I have a question in regards to the hypoglycemia directive. We were dispatched to a patient who suffered a fall, with history of diabetes. Upon assessment the patient was GCS 15, answering questions appropriately and oriented to person, place, time and event, however the patient was unable to move their limbs, and had loss of sensation in portions of the arms, torso, and legs, as well as a depressed skull fracture. The patient was hypovolemic and hypoglycemic at 3.2, stating he has not been eating or drinking fluids all day. Due to a complaint of back pain and paralysis, the a c-dollar was applied and scoop was used to extricate. Because the patient was secured to the stretcher supine, treating with oral gel was not an option, and transport was a priority. Some of the symptoms exhibited by the patient are concurrent with typical signs of hypoglycemia. In this situation where the patient is NOT altered, but hypoglycemic, with sufficient suspicion to suspect that low blood sugar may be causing some of the symptoms, would it be reasonable to treat the patient with IV dextrose? How do we proceed in situations where patients may be hypoglycemic, are not altered (GCS less than 15) but are unable to tolerate oral glucose or carbs? I can see this being the case for traumas.

It would be reasonable to treat for suspected hypoglycemia given the patients blood glucose level and symptoms described. As you have astutely pointed out, the patients symptoms may be from their hypoglycemia as well as the trauma. One of the changes to the ALS-PCS v4.9 was the removal of the set prescriptive list of symptoms of hypoglycemia. No longer must a patient have Agitation; OR Altered LOA; OR Seizure; OR Symptoms of a stroke. This allows for paramedic clinical judgement in utilizing the Hypoglycemia Medical Directive. In complex situations such as these, ensure you treat the life and limb threats (here utilizing spinal precautions, as you did) and consider all potential causes for the patients symptoms. As always, ensure to document your rationale for treatment and thought process.

Hypoglycemia,Level of Consciousness

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