Comments on: Should EMS Improvise? And the Recipe for the “Kaiser Cocktail”

By: FoxxNY

FoxxNY — Sat, 04 Feb 2012 03:43:00 +0000

Sounds great, i like that a lot, very good improvising but i ‘d ensure they have no allergies to the Honey or syrup prior to administration, there are those who can be allergic, some highly. God forbid something happens you might get screwed. If its in their house it’s probably unlikely there allergic to it, but they could be. I suppose the Honey or syrup is the only possible contraindication so you could leave it out and the rest seems okay to me. Most Regions allow you to administer soda and fruit juice.

By: Jdmedic

Jdmedic — Sat, 14 Aug 2010 02:50:00 +0000

Uh Oh – just when my doctor said I was doing so well you want me to jump into a controversy. I guess it’s back to the electro shock room for me. LOL

By: Jacqueline EMT-B, NJ

Jacqueline EMT-B, NJ — Tue, 10 Aug 2010 00:15:40 +0000

i don't see a problem with this, in NJ we have started carrying cake icing(i am dead serious) on our rigs in place of oral glucose because lets be honest: that stuff tastes like crap.
And i have made a sandwich on more than a few occasions for a patient who was a known diabetic and who had pricked herself to prove her sugar was low.

By: Ckemtp

Ckemtp — Mon, 09 Aug 2010 18:43:30 +0000

JD! I was wondering when you were going to come back and weigh in on something. I'm glad it was this one. I like having your perspective and appreciate the comments.

Stick around. I plan on upcoming controversy.

By: Jdmedic

Jdmedic — Mon, 09 Aug 2010 18:31:31 +0000

As a “recovering attorney” (my thanks to Harold Cohen for use of that phrase), not only will I endorse your cocktail but I will advocate the cause of common sense by stating I have used similar strategies. If using some variation of the cocktail is not permitted by your state/local protocols you could wind up having to deal with a beaurocrat however, a court of law is different. In the event there was some adverse event from this treatment (the Pt was allergic to OJ?) you would be judged by the “reasonable man” standard. What would a reasonable man in the same situation do? I would argue vehemently a reasonable man would say: provide help, do no harm and save the poor person an additional medical bill he/she does not need because of all the rest of the medical bills the person probably has.

As far as the “cocktail” goes, I have learned a lot more from my fiancee who has been a diabetic since 16 than from medic school. No sugar is needed in any fruit juice. In fact apple juice has more available sugar than the same amount of soda. The only time you have to add sugar to soda is if the family has been giving the person diet soda and can't understand why the Pt's BGL has not risen.

By: What is the next “Low Hanging Fruit” of EMS 2.0 and of US Healthcare Reform? | Life Under the Lights

Mon, 26 Jul 2010 23:43:33 +0000

[...] (hypoglycemia) to receive a treatment with IV D-50, IM Glucagon, oral Glucose, or even with the “Kaiser Cocktail” and then sign off with an AMA refusal. The patients are encouraged to eat something containing [...]

By: CBEMT

CBEMT — Thu, 24 Jun 2010 08:00:54 +0000

Yeah, why think critically and advocate for the patient's needs. It's so hard. Monkey see/monkey do protocols 4eva! w00t!

I was talking about TRIAGE. The only thing they do for those patients before they break out the juice is... oh wait, they did the exact same thing- a capillary blood sugar. The same thing EMS did 10 minutes ago.

Point is. If I assess the patient to be suffering from a known diabetic condition resulting from a clearly identifiable cause, and can treat it with something less invasive and risky than an IV and far more palatable than the tube of suck we carry, I will, and I can guarantee the state med director will back me up on it.

THINK- it's not illegal yet!

By: MedicMac

MedicMac — Thu, 24 Jun 2010 00:51:09 +0000

This is similar to treatment the patient would receive at the hospital – awake and mostly oriented with a patent airway = oral intake of sugar/nutrients, NOT injections or IVs. Is the treatment appropriate and acceptable? Yes. Does it put you at risk in pre-hospital? Yes. While I consider it appropriate, it's also really 'winging it' because you're moving beyond any 'remedies' you are provided on the ambulance. A key issue is whether your medical director thinks it's appropriate pre-hospital treatment. If the medical director doesn't have an issue with it, I wouldn't have an issue with it. If uncomfortable with an 'unwritten approval/protocol', then I would recommend a call to on-line medical control, providing them with my patient assessment, differential diagnosis, and treatment plan – if approved, you save the patient a trip to the ED. If denied, then the doctor can provide a similar treatment when the patient arrives. Still covered by 'protocol' but advocating what you feel is right for your patient.

By: Tracyb4403

Tracyb4403 — Wed, 23 Jun 2010 23:47:46 +0000

Prior to working in EMS, I worked in an “assisted living facility” and I used this many times with our residents in 2005. Of course, it was only used in patients exhibiting classic signs of hypoglycemia, and after a stroke was ruled out. I never saw one adverse reaction or negative displayed due to the resident drinking it and most of the time once the medics arrived the blood sugar was well within normal and usually they didn't even transport. Our protocols do not give us permission to give anything by mouth either, however in an pinch, if nothing else was available I would definitely use it.

By: Medicprincess72

Medicprincess72 — Wed, 23 Jun 2010 21:52:36 +0000

British Columbia has moved from a protocol based system, to a “Treatment Guidelines” system. All of our protocols have a medical principals document attached to them, and our priority is to meet our objective within the scope of practice and based on the appropriate medical principals, ie, get his blood sugar up in this case. Juice and a “medical sammich” as you are doing here would be encouraged, as the risk is lower for administering juice than for IV D-10 or glucagon, with the same likely benefit. As I said, accomplish the objective, within your scope of practice, and based on the medical prinicipals involved, with a consideration to risk / benefit ratios, and you're golden. Scared me at first, but I can not imagine going back to medicine by cook book now ( A + B = C, etc)