I’m seeking clarification regarding a call we attended today. 
We were dispatched for a shortness of breath patient who was in acute CHF and also presented with slurred speech. At the time, we were not aware that his slurred speech was baseline due to tongue CA. Out of caution, we checked his blood glucose, which returned at 3.6 mmol/L. 
We initiated CPAP in conjunction with nitroglycerin for the CHF, which the patient tolerated well. However, due to the CPAP, we were unable to administer oral glucose paste. The directives for glucagon and dextrose specify that the patient must have an “altered LOA” to administer these agents. In this case, the patient had no signs of hypoglycemia and no altered mental status. 
My question is: in situations like this, when a patient cannot receive oral glucose but does not meet the conditions for glucagon or dextrose, should we attempt to administer either of those treatments, or is withholding them appropriate? 

In situations like this, where the treatment as written in the ALS PCS Medical Directives is in question, a patch to the Base Hospital Physician (BHP) would be beneficial to help work through the appropriate treatments. 

Acute Cardiogenic Pulmonary Edema,Airway/Breathing,Cardiac/Circulation,Continuous Positive Airway Pressure (CPAP),Hypoglycemia,Level of Consciousness

Base Hospital Physician, BHP Patch, Conditions, hypoglycemia, Indications, Level of Awareness, Patch

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