EMT Q 4 fudgie

[DFragn]

Wonder if you have an explanation...

Almost 4 months ago my pancreas decided to kick in after I shot my insulin. I had to dial 911. Had 'em all. The FD, patrol officer & 4 EMT's. Last I heard them say was my blood glucose was 24 and dropping.

They couldn't get an IV in the back of my left hand so they moved to right. That Dextrose syringe was the size of shotgun barrel. Gawd, I don't mind needles, but that was a monster.

They, in my opinion, were pushing [the plunger] it in way too fast - it hurt like an SOB. I asked 'em to slow down a bit. But, the EMT behind me told the rifleman "no-no-no get in - get in".
I was released the next mid-day.

2 days later I'm in ER with a massive infection in my right arm. 2 more days with IV antibiotics.

Now 4 months later the veins [2] in the back of my hand have 1/4" bulge and they hurt when I use my hand, even on the throttle.

What do think happened. My GP told me it would clear up in a month. I haven't gone back yet.

[3fan4life]

I ain't Fudgie but i did stay at A Holiday Inn one time. 


My guess would be that some of the IV may have "infiltrated" (fancy word for leaked).

D50 is necessary and life saving for a diabetic that is in insulin shock, but if it leaks into the surrounding tissue it can be very damaging.

Keep an eye on it, if it seems to be getting worse see your Dr. and tell him that you think that it may have been caused by the D50.

If it seems to be healing I wouldn't be too concerned, it might've been a really small amount.

D50 is very thick, almost like syrup. It is very hard to push into an IV, I have actually hurt my hand trying to get it into a vein.

If your Blood sugar was 24 and dropping those guys literally saved your life.

That is a critically low blood sugar and you were very much in danger of dying.

If you are still taking insulin always remember one thing, NEVER take your insulin without eating a meal.

If you continue to have problems with your sugar dropping after taking insulin, ask your Dr about taking your insulin on a "sliding scale".

[DFragn]

I ain't Fudgie but i did stay at A Holiday Inn one time.  


My guess would be that some of the IV may have "infiltrated" (fancy word for leaked).

D50 is necessary and life saving for a diabetic that is in insulin shock, but if it leaks into the surrounding tissue it can be very damaging.

Keep an eye on it, if it seems to be getting worse see your Dr. and tell him that you think that it may have been caused by the D50.

If it seems to be healing I wouldn't be too concerned, it might've been a really small amount.

D50 is very thick, almost like syrup. It is very hard to push into an IV, I have actually hurt my hand trying to get it into a vein.

If your Blood sugar was 24 and dropping those guys literally saved your life.

That is a critically low blood sugar and you were very much in danger of dying.

If you are still taking insulin always remember one thing, NEVER take your insulin without eating a meal.

If you continue to have problems with your sugar dropping after taking insulin, ask your Dr about taking your insulin on a "sliding scale".

Thanks 3fan4life

Oh yeah, I know they saved my life. And that's not the first time. I'm not mad at 'em, but the infection had to be from IV insertion.

The first time is when I found out I was diabetic. If it hadn't been Xmas I'd be dead. I was a no show for a family event Xmas eve. No one could reach me. My girlfriend came to see what the problem was. I was barely conscious. EMT clocked me at 800. As you know that's as high as home, EMT and triage meters go. Apparently the EMT's started pumping insulin into me. ER took over as I was still at 800. The lab work came back as maple syrup, they had me at over 1000 and estimate I may have been as high as 1200. I sheet you not. I came to about 3 hrs later. I was told I never would have woke up in the morning. Christmas day is not a good day to die. I think it would be terrible to forever screw up everyone's Christmas.

I am on a sliding scale with R in addition to N. For 5 years I was doing about 90 units shared/day. My eating habits have not changed and in the last 5 months I'm down to a fifth of that if at all and take 2-3 units less then the sliding scale recommends. I'd rather float at around 150 then go Hypo again.
I've other undetermined health issues and the diabetes may by a side symptom. Been to all the top Chicago hospitals and specialists. I should venture up to Mayo or Cleveland.

Thanks for your info, I appreciate it.
I should change my handle to Conundrum...

