: Unconscious/unresponsive/unknown----check blood sugar level regardless of whether or not the patient has a history of diabetis!!!! Maxine In a message dated 7/23/00 12:54:18 AM Central Daylight Time, malouf@... writes: > He immediately took out the glucometer and found the pt's blood sugar at 30! > Evidently, the pt was diabetic and hadn't been checked in a few days, or > weeks -- and hadn't eaten, but kept getting his insulin shots anyway. > > Lesson: READ THE RECORDS -- if you can get them! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 I've seen the opposite. The nursing home called because pt was unresponsive, they told us he was diabetic and his blood sugar just read HI on our glucometer. I asked when the last insulin shot was and the staff went blank. " We don't have that listed in his medication orders " . Well, the poor man had been there just over a month and since the family was present when the staff mentioned they hadn't given him his insulin since he'd been there because they didn't have it on their medication list, they have since sued. Don't know what became of the pt. Doc at hospital said it was it one of the worst cases of DKA he'd seen in a while. Ken Re: [texasems-L] Nursing Home Call >I went on a run as a student to a nursing home for a pt that had been >unconscious and unresponsive for two days or so and " just not himself " per >the nursing staff. We loaded him along with a copy of his records, which >the paramedic began reading. When we approached the ER entrance, I heard a >rather loud " exclamation " from the medic. > >He immediately took out the glucometer and found the pt's blood sugar at 30! >Evidently, the pt was diabetic and hadn't been checked in a few days, or >weeks -- and hadn't eaten, but kept getting his insulin shots anyway. > >Lesson: READ THE RECORDS -- if you can get them! > >Melody Malouf > >~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ >I have not been to every nursing home in this county, so I cannot say that >there is not a good one located here, but I have not found it yet. >Good nursing homes seem to be the exception, unfortunately, rather than the >rule. > >Gene Deck, Lt., LP, BAAS >City of Devine EMS >webmaster@... > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 Larry: Maybe this is a good time to review what every one considers a " coma cocktail " . Melody ~~~~~~~~~~~~~~~~ <<Melody illustrates a point well. It is safer practice to treat any unconscious / unresponsive patient with a " coma cocktail " until proven otherwise. . . >> " Leadership is action, not position " Larry RN CFRN LEMT-P .....and some other stuff Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 What is it about this call that supports the use of a " coma cocktail " ? A history and physical exam and a gkucometer would have given you the information required. How would thiamine and naloxone helped? BE Bledsoe, DO lanelson1@... wrote: > On Sun, 23 Jul 2000 00:53:09 -0500 " m & m's " writes: > > He immediately took out the glucometer and found the pt's blood > > sugar at 30! ... Lesson: READ THE RECORDS -- if you can get them! > > Melody illustrates a point well. It is safer practice to treat any > unconscious / unresponsive patient with a " coma cocktail " until proven > otherwise. The tickler for me would be " he is just not himself " . > > " Leadership is action, not position " > Larry RN CFRN LEMT-P > ...and some other stuff > > ________________________________________________________________ > YOU'RE PAYING TOO MUCH FOR THE INTERNET! > Juno now offers FREE Internet Access! > Try it today - there's no risk! For your FREE software, visit: > http://dl.www.juno.com/get/tagj. > > ------------------------------------------------------------------------ > Wish you had something rad to add to your email? > We do at www.supersig.com. > http://click./1/6810/9/_/4981/_/964351339/ > ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 We routinely check glucose as part of our protocol. We have found 20's on more than one occasion. We have had patients Alert and Oriented x 4 not more than !