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?

Regarding Gravol for patients over 65 years. The age condition was removed, but the treatment section states that gravol may be considered for patients over the age of 65 if ondansetron is “unavailable.” My question: would it still be a patch to BHP if ondansetron is available, but Gravol would be the more appropriate antiemetic? Example being vertigo symptoms where the pt can’t even consume the PO ondansetron, but technically it is “available.”