[donaldcc]

 
  So sorry your health has been bad, but . . . Go talk to your doctor.  A motorcycle board is NOT the place to get your health advice.

[DFragn]

  So sorry your health has been bad, but . . . Go talk to your doctor.  A motorcycle board is NOT the place to get your health advice.

Appreciate your opinion. But, if you had foregone the Evelyn Woods speed reading you would have deciphered that I was trying to get an opinion of what went wrong in the Bambulance from an actual EMT who's not affiliated. Nothing more. I know what the Dr's say. But of course they would shy away of expressing negligence on the part of the EMT's. I have had opportunities in life to pursue suits. I never have and likely wouldn't. It's not my nature. I would, however,  like to make a decision of having a chat with emergency services so that perhaps this could be avoided [infection] in the future. My guess is the paramedic contaminated the IV when he moved from one hand to the other. Which I was clear about [the switch] in the original post.

Then in response to 3fan4life I simply confirmed to him I know how lethal this all can be from experience. And responded to his other recommendations. Of which I wasn't looking for, but appreciated and responded to. Maybe that response was a little long in the tooth, but so what.

Then, you also may have noticed I made mention That I Have exhausted the medical services in one of the countries largest metropolitan areas with some of the best medical care available. Hence my mention of needing to drag my butt to Mayo or Cleveland Clinic. And, of course I'm under a Dr's care. But, tired of symptoms alone being treated without discovering a root cause.

So, based on your opinion...Politics & religion should have no place here either. Of which I would agree. But this thread stands very little chance of members drawing sides as politics & religion would and do.

Thanks for your concern. Be assured I am & have taken counsel from so called medical specialists.



 

[Gunslinger]

I would make a bet that the IV catheter (needle) was rather large. D50 (50% dextrose solution) is extremely viscous and almost impossible to push through a small bore catheter. I personally would not even try to start an IV with the intent to push D50 unless I was pretty confident I could get an 18 ga in.

There is a distinct possibility that the IV infiltrated, it happens. More likely I would guess that the site was not flushed well after the D50 administration or that you as a diabetic have poor perfusion which allowed the D50 to remain in one area longer than it would in a 'normal' diabetic.

The fact that your blood sugar was 24 and you still recall the events tells me that your body has experienced low sugar levels repeatedly, which also indicates that you have been insulin dependent for a long period of time. My guess is poor peripheral perfusion preventing the body from distributing the glucose and causing some venous irritation. If the IV infiltrated you would more likely be describing dead tissue (necrosis) and not irritation.

I'm not a Dr. but I did take a paramedic class or two.
You results may vary, objects in the mirror could be hallucinations and this is not legal or medical advice.

[Jabba]

I had something a LITTLE similar to that a couple weeks ago...

I had a blood sugar of 42 right before bed.  When I drop low... it wakes me up in a hot sweat and I can eat something sweet.  This one happened before I went to sleep, which is rare.

I ate 10 Halloween size candy bars and 2 fiber one bars... felt better and went to sleep.  My sugar was still 96 in the AM.

That scared me. 

Jabba

[solo1]

As far as asking for advice here on this board, I have a comment.

When I was a caregiver for my wife, before she died,  there were times that the medical profession failed her, specifically a  loss of communication and sensitvity, and once, maybe more, a defective medical decision by a doctor.  

Knowing the amount of wide experience found on this board, I, too wouldn't have hesitated to ask for professional opinions here among knowledgable friends.

That's what makes this board so much more than a motorcycle orientated one.

Just for the record, I was at one time, a registered Xray tech at a VA facility.

Wayne

[f6gal]

Hey DFragn!  First let me say that armchair quarterbacking is easy... without being there no one can really say what happened or should have happened.

That said... there may be a few things that could have been done differently.
1) The back of the hand isn't the best place to push a thick fluid, a bigger vein on the front of the elbow (antecubital) would've been better.
2) Dextrose should be pushed slowly
3) Running the main IV fluid wide open while pushing the dextrose helps move it along (gets it in the system faster, without having to push faster).  I'm not sure if all paramedics know this trick though.

From what you said, it doesn't sound as if the IV infiltrated while the dextrose was going in... since there is no tissue necrosis.  But it may have infiltrated later.
Unfortunately infection happens and it can do a lot of damage.  It can happen whether or not there was infiltration.