/2 mile from the Nursing Home with admin of D-50 IV. There would not be up to date records if there were any at all. This, I will admit, is not the norm as far as record keeping. But the patients that we are called on seem to be new patients or have recently been transferred in and the staff is not familiar with him/her. We have worked codes where the staff was insistent that the patient be taken to a facility 25 miles - 45 miles farther than the closest appropriate facility because it was the hospital preferred by the attending physician. H - E - L - P ! Am I the only one that finds this a bit bizarre? Gene Deck, Lt., LP, BAAS City of Devine EMS webmaster@... Re: [texasems-L] Nursing Home Call > I went on a run as a student to a nursing home for a pt that had been > unconscious and unresponsive for two days or so and " just not himself " per > the nursing staff. We loaded him along with a copy of his records, which > the paramedic began reading. When we approached the ER entrance, I heard a > rather loud " exclamation " from the medic. > > He immediately took out the glucometer and found the pt's blood sugar at 30! > Evidently, the pt was diabetic and hadn't been checked in a few days, or > weeks -- and hadn't eaten, but kept getting his insulin shots anyway. > > Lesson: READ THE RECORDS -- if you can get them! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 , I know that you didn't work at DFW forever before Tyler, so you've seen what happens at MOST nursing homes. I'm sure that the homes your mother worked for were probably good and may still be, but I honestly have only found one nursing home that I would place my parents in in FW, HEB, or Burleson and that one is in FW and only takes Alzheimer's pts. You are right that we should not group all homes together, but you also have to admit that the biggest majority have some major problems! When it comes time for my parents, I honestly don't know what I'll do! Maybe I'll have to place them in one of the homes where your mother worked. Maybe you or your mom can tell us what we can do to better the ones that are bad. I'm open to suggestions, and I'd love some input because it's becoming more and more important that we give our elders good care and there are more and more elders to care for. , I have a lot of respect for you and understand you point and take it to heart, but there has to be something we can do as part of EMS or even as individuals that can raise the level of care at the homes that are not good. I guess that's what I was getting at in my post, more than just venting, is that maybe some of you with more experience or knowledge can lend your expertise and make some suggestions. (You'll notice that I ended with this type of questions.) I know at the ER at HEB where I used to work and the ER where I now work, this is a daily problem. I've given many of these pts. baths and some TLC while in the ER when I have the time, but it frustrates me because I know that's only a few hours that many of these people actually get some real TLC. And, we are often so busy that I'm not even able to provide much of the TLC that they need. I'm open to any and all suggestions, and let's make this thread about how we can help, not just a " gross " or " sad " stories time. Take care, stay safe, and practice mercy, ya'll!! Jana FW,TX Re: [texasems-L] Nursing Home Call > In a message dated 7/22/00 9:02:04 PM Pacific Daylight Time, lpate@... > writes: > > << Your Grandma was blessed to have family who was willing to stand up and > fight > for what she needed. Can you imagine how bad it must be for the nursing > home > patients who do not have family nearby to check on them and make sure that > they are being cared for properly. Often, it seems to be a case of the > squeaky wheel getting the grease. > > A few years back, one of our crews answered a respiratory distress call at a > nursing home and arrived to find a patient in cardiac arrest. No CPR was > being done, but someone had placed a nasal cannula in the patient's mouth > " to > blow air into his lungs. " > > Because aspiration seems to be a frequent problem, I've learned to be real > specific in getting the history of the episode when I have a nursing home > patient experiencing respiratory distress--I want to know if the patient was > eating and/or had vomited prior to the onset of the episode. > > Maxine > > In a message dated 7/22/00 8:36:27 PM Central Daylight Time, > medicgirl@... writes: > > > I could go on forever! You just wouldn't believe and I thought I'd seen > > it all on the runs I'd made to nursing homes my few hours on an ambulance, > > and in my experience in the ER that I'd received so many horrid nursing > home > > pts that were improperly care for. I'm amazed every time! Guess you just > > don't get used to that sort of thing. And, it seems as though law suits > > (won by the pt or pts' family) don't even make a difference. What can we > > do? Can we give classes? Can we pester the life out of the regulatory > > agency? I wish I had the answer, because I cried for 2 days when it > became > > impossible for us to keep Grandma at home and we had to take her to the > > nursing home.