scholarly journals P038: How frequently is hypoglycemia found in ambulance calls for “seizure”?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S91-S91
Author(s):  
D. Eby ◽  
J. Robson ◽  
M. Columbus
Keyword(s):  
Retrospective Analysis ◽  
Blood Sugar ◽  
Rural Population ◽  
Random Number ◽  
Recent Literature ◽  
Hospital Setting ◽  
Summary Statistics ◽  
Paediatric Age ◽  
Random Number Table

Introduction: Paramedics often attend seizure patients in the pre-hospital setting. Received wisdom is that hypoglycemia is frequently present during a seizure or is a ‘cause’ of seizures. Recent literature disputes this. The purpose of this study was to determine the frequency of hypoglycemia in patients identified as having “seizure” listed as the primary or final problem code in Ambulance Call Reports from a large regional paramedic base hospital program. Methods: Retrospective analysis of a database of ambulance call reports (ACRs) from January 01-December 31, 2014. All 2854 ACRs with paramedic determined primary or final problem codes of “seizure” were identified from a database of all calls performed by 8 municipal paramedic services covering a total urban and rural population of 1.4 million. Municipal paramedic services used iMedic electronic ACRs. A 10% sample generated by a random number table was analyzed. ACRs were manually searched and data extracted onto spreadsheets. Results were described using frequencies and summary statistics. Results: A total of 285 call were analyzed. 207 (72.6%) calls were adults and 78 (27.4%) were paediatric (age <18). Seizures were witnessed by paramedics in 23/285 (8.1%) calls; adults 17/207 (8.2%), paediatric 6/78 (7.7%). A blood sugar was determined in 237/285 (83.2%) of all calls; adults 182/207 (87.9%), paediatric 55/78 (70.5%). In calls were paramedics witnessed a seizure a blood sugar was determined 17/21 (80.9%) of the time; adults 13/17 (76.5%), paediatric 6/6 (100%) Hypoglycemia (BS < 4.0 mm/L) was found in only 1 case - 1/237 (0.4%); adults 0/ 207 (0%), paediatric 1/78 (1.3%). The child was age 1, had a GCS 13, and the blood sugar was 3.9 mm/L. Conclusion: Hypoglycemia was rarely found in patients who had a seizure and were attended to by paramedics in the pre-hospital setting. The routine determination of blood sugars in all patients who have had a seizure prior to paramedic arrival should be reconsidered.

scholarly journals LO38: Hypoglycemia is a rare peri-seizure finding in pre-hospital patients

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S40-S41
Author(s):  
D. Eby ◽  
J. Woods
Keyword(s):  
Blood Sugar ◽  
Random Number ◽  
Recent Literature ◽  
Conventional Wisdom ◽  
Descriptive Statistics ◽  
Rural And Urban ◽  
Hospital Patients ◽  
Paediatric Age ◽  
Random Number Table

Introduction: Conventional wisdom states that hypoglycemia is a frequent peri-seizure phenomenon and must be tested for. Conventional wisdom also lists hypoglycemia as a cause of seizures. Recent literature disputes this. Paramedic medical directives continue to direct paramedics to determine the blood sugar level on all seizure patients. The purpose of this study was to determine the frequency of hypoglycemia in patients identified as having “seizure” as the primary or final problem code in Ambulance Call Reports (ACRs) from a large regional paramedic base hospital program. Methods: We conducted a retrospective analysis of iMedic platform, electronic ACRs, for a 2 year period (Jan 01, 2014 to Dec 31, 2015), from 8 Paramedic Services serving a rural and urban population of 1.4 million. 5854 calls, had “seizure” listed as a primary or final problem code. A 10% sample was generated using a random number table. ACRs were manually searched, data abstracted onto spread sheets, and the results analyzed using descriptive statistics (Wizard ver 1.8.16 for Mac). Results: 582 calls were analyzed. 430 (73.9%) were adults and 152 (26.1%) were paediatric (age &lt;18). A blood sugar was determined in 501/582 (86.1%) of all calls; adults 388/430 (90.2%), peadiatric 113/152 (74.3%). The Glasgow Coma Score, when measured, was 15 in 280/575 (48.7%) cases. Seizures were witnessed by paramedics in 47/582 (8.1%) calls; adults 33/430 (7.7%), paediatric 14/152 (9.2%). In calls were paramedics witnessed a seizure a blood sugar was determined 36/47 (76.6%) of the time; adults 25/33 (75.8%), paediatric 11/14 (78.6%). Hypoglycemia (BS&lt;4.0 mmol/L in an adult and 3.0 mmol/L in child&lt;age 2 ) was found in 1 case when BS was checked-overall 1/501 (0.2%); adults 1/388 (0.3%), paedatric 0/113 (0.0%). Case 1-age 70 yr, GCS 12, BS 3.8 mmol/L. Conclusion: Hypoglycemia was rarely found in patients who had a pre-hospital seizure. It did not require treatment. When it was found, hypoglycemia was unlikely to be the cause of the seizure. The results are similar to the findings from other recent, retrospective, reviews. The routine determination of blood sugars in all patients who have had a seizure prior to paramedic arrival should be reconsidered.

