Many times throughout the Paramedic Program I have come across a drug that has an unexpected use listed in the profile. Not very often are we given a comprehensive explanation as to why this drug works for this other use and it is left to us to try and figure this out. One example that I have seen recently is the use of Glucagon for beta blocker overdose. Glucagon is a hormone used in diabetic emergencies; its use for beta blocker overdose is actually pretty simple once it is explained.

Glucagon – Profile

Glucagon is a hormone produced by the alpha cells in the pancreas, it is opposed by insulin, a hormone produced by the beta cells in the pancreas. During periods of low blood sugar, for example, between meals, glucagon is secreted into the bloodstream which then begins the process of breaking down glycogen stores in the liver and muscle (glycogenolysis) to increase available blood glucose. After meals and at time of increased blood sugar, insulin is secreted to allow the cells to take up circulating glucose and stimulate the formation of glycogen (glycogenesis). Glucagon is also released during periods of stress to increase available energy during the fight or flight response. Additionally, glucagon possesses an inotropic quality, increasing the contractility of the myocardium thereby increasing stroke volume and cardiac output.

Glucagon – Use in Emergency Medicine

As an emergency drug, glucagon is administered to patients in severe hypoglycemia/insulin shock where IV access is unavailable. The expected response takes around 10 minutes to start and will only work if the patient has adequate glycogen stores available. This will not work for starving patients and alcoholics. The dose is 1mg IM.

Its use for beta blocker and calcium channel blocker overdose relies on its inotropic properties. Being that the beta adrenergic receptors are being blocked, epinephrine cannot exert its inotropic effect on the heart. Glucagon, in high doses (initial dose of 3-5mg IV) may have enough of an inotropic effect to increase cardiac output and blood pressure. For CCB overdoses it works the same way, just this time it the calcium channels that are blocked which also cause reduced contractility.

Glucagon is also used in cases of anaphylactic shock when epinephrine is not working (usually due to beta blocker use). The dose in this case would be 1-2mg IV over 5 minutes.

Hope it’s clear now, worked for me

Some great new blog posts over at EMS 12 Lead

• Discordant ST-Segment Elevation in LBBB or Paced Rhythm
• The Six Step Method for 12-Lead ECG Interpretation
• "New" LBBB – What’s the big deal?
• Identifying AMI in the presence of LBBB

Relates well the the Tim Phalen lecture we had on 12 Lead EKGs.

Good Stuff….

Components of blood – 45% RBC (hematocrit – 48% men/ 38% women), 54% Plasma, 1% WBC and Platelets

Blood tests:

Hemoglobin (Hgb) usually around 14  (Varies for men and women, adults and children)

Hematocrit is (Hct) usually about three times Hemoglobin levels,

Platelet count usually between 150,000 and 450,000 per uL of blood

CBC – Complete blood count

Diff – Measures percentage of different types of white blood cells (differential hematology blood analyzers)

92% of blood plasma is water, 6-7% Proteins, remainder includes clotting factors, glucose, and electrolytes

Contains 3 Important proteins

Albumins – keep water in blood – low proteins will let water leak out – edema – (seen in poor nutrition, elderly, etc)

Immunoglobulins – immune system response

Fibrinogens – for blood coagulation

 

Red Blood Cells

Most abundant cells in body

Primarily responsible for tissue oxygenation

White Blood Cells

Cells of the immune system, also called leukocytes, 5 types exists. Produced in Bone Marrow. Elevation of WBC count indicative of disease.

Arterial Blood Gas Levels (ABGs)

• Partial pressure of oxygen (PaO2) – 75 – 100 mmHg
• Partial pressure of carbon dioxide (PaCO2) – 35 – 45 mmHg
• A pH of 7.35 – 7.45
• Oxygen saturation (SaO2) – 94 – 100%
• Bicarbonate – (HCO3) – 22 – 26 mEq/L

Note: low HCO3 decreases the effectiveness of many drugs – specifically epinephrine.

I figured I’d write one Mnemonic to help remember all the other acronyms we use. (Not in order but what the heck! – Each one has the full description below) Enjoy!

Mamas Dogs Flips

M – MONA

A- ABC DEF GO

M- MOIST N DAMP

A- AEIOU TIPS

S- SAMPLE

D – DCAP BTLS

O- OPQRST

G- GUT PAINS

S- SIFDO

F – FAST

L- LEAN

I – IPASSO

P- PERRL

S- SLUDGEM

MONA – For ACS – Morphine, Oxygen, Nitrates, Aspirin

ABC DEFG – Airway, Breathing, Circulation, Disabilities, Extremities/Expose, Full set of vitals, GO!

MOIST N DAMP – For CHF –

Morphine
Oxygen
Intubation
Sit-up
Twelve lead
Nitrates
Dangle legs
Ativan (lorazepam)
Monitor Q 3-5
Pulmonary Congestion (CPAP)

AEIOU TIPS – AMS/Seizures

Alcohol

Epilepsy

Infection

Overdose

Uremia

Trauma

Insulin

Psychosis

Poison

Stroke

SAMPLE – Signs/Symptoms, Allergies, Medications, Past History, Last oral intake, Events leading up

DCAP BTLS – Deformities Contusions Abrasions Punctures/Penetrations Burns Tenderness Lacerations Swelling

OPQRST – Onset, Provokes/Palliates, Quality, Radiation, Severity, Time

GUT PAINS – (For Abdominal Pain)

G- Gallbladder, Gas, Gastritis,Gynecological
U- Ulcer
T- Trauma such as ruptured spleen, etc.
P- Pancreatitis, PID, Pregnancy (ectopic), Perforated Ulcer
A- Aortic Aneurysm, Appendicitis, Abdominal Angina
I-  Intestinal Obstruction, Infection, Ischemia of the bowel
N- Neoplasm
S- Spasm of the esophagus, Splenic rupture

SIFDO (Order of exam) Scene Size Up, Identify life threats, Focused Exam, Detailed Exam, Ongoing Assessment

FAST – Neuro assessment for Stroke/CVA – Facial paralysis, Arm weakness, Speech difficulties, Time to act

LEAN – Meds that can given down the ET tube. Lidocaine, Epi, Atropine, Narcan

IPASSO – Inspect, Palpate, Auscultate, Stabilize, Seal, Oxygen

PERRL – Pupils Equal Round Reactive to Light

SLUDGEM – Organophosphate exposure, Salivation, Lacrimation, Urination, Defecation, Gastric Upset, Emesis, Miosis

Ok, so i cheated.. I used this anagram creator to come up with the word; you can plug in these letters and choose from 1000 other variations. (saiosafdmmsplg)

This pharmacology booklet was handed out the other night, it is very useful and comprehensive. This was originally prepared for the St Vincent’s class and any references to protocols refer to NYC REMAC (as of 2006).

Sample page:

_________

También encontré un gran recurso si usted está buscando para comprar en línea de equipos médicos. Ellos llevan las máquinas de EKG, máquinas de ultrasonido, así como desfibriladores