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?

Question regarding procedural sedation. During a recent call we had a patient that was believed to be flash pulmonary oedema (audible crackles, blood tinged frothy sputum, confusion). The patient was quite agitated, wouldnt answer questions, resistive to any intervention or assessment, resistant to vitals and non-tolerable of O2 via any route and had difficulty remaining still. Is it reasonable to consider sedation for these patients? Would this be considered a special circumstance requiring BHP consultation? Would Ketamine be the drug of choice over Midazolam?