scholarly journals P039: What are the frequencies of interventions performed by paramedics during seizure calls?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S91-S91 ◽  
Author(s):  
D. Eby ◽  
J. Robson ◽  
M. Columbus
Keyword(s):  
Primary Care ◽  
Blood Sugar ◽  
Random Number ◽  
Descriptive Statistics ◽  
Scope Of Practice ◽  
Glucose Levels ◽  
Secondary Database ◽  
Blood Glucose Levels ◽  
Paediatric Age ◽  
Random Number Table

Introduction: Paramedics frequently attend out-of-hospital seizure patients. They administer oxygen, check blood glucose levels and if within scope of practice, start IVs and administer benzodiazepines. Little is know about how frequently these procedures are performed. The objective of this study was to determine the frequency of procedures performed by paramedics (Advanced Care (ACP), Primary Care IV (PCP-IV) and Primary Care non-IV (PCP)) attending seizure patients in a regional paramedic base hospital program. Methods: Retrospective analysis of a secondary database of ambulance call reports (ACRs) (January 01-December 31, 2014). All 2854 ACRs with paramedic determined primary / final problem codes of “seizure” were identified from total calls performed by 8 municipal paramedic services (MPSs), covering an urban and rural population of 1.4 million. MPSs used iMedic electronic ACRs. A 10% sample, generated using a random number table, was analyzed. ACRs were manually searched and data extracted onto spreadsheets. Findings were summarized using descriptive statistics. Results: 285 calls were analyzed; (adult 72.7%, paediatric (age <18) 27.3%). Paramedics witnessed seizures in 8.1% of all calls they attended; (paediatric 7.8%). The blood sugar was checked in 87.9% of adult calls; (ACP 88.7%, PCP-IV 89%, PCP 77.8%) and in 70.5% of paediatric calls; (ACP 72.0%, PCP-IV 63.3%, PCP 70.5%). Oxygen was administered in 80.7% of adult calls; (ACP 85.9%, PCP-IV 78.0%, PCP 80.7%) and 83.3% of paediatric calls; (ACP 92.0%, PCP-IV 80.1%, PCP 82.4%). IVs were started by paramedics (if in scope of practice) in 28.0% of adult calls; (ACP 47.9%, PCP-IV 16.1%) and 6.6% of paediatric calls; (ACP 8.0%, PCP-IV 5.6%) Midazolam was administered in 10.4% of ACP attended calls and in 91.0% of the calls were they witnessed seizures. Transport occurred in 93.2% of adult calls and 100% of paediatric calls. Conclusion: ACPs were more likely to perform procedures on seizure patients than PCPs or PC-IVs. Children were much less likely to have procedures performed on them - blood sugar checks, and IV starts - but more likely receive oxygen and be transported. These findings have training implications.

scholarly journals A STUDY OF THE NEW BENEDICT METHOD FOR THE DETERMINATION OF BLOOD SUGAR

1926 ◽  
Vol 69 (1) ◽  
pp. 187-196
Author(s):  
Reed Rockwood ◽  
Sxczypinski Adam
Keyword(s):  
Blood Sugar

scholarly journals THE DETERMINATION OF BLOOD SUGAR

1925 ◽  
Vol 64 (1) ◽  
pp. 207-213 ◽  
Author(s):  
Stanley R. Benedict
Keyword(s):  
Blood Sugar

First- and second-line pharmacological treatment for delirium in general hospital setting—Retrospective analysis