>> > > May I please say one thing? Let us not condemn ALL nursing homes because of > some mistakes, poor care, or other events as a minority of nursing homes. > There are some very good nursing homes in Texas. Not all nursing homes are > bad. My mother is an RN, retired now, but she was director of nursing homes > in Dallas and also in Irving. I can say, without any hesitation, that the > care provided at both of these homes was very good. Professional staffs were > employed at the homes and I know there are other nursing homes in Texas with > the same caliber of fine health care providers. Let's be careful in > catagorizing " all " facilities as providing poor care. > > Just my thoughts, > > , B.S., LP > > ------------------------------------------------------------------------ > Remember four years of good friends, bad clothes, explosive chemistry > experiments. > http://click./1/7077/9/_/4981/_/964325819/ > ------------------------------------------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 Larry, I think I see what you're saying, that the home can spend some money and hide some things. But, I always hear that they can't afford to pay people well and can't afford this, or that, which is what I thought could be overcome since we were willing to pay for, purchase, rent, lease, whatever, anything that Grandma needed. So, where does the cash come from to " hide the trash " ? I'm just curious and hoping that you have an answer or two. I've tried to obtain information from several nursing homes as a citizen, not as any part of EMS or a hospital, and can't seem to get a straight answer. Do you know anything that would help. I know this sounds like my soapbox and, I guess, it is because it really bothers me! Thanks for the insight! Take care, stay safe, and practice mercy, ya'll!! Jana FW,TX Re: [texasems-L] Nursing Home Call > > In a message dated 7/22/00 8:36:27 PM Central Daylight Time, > medicgirl@... writes: > > > And, it seems as though law suits (won by the pt or pts' family) don't > even make a > difference. > > A little cash can hide a lotta trash. > > > " Leadership is action, not position " > Larry RN CFRN LEMT-P > ...and some other stuff > > ________________________________________________________________ > YOU'RE PAYING TOO MUCH FOR THE INTERNET! > Juno now offers FREE Internet Access! > Try it today - there's no risk! For your FREE software, visit: > http://dl.www.juno.com/get/tagj. > > ------------------------------------------------------------------------ > Find long lost high school friends: > http://click./1/7080/9/_/4981/_/964351339/ > ------------------------------------------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 23, 2000 Report Share Posted July 23, 2000 Jana: I know when Ann s was Governor she tried to do something about it by having unannounced " midnight raids " on nursing homes. I remember one TV interview of her as she came out of a nursing home. The conditions were so bad that she was virtually speechless (believe it or not). I don't know what happened to this " Task Force " after Bush took office but I bet we can guess . . . Melody ~~~~~~~~~~~~~~~~~~~~ <<I'm just curious and hoping that you have an answer or two. I've tried to obtain information from several nursing homes as a citizen, not as any part of EMS or a hospital, and can't seem to get a straight answer. Do you know anything that would help. I know this sounds like my soapbox and, I guess, it is because it really bothers me!>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 With regard to the " coma cocktail " please use caution. If the patient could be having a head bleed the glucose is probably contraindicated and might worsen the patient's condition. Now that we have the capability of getting a blood glucose level on scene or in the truck, it is questionable practice to give D50 or even start D5W unless there is a clear indication to do so or you are unable to check blood glucose. Administration of the " coma cocktail " could be lifesaving if the patient's status is hypoglycemia, won't hurt if the patient is hyperglycemic, but could be detrimental in a patient with cerebral edema or hemorrhage. Therefore, every effort should be made to rule out CVA before administering D50. Gene Gandy, JD, LP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 The only problem with educating nursing home staff is they have a high turn over. The patient care standard should already be in place prior EMS involvement. Larry Mc Brad Bolton wrote on 7/22/00 11:17 pm: The problem is not in just nursing homes. I have seen things just a bad in hospitals and even ICU. Brad ------------------------------------------------------------------------ Best friends, most artistic, class clown Find 'em here: http://click./1/7078/9/_/4981/_/964326673/ ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 My experience with Nursing Home in general is this - The Nurses, (RN & LPN) are the " bottom of the barrel " when it comes to knowledge. Please Nurses on this list don't get me wrong, there are some good caring nurses out there in Nursing Homes, but for the most part, the nurses that I have seen in Nursing homes are the ones who couldn't make it in a Hospital setting, whether it was because they lacked the drive, or could barely pass the requisite skills necessary to work and obtain certification/licensure. A lot of time they try but there is someone out there that will come along and put down the ones who do try. A lot of the time the nurses don't just have the whereforeall to think on their feet. Paramedics and EMT's are taught the think and react to a problem, whereas a nurse is taught to ask " Dr. may I? " I am sorry about this nurse bashing, like I said there are some good nursing home nurses out there, but they are few and very far in-between. L. Stockton, AAS-EMT-P Paramedic Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 On Sun, 23 Jul 2000 13:32:37 -0500 " m & m's " writes: > Larry: > > Maybe this is a good time to review what every one considers a " coma > cocktail " . Please note: refer to your own local protocols for propriety, criteria, and dosage. A " coma cocktail " is the three medications used in medical (non-trauma) unconscious / non-responsive patient: Glucose (commonly D50 or D25); Narcan (Naloxone), for signs of narcotic overdose; and thiamine (vitamin B1), for alcohol related neurological / hypoglycemic states. For the " unconscious / unresponsive " patient, after the ABCs are dealt with consider the causes: If there are signs of trauma, treat as a Head Injury (open or Closed) and use appropriate Trauma Protocols / Standing Orders. If there is no signs of trauma, assess the following: glucose with a glucometer. If below 70, treat with D50 or D 25, dependant on age and size of IV If there is evidence of narcotic overdose or respiratory depression, protect airway and give Narcan. The usual initial dose is 2 mg, given slowly. If the patient's LOC and respiratory efforts improve, stop administration and watch for rebound. Narcan has a limited life. Readminister as needed. If the exhibits signs of chronic alcohol abuse, consider alcohol related neuropathies and hypoglycemia. Thiamine will potentiate the effect of glucose metabolism. Thiamine can also be used for pregnancy related neurologic symptoms. " Leadership is action, not position " Larry RN CFRN LEMT-P ....and some other stuff ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 On Sun, 23 Jul 2000 14:34:11 -0500 " Bledsoe, DO, EMT-P " writes: > What is it about this call that supports the use of a " coma > cocktail " ? A > history and physical exam and a gkucometer would have given you the > information required. How would thiamine and naloxone helped? > Dr Bledsoe: I was thinking in terms of " Well, if plan A (in this case D50/D25) doesn't work, then go to plan B or plan C " . I would rather think about the number and types of lures in the tackle box, rather than just the first one I pull out. Granted, the exam, etiology and use of a glucometer would pretty well eliminate narcan, and probably thiamine. " Leadership is action, not position " Larry RN CFRN LEMT-P ....and some other stuff ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2000 Report Share Posted July 24, 2000 On Sun, 23 Jul 2000 20:26:21 -0500 " JL Jordan " writes: > Larry, > I think I see what you're saying, that the home can spend some > money and hide some things. You nailed it. >But, I always hear that they can't afford to pay people > well and can't afford this, or that, Someone who doesn't really understand elder care, or who is only interested in an obscene profit (note: I love capitalism and am in favor of a REASONABLE profit) will try to work at minimal cost until they get caught, and pay for that incident, rather than doing it right the first time. Put another way, they are " Penny wise and pound foolish " > So, where does the cash come from to " hide > the trash " ? I'm just curious and hoping that you have an answer or > two. " So there is a little less profit today; keep a problem quiet and there will be more profit tomorrow " - at least, that seems to be some of the mentality. > not as any part of EMS or a hospital, and can't seem to get a > straight answer. Welcome to the club!!! " Leadership is action, not position " Larry RN CFRN LEMT-P ....and some other stuff ________________________________________________________________ YOU'RE PAYING TOO MUCH FOR THE INTERNET! Juno now offers FREE Internet Access! Try it today - there's no risk! For your FREE software, visit: http://dl.www.juno.com/get/tagj. