This is kinda off topic - but early in my career, I was in field as a medic and I had a very severe diabetic that was obtunded with a glucose that was too low to read, 40 miles from the ED, and no way in hell to get access on her. I tried EVERYTHING. And if I can't get access, you have none. She did have a port. I had only seen done several times and had one unsuccessful attempt - did not have Huber needle and no protocol for doing it. Actually it was FORBIDDEN.
I called our hospital medical control and the doc advised to give the patient "multiple subQ injections of D50".
I was sure I had a bad connection. I told him I was going to call him right back. I called state police post and asked for a recorded monitored line patched access to the physicians line at the hospital medical control - they complied (they were our dispatch agency) - I had him repeat "give the patient multiple subQ injections of D50" and "do not access the port". I replied that the patient had no subQ tissue weight under 90 pounds at 5'6" and I was unable to comply. Thank you medcontrol. We will be enroute will contact you with ETA. Have a good day.
I had given IM Glucagon earlier. It was going to be useless as she had no reserves.
Now I really owned this. We are loading & going enroute. I was going to cut O2 supply tubing and do a DL assisted confirmed NG tube and dump D50 in the gut while transporting. Her nurse sister met us 10 miles in and had equipment & the ability to access port and supplemented some D25. She was awake and intact on ED arrival. "Pulled my NG", the port access stayed. Observed for a few hours and had a meal.
I wrote up up a variance for my medical director. No big deal. NG tubes were in our protocol, though drug delivery via NG tubes was not. I ultimately had no issues. He remarked my innovative thinking may have saved the patient and was solid clinically. Sure. I was freaking desperate. Desperate does that. Death is scary.
Can anyone imagine the hell and wrath I would have likely endured if I HAD injected that girl subQ with D50? I just cannot.
I like RECORDED LINES. A LOT.
Recorded lines can be your friend.
Should hospitals used RECORDED LINES for ORDERS? I think it would stop a lot of NONSENSE.
When you call a doc for orders you call on the "doc order line" - easy peasy?