Directives

• Indications for hypoglycemia: suspected hypoglycemia
• Age for Glucagon admin is irrelevant unless the route is IN, in which Pt must be 4 or older
• LOAs must be altered for Glucagon admin
• Glucagon contraindications: allergy or sensitivity to Glucagon and Pheochromocytoma
• For Dextrose admin, age must be 2 or older
• Dextrose admin is considered before Glucagon in the Hypoglycemia directive
• If PT weighs less than 25 kg, you give 0.5 mL of Glucagon IM. There is a dosing interval of 20 minutes with a max dose # of 2. If PT weighs more than 25 kg, you can give 1 mL of Glucagon IM with the same dosing interval and max # of doses
• If giving Glucagon IN, PT must be 4 or older and the dose is 3 mg regardless of age and the dosing interval is 20 minutes, with the max # of doses of 2.
• Clinical considerations for hypoglycemia: 1. If PT responds to dextrose or Glucagon, they may receive oral glucose or simple carbs
• Part 1 of treat and discharge for hypoglycemia: PT is 18 or older and under 65, the PT has a diagnosis of diabetes, hypoglycemia can be explained by insulin admin with inadequate oral intake, hypoglycemia responded quickly to any treatment, this was a single episode within the last 24 hours, BGL is 4 or greater, PT is unaltered and asymptomatic and a complete set of vitals taken and are within normal range
• Part 2 of treat and discharge for hypoglycemia: not an intentional overdose, hypoglycemia is not related to alcohol or substance abuse/withdrawal, no seizure/reported hx of it prior to treatment, not on any oral hypoglycemic medications, hypoglycemia is not related to an acute medical illness and PT is not pregnant
• Indications for suspected adrenal crisis: A PT with primary adrenal failure who is experiencing clinical signs of an adrenal crisis
• LOA, age and vitals are all irrelevant for the admin of Hydrocortisone in an adrenal crisis
• Hydrocortisone "other" conditions: Paramedics are presented with a vial of hydrocortisone for the identified PT AND have any of these conditions: age-related hypoglycemia or GI symptoms or Syncope or Temperature of 38 degrees C of greater(or hx of fever) or altered LOAs or age-related Tachycardia or age-related hypotension
• Contras for Hydrocortisone: allergy or sensitivity to hydrocortisone
• Hydrocortisone is given IV/IM @ a dose of 2 mg/kg(rounded to the nearest 10 mg), for a max single dose of 100 mg and just 1 dose.