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2000 Report Share Posted July 25, 2000 It is unfortunate, but I think most of us will have to agree with you about the average quality of nurses found in your typical nursing home. Over the years, I have found the vast majority of them fit into one of three categories. 1. The nurses who are, as you mentioned so incompetent that they cannot meet the credentialing requirements of any primary healthcare facility. I also include in this group nurses who have been fired from multiple facilities due to behavioral or attitudinal deficiencies. In the past, this group also included substance-abusing nurses who were just fired, rather than turned in to the authorities. These nurses either do not have the ability or do not have the heart to care for difficult patients. 2. The second group are fresh-out-of-school nurses whose training is substandard enough that they can't compete successfully for better nursing positions. This group used to be fairly common, which was unfortunate because they became exposed to the worst role models possible. Nowadays, I'd speculate this group is almost extinct because of the nursing shortage. 3. The third group has always been rare but has always been there. Not every nursing home has them, but you can sure tell the ones who do. These are the nurses who work in the nursing home by choice. They have been called to this by something within. They are good nurses (I'd even go so far as to say they are among the best) who feel that they are needed at such a place. They act as a true patient advocate for the residents. They take it upon themselves to make the most of the resources available to make life as good as they can for their patients. They do this despite the bad working conditions and the rotten pay. If you look at any of them in the right light and at the right angle, you can almost see the outline of their wings. I suspect whereever you find a nursing facility that is at least tolerable, there you will find that one or more of these have come to Earth. I realize that the three categories I have mentioned don't encompass all the nursing home nurses; that it is an oversimplification, but I think it hits pretty close to the mark. Be that as it may, I think we need to acknowledge that poor nurses are not the thing that is wrong with nursing homes. The thing that is wrong cuts much deeper than that. We in the U.S. simply do not value our elderly. We are not willing to go all out for their care and quality of life like we are for someone who is around 35. I've seen doctors, nurses, paramedics, EMTs and other healthcare professionals alike display the attitude I am denouncing. I have even had the distasteful experience of seeing it directed at my own parents. We use all kinds of cute names for these patients: GOMER, lizard, grunt, teradactyl, etc. We focus on their physical deterioration rather than on the person who is inside that container of flesh. We adopt the idea that these people are just old and they have to accept a reduce! ! d quality of life. We use that to justify being conservative in treating them. When we talk of rationing healthcare, the elderly seem to be the first group to which the limits are applied. Who are the villians of the sad story of nursing homes and their patients? Not the miserable nurses and other staff members of these hell-holes (and the ones not so hellish). When the guilty in this case look in the mirror, the reflection shows the face of almost all of us. Dave My experience with Nursing Home in general is this - The Nurses, (RN & LPN) are the " bottom of the barrel " when it comes to knowledge. Please Nurses on this list don't get me wrong, there are some good caring nurses out there in Nursing Homes, but for the most part, the nurses that I have seen in Nursing homes are the ones who couldn't make it in a Hospital setting, whether it was because they lacked the drive, or could barely pass the requisite skills necessary to work and obtain certification/licensure. A lot of time they try but there is someone out there that will come along and put down the ones who do try. A lot of the time the nurses don't just have the whereforeall to think on their feet. Paramedics and EMT's are taught the think and react to a problem, whereas a nurse is taught to ask " Dr. may I? " I am sorry about this nurse bashing, like I said there are some