2018 ◽  
Vol 32 ◽  
pp. 50-53 ◽  
Author(s):  
Ken Wada ◽  
Yukitaka Morita ◽  
Takashi Iwamoto ◽  
Yoshihiro Mifune ◽  
Shinji Nojima
Keyword(s):  
Retrospective Analysis ◽  
General Hospital ◽  
Pharmacological Treatment ◽  
Hospital Setting ◽  
Second Line

The Micro Determination of Blood Sugar

1930 ◽  
Vol 27 (6) ◽  
pp. 480-483 ◽  
Author(s):  
R. B. Gibson
Keyword(s):  
Blood Sugar

Determination of Blood Sugar in Newborn Infants

PEDIATRICS ◽  
1961 ◽  
Vol 28 (5) ◽  
pp. 850-851
Author(s):  
GLORIA S. BAENS ◽  
WILLIAM OH ◽  
EVELYN LUNDEEN ◽  
MARVIN CORNBLATH
Keyword(s):  
Blood Sugar ◽  
Newborn Infants ◽  
Newborn Period ◽  
Claude Bernard

To the Editor: Recently, there has been a renewed interest in the level of blood sugar in the newborn period, with very low or zero blood sugars being reported1, 2 In some of these reports there is no mention of how the blood was collected, how long it was permitted to stand, how it was precipitated, or analyzed. As reviewed by Peters and Van Slyke,3 the disappearance of sugar from blood in vitro has been well documented since the time of Claude Bernard.

5 -Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU

2022 ◽  
Author(s):  
Audrey Marie O'Neil ◽  
Cassandra Rush ◽  
Laura Griffard ◽  
David Roggy ◽  
Allison Boyd ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Recent Literature ◽  
Total Body Surface Area ◽  
Early Mobilization ◽  
Burn Patients ◽  
Mechanically Ventilated ◽  
Line Placement ◽  
Total Body ◽  
Stage 1 ◽  
Significant Attention

Abstract Early mobilization with mechanically ventilated patients has received significant attention within recent literature, however limited research has focused specifically on the burn population. The purpose of this single center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 to December 2019. Burn Therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In 5 years following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average total body surface area of 22.8%. No adverse events occurred. Stage 1 (Range of motion) was completed with 100% of patients (n=127). Chair mode of bed, stage 2a, was utilized in 39.4%(n=50) of patients, while 15.8% (n=20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge-of-bed) was completed with 25% (n=32) of patients, with 11% (n=14) progressing to stage 5 (standing), and 3.9% (n=5) actively transferring to a chair. In 5 years, only 4.7% (n=6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges including airway stability, sedation, and line limitations.

scholarly journals Why direct and post-refinement determinations of absolute structure may give different results

2016 ◽  
Vol 72 (5) ◽  
pp. 661-683 ◽  
Author(s):  
David John Watkin ◽  
Richard Ian Cooper
Keyword(s):  
Recent Literature ◽  
Structure Refinement ◽  
Direct Determination ◽  
Standard Uncertainty ◽  
Data Sets ◽  
Normal Probability Plot ◽  
Normal Probability ◽  
Structure Determinations ◽  
Absolute Structure

Direct determination of the Flack parameter as part of the structure refinement procedure usually gives different, though similar, values to post-refinement methods. The source of this discrepancy has been probed by analysing a range of data sets taken from the recent literature. Most significantly, it was observed that the directly refined Flack (x) parameter and its standard uncertainty are usually not much influenced by changes in the refinement weighting schemes, but if they are then there are probably problems with the data or model. Post-refinement analyses give Flack parameters strongly influenced by the choice of weights. Weights derived from those used in the main least squares lead to post-refinement estimates of the Flack parameters and their standard uncertainties very similar to those obtained by direct refinement. Weights derived from the variances of the observed structure amplitudes are more appropriate and often yield post-refinement Flack parameters similar to those from direct refinement, but always with lower standard uncertainties. Substantial disagreement between direct and post-refinement determinations are strongly indicative of problems with the data, which may be difficult to identify. Examples drawn from 28 structure determinations are provided showing a range of different underlying problems. It seems likely that post-refinement methods taking into account the slope of the normal probability plot are currently the most robust estimators of absolute structure and should be reported along with the directly refined values.

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