Whatever the cause, it can take a long time for damaged veins to recover; sometimes they don't.  They can do vein ablation to get rid of them.  But I wouldn't do that for a least a year... to give them a chance to heal.

[DFragn]

I had something a LITTLE similar to that a couple weeks ago...

I had a blood sugar of 42 right before bed.  When I drop low... it wakes me up in a hot sweat and I can eat something sweet.  This one happened before I went to sleep, which is rare.

I ate 10 Halloween size candy bars and 2 fiber one bars... felt better and went to sleep.  My sugar was still 96 in the AM.

That scared me.  

Jabba

Jabba, yup a terrible body & mind sensation and dangerous.

You might want to try Chewable Glucose Tablets with Dex4 or the Gluco Shot with Dex4 liquid.
Much faster acting then candy, orange juice or anything else. You'll feel it in just a few minutes.
Walgreens brand is very inexpensive too.

More importantly they taste great for the sweet tooth in us.

Don't ingest any candy or high carbs in addition or your numbers will skyrocket.

If your in your 40's +. Start with 4 - 6 chewable or half a shot. Everyone's different, but in general that's a good start place to recover your numbers.

Run it by your Dr. for your personal application.

[DFragn]

Gunslinger, Solo1 & F6Gal

Thank you kindly for your input.
All very informative.

[rainman]

there are times when my sugar drops down to around 42 or lower for no reason at all sometimes with  in three hours after I eat.  I all ways carry small bag of M&Ms whit me and that give the fix if at home I eat a peanut butter sandwitch and some millk. and then I am as good as can be.

good luck

[Jabba]

I have only seen below 50 once.  And only below 60 one other time.  Usually when I am low... it's in the 70's.  Not really that dangerous.  I was 78 when I got up this AM.

I have been in the gym HARD for the last month or so, and have been using a lot less, or even sometimes no insulin.  I took 10 units of Novolog after dinner last night as I had a little Pasta.  Again, rare lately.  I have been averaging about 20 units per DAY of Novolog.  Not a lot.  Diet and exercise have been helping a lot.

I take 60 units of Lantus daily too.  I am hoping to lose enough weight that I can kick this crap to the curb.

Jabba

[fudgie]

Sorry it took so long. But yea, the other summed it up well. D50 is very necrotic (sp). Its kinda fun to squirt a little on the FF's clothing. Not that its ever done. 
Could just be from the inital poke of the IV. Did they use the same needle on each hand? Or did they get a new one? My guess is that they used the same one or didnt clean the site.
When I was in advanced class learning IV's in 03 we practice on each other. They guy I stuck in the hand still has the mark and the sight still hurts when he touches it today.
As far as pushing it fast I dont know. I'm not allowed to push meds, well legally.  But 90% of us push stuff fast. We usually dont have a nice controlled enviornment to take time to do it as its written. They shoulda followed it was a saline chaser. Like g'slinger said 18 ga is perferred. That stuff is hard to push anyway. Trying to push it through a 22 or 24 takes alot of time.

Was at a party at the x's a few weeks ago and she wanted me to check on her dad cause he was vomiting and has sugar problems. He said its not sugar related even tho he was at 500 mg/Dl. Told him he was going into DKA. He was thirsty, kussmaul breathing, etc. He didnt believe me since he has been high before and never felt this way. Radioed in a truck to get their opinion and he ended up going. Our ER doc knew he was DKA when he came through the door. Said he was so acidotic that he would have been dead in 7 hours.
We have a guy, non compliant with his meds, that comes to the ER all the time and he is always over 1100 mg/dl.
Diabetic are one of my favorite runs. Treat'm and street'm is what we do most of the time. A amp of D50 wakes them up and they never want to go to the hospital. Sweet, not my chart anyway.
Just remember to eat if it happens again and you decide not to go to the ER. The amp is a quick fix and you will drop again as fast without eating.

[f6gal]

My guess is that they used the same one

Seriously??  Wow... can't even fathom that.

[fudgie]

My guess is that they used the same one

Seriously??  Wow... can't even fathom that.

I know. Its a long shot but happens. I've done it, but only on full arrests.  Back before we did I/O's.