good nursing home nurses out there, but they are few and very far in-between. L. Stockton, AAS-EMT-P Paramedic ------------------------------------------------------------------------ Failed tests, classes skipped, forgotten locker combinations. Remember the good 'ol days http://click./1/7076/9/_/4981/_/964482513/ ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2000 Report Share Posted July 25, 2000 Question regarding Thiamine administration. I seem to recall that Thiamine (B12?) is (one of?) the necessary component for breaking glucose apart for use. Seems to me that if a patient has been NPO for a duration of time their B12 level would be kinda low. Therefore, wouldn't it be wise to give the B12 at the same time as the D50 to make sure the patient was able to utilize the ton of glucose you just put in his/her system? Or is there some contraindication (other than allergy, duh) that I am unaware of? Webb, LP FLW EMS, MO ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2000 Report Share Posted July 25, 2000 Please keep your politics out of this. There are plenty of other listservers for that. Ken Re: [texasems-L] Nursing Home Call >Jana: > >I know when Ann s was Governor she tried to do something about it by >having unannounced " midnight raids " on nursing homes. I remember one TV >interview of her as she came out of a nursing home. The conditions were so >bad that she was virtually speechless (believe it or not). > >I don't know what happened to this " Task Force " after Bush took office but >I bet we can guess . . . > >Melody >~~~~~~~~~~~~~~~~~~~~ > ><<I'm just curious and hoping that you have an answer or two. >I've tried to obtain information from several nursing homes as a citizen, >not as any part of EMS or a hospital, and can't seem to get a straight >answer. Do you know anything that would help. I know this sounds like my >soapbox and, I guess, it is because it really bothers me!>> > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2000 Report Share Posted July 25, 2000 : Thiamine is Vitamin B1 (B12 is cyanocobalamin). Thiamine is only deficient in people who do not consume anything other than grain alcohol and, in a few instances, in malnourished prisoners. It is a necessary product for glucose to enter the Kreb's cycle, but very common in foods. Giving thiamine will not " wake a person up " like Narcan. It is administered over 3 days and improvement will usually be seen on Day 3. There is so little true need for thiamine in the United States that we should consider taking it off of the ambulances. More people receive unnecessary thiamine than any other prehospital drug. BE Bledsoe, DO P.S. It is said that virtually all cases of Wernicke's syndrome and Korsakoff's psychosis could be avoided if the manufacturers of cheap wines and alcohol would simple add some B vitamins to their product. M Webb wrote: > Question regarding Thiamine administration. I seem to recall that Thiamine > (B12?) is (one of?) the necessary component for breaking glucose apart for > use. Seems to me that if a patient has been NPO for a duration of time their > B12 level would be kinda low. Therefore, wouldn't it be wise to give the B12 > at the same time as the D50 to make sure the patient was able to utilize the > ton of glucose you just put in his/her system? Or is there some > contraindication (other than allergy, duh) that I am unaware of? > > Webb, LP > FLW EMS, MO > ________________________________________________________________________ > Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2000 Report Share Posted July 26, 2000 Dr. Bledsoe, Thanks for the information. See, I KNEW falling asleep in class that day was probably a bad thing! *grin* ----Original Message Follows---- Reply-To: egroups To: egroups Subject: Re: [texasems-L] Nursing Home Call Date: Tue, 25 Jul 2000 18:58:55 -0500 : Thiamine is Vitamin B1 (B12 is cyanocobalamin). Thiamine is only deficient in people who do not consume anything other than grain alcohol and, in a few instances, in malnourished prisoners. It is a necessary product for glucose to enter the Kreb's cycle, but very common in foods. Giving thiamine will not " wake a person up " like Narcan. It is administered over 3 days and improvement will usually be seen on Day 3. There is so little true need for thiamine in the United States that we should consider taking it off of the ambulances. More people receive unnecessary thiamine than any other prehospital drug. BE Bledsoe, DO P.S. It is said that virtually all cases of Wernicke's syndrome and Korsakoff's psychosis could be avoided if the manufacturers of cheap wines and alcohol would simple add some B vitamins to their product. M Webb wrote: > Question regarding Thiamine administration. I seem to recall that Thiamine > (B12?) is (one of?) the necessary component for breaking glucose apart for > use. Seems to me that if a patient has been NPO for a duration of time their > B12 level would be kinda low. Therefore, wouldn't it be wise to give the B12 > at the same time as the D50 to make sure the patient was able to utilize the > ton of glucose you just put in his/her system? Or is there some > contraindication (other than allergy, duh) that I am unaware of? > > Webb, LP > FLW EMS, MO > ________________________________________________________________________ > Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com > > ________________________________________________________________________ Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 26, 2000 Report Share Posted July 26, 2000 I want to throw in a couple of thoughts also, but let me preferance them by letting you know where I'm coming from. * My wife is a former nursing home nurse, one of those Dave would call a Category 3 nurse, who worked with the elderly because she loved doing that and who was a strong advocate for patients and their families. (Which sometimes irritated her administration when she wouldn't let them do things that were good for the bottom line but not the patient.) * While in school, I used to work at the same nursing home, which gave me great insight into what nursing home nurses do and how they are trained. Unfortunately, it also affirmed that there are a number of nurses in long term care that fall into Dave's Category's 1 & 2. * This nursing home was in the response area for the first responder agency that my wife and I were members. One of the things that opened my eyes is that nurses (particularly LVNs) are not trained on some of the emergency skills that we (EMS) consider basic. They got basic two-man CPR but not how to use the BVM or the CPR board. They weren't taught how to use airways, pocket masks or any of the tools that we take for granted. It's not that they were stupid, they just weren't shown how to use them. I started included how to use the toys in their crash carts during CPR classes and shazaam, they started using them. We worked with them to let them know what we needed from their staff during EMS calls to the facility and amazingly, patient information and staff were present during calls (at least until staff turnover moved the ones who knew what to do to other facilities). Most people in the medical field are there because they want to help, if we can work with them to help them know what we know and what we need, things can improve. After all, while working at the nursing hom, I learned there are a lot of things that my wife knows as a nurse that I really don't want to learn a whole lot about (anyone want an inserve on bedpans?). Thanks for letting me throw in my 2-cents. Barry Sharp, MSHP, EMT, CHES Education Specialist Office of Tobacco Prevention & Control Texas Department of Health barry.sharp@... Check out the coolest tobacco site on the web: www.dontgetburned.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2000 Report Share Posted July 31, 2000 Thiamine and D50 = Coma Cocktail........Doesn't work worth a damn! Re: [texasems-L] Nursing Home Call > : > > Thiamine is Vitamin B1 (B12 is cyanocobalamin). Thiamine is only deficient in > people who do not consume anything other than grain alcohol and, in a few > instances, in malnourished prisoners. It is a necessary product for glucose to > enter the Kreb's cycle, but very common in foods. Giving thiamine will not > " wake a person up " like Narcan. It is administered over 3 days and improvement > will usually be seen on Day 3. There is so little true need for thiamine in the > United States that we should consider taking it off of the ambulances. More > people receive unnecessary thiamine than any other prehospital drug. > > BE Bledsoe, DO > > P.S. It is said that virtually all cases of Wernicke's syndrome and Korsakoff's > psychosis could be avoided if the manufacturers of cheap wines and alcohol would > simple add some B vitamins to their product. > > M Webb wrote: > > > Question regarding Thiamine administration. I seem to recall that Thiamine > > (B12?) is (one of?) the necessary component for breaking glucose apart for > > use. Seems to me that if a patient has been NPO for a duration of time their > > B12 level would be kinda low. Therefore, wouldn't it be wise to give the B12 > > at the same time as the D50 to make sure the patient was able to utilize the > > ton of glucose you just put in his/her system? Or is there some > > contraindication (other than allergy, duh) that I am unaware of? > > > > Webb, LP > > FLW EMS, MO > > ________________________________________________________________________ > > Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2000 Report Share Posted August 1, 2000 Dr. Bledsoe, What harm are we doing by giving thiamine? I realize that the patient who truly needs it is rare, but giving it does no harm. By the way, cool idea about the producers adding B-vitamins. Has anyone suggested it to them? Steve Pike Re: [texasems-L] Nursing Home Call Thiamine and D50 = Coma Cocktail........Doesn't work worth a damn! Re: [texasems-L] Nursing Home Call > : > > Thiamine is Vitamin B1 (B12 is cyanocobalamin). Thiamine is only deficient in > people who do not consume anything other than grain alcohol and, in a few > instances, in malnourished prisoners. It is a necessary product for glucose to > enter the Kreb's cycle, but very common in foods. Giving thiamine will not > " wake a person up " like Narcan. It is administered over 3 days and improvement > will usually be seen on Day 3. There is so little true need for thiamine in the > United States that we should consider taking it off of the ambulances. More > people receive unnecessary thiamine than any other prehospital drug. > > BE Bledsoe, DO > > P.S. It is said that virtually all cases of Wernicke's syndrome and Korsakoff's > psychosis could be avoided if the manufacturers of cheap wines and alcohol would > simple add some B vitamins to their product. > > M Webb wrote: > > > Question regarding Thiamine administration. I seem to recall that Thiamine > > (B12?) is (one of?) the necessary component for breaking glucose apart for > > use. Seems to me that if a patient has been NPO for a duration of time their > > B12 level would be kinda low. Therefore, wouldn't it be wise to give the B12 > > at the same time as the D50 to make sure the patient was able to utilize the > > ton of glucose you just put in his/her system? Or is there some > > contraindication (other than allergy, duh) that I am unaware of? > > > > Webb, LP > > FLW EMS, MO > > ________________________________________________________________________ > > Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 1, 2000 Report Share Posted August 1, 2000 Although rare, there have been a few allergic reactions. Although not an expensive drug, thiamine does cost. With reimbursements being way down, we have to look for any way possible to cut costs. Bledsoe, DO Steve Pike wrote: > Dr. Bledsoe, > > What harm are we doing by giving thiamine? I realize that the patient who > truly needs it is rare, but giving it does no harm. > > By the way, cool idea about the producers adding B-vitamins. Has anyone > suggested it to them? > > Steve Pike > > Re: [texasems-L] Nursing Home Call > > Thiamine and D50 = Coma Cocktail........Doesn't work worth a damn! > Re: [texasems-L] Nursing Home Call > > > : > > > > Thiamine is Vitamin B1 (B12 is cyanocobalamin). Thiamine is only > deficient in > > people who do not consume anything other than grain alcohol and, in a few > > instances, in malnourished prisoners. It is a necessary product for > glucose to > > enter the Kreb's cycle, but very common in foods. Giving thiamine will > not > > " wake a person up " like Narcan. It is administered over 3 days and > improvement > > will usually be seen on Day 3. There is so little true need for thiamine > in the > > United States that we should consider taking it off of the ambulances. > More > > people receive unnecessary thiamine than any other prehospital drug. > > > > BE Bledsoe, DO > > > > P.S. It is said that virtually all cases of Wernicke's syndrome and > Korsakoff's > > psychosis could be avoided if the manufacturers of cheap wines and alcohol > would > > simple add some B vitamins to their product. > > > > M Webb wrote: > > > > > Question regarding Thiamine administration. I seem to recall that > Thiamine > > > (B12?) is (one of?) the necessary component for breaking glucose apart > for > > > use. Seems to me that if a patient has been NPO for a duration of time > their > > > B12 level would be kinda low. Therefore, wouldn't it be wise to give the > B12 > > > at the same time as the D50 to make sure the patient was able to utilize > the > > > ton of glucose you just put in his/her system? Or is there some > > > contraindication (other than allergy, duh) that I am unaware of? > > > > > > Webb, LP > > > FLW EMS, MO > > > ________________________________________________________________________ > > > Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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