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 <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<4.0 mmol/L in an adult and 3.0 mmol/L in child<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 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 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

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.

scholarly journals Clinical and Epidemiological Features of the Course of Acute Bacterial Meningitis in Various Age Groups

2019 ◽  
Vol 5 (11) ◽  
pp. 104-114
Author(s):  
A. Beregovoi ◽  
Z. Dzholbunova ◽  
R. Kadyrova
Keyword(s):  
Bacterial Meningitis ◽  
Age Groups ◽  
Statistical Processing ◽  
Descriptive Statistics ◽  
Acute Bacterial Meningitis ◽  
Bonferroni Correction ◽  
Case Histories ◽  
Epidemiological Features ◽  
Disease Indicators

The clinical and epidemiological features of the course of acute bacterial meningitis in various age groups of patients in the period from 2014 to 2018 are described. An analysis of 398 case histories of patients was performed. Patients were divided into 5 age groups. The inclusion criterion is the presence of bacterial meningitis of any etiology. Patients with serious meningitis of viral and tuberculous etiology were excluded. Statistical processing was carried out using the SPSS program (determination of compliance with Gauss law, descriptive statistics, determination of average values, relationships between disease indicators, Bonferroni correction). Risk factors were determined, the course of neuro infection in various age groups was revealed, the criteria and the timing of the diagnosis of meningitis.

scholarly journals Interrelation between body weights of sire, dam and their lambs at early stage of growth

2020 ◽  
Vol 36 (2) ◽  
pp. 205-214
Author(s):  
Violeta Caro-Petrovic ◽  
Milan Petrovic ◽  
Dragana Ruzic-Muslic ◽  
Nevena Maksimovic ◽  
Irina Sycheva ◽  
...  
Keyword(s):  
Body Weight ◽  
Early Stage ◽  
Descriptive Statistics ◽  
Coefficient Of Determination ◽  
Measures Of Association ◽  
Paired Sample ◽  
Body Weights ◽  
Sample Test ◽  
Highly Correlated

Records of female lambs and their parents of the Mis sheep breed have used. All animals are approximately have weaned at 90 days of age. Descriptive statistics, paired sample test, paired differences, measures of association, correlations and regression of body weights between female lambs and their parents have done. A complementary least body weights at 30 days and weaning between dams and lambs but utmost weight at 30 days, the lambs were higher while at weaning, the dams had higher weight. It can observe that the averages on body weights the rams were the highest, followed by lambs and the lowest the dams? body weights. The coefficient of determination of R2 varies from low to high, indicating that the lamb's body weight has more influenced by other factors that we have not considered. There were significant correlations between lamb body weight at birth and sire/dam body weight at birth. The results showed highly significant correlations of lamb's body weight at 30 days with dams but with sires, positive and very low. There had positive but no significant correlation between lamb body weight at weaning and sire body weight at weaning. Lamb body weight at weaning and dam body weight at weaning are highly correlated.

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.

scholarly journals MP10: How dry I am: how much fluid do paramedics give when they administer an IV fluid bolus?

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S68
Author(s):  
D. Eby ◽  
J. Woods
Keyword(s):  
Primary Care ◽  
Random Number ◽  
Bolus Administration ◽  
Further Training ◽  
Bolus Volume ◽  
Initial Sample ◽  
Fluid Bolus ◽  
Procedure Code ◽  
Random Number Table ◽  
The Mean

Introduction: How is “administer a fluid bolus” interpreted by paramedics? There is no existing literature describing this practice in the prehospital setting. Paramedic medical directives authorize the administration of Normal Saline 20 ml/kg to hypotensive patients (systolic BP &lt;90). Anecdotally, auditors of Ambulance Call Reports (ACRs) and paramedics report this amount of fluid is rarely administered. The aim of this study was to determine the amount and rate of IV fluid administered by Advanced Care (ACP) and Primary Care (PCP) paramedics when they give an IV ‘fluid bolus’ during an ambulance call. Methods: We conducted a retrospective analysis of iMedic platform, electronic, ACRs (January 01, 2015 to June 30, 2015) from 8 municipal paramedic services that serve an urban and rural population of 1.4 million. ACRs containing a procedure code 351 (intravenous fluid bolus) were identified. A stratified, random sample of 20 cases per paramedic category (ACP and PCP) from each service 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: The initial sample was 220 cases. 25 were excluded for incomplete documentation, leaving 195 cases (ACP 59, PCP 136) for analysis. The mean IV fluid bolus volume delivered was: ACP 414.8 ml (95%CI: 344.2, 485.4), PCP 242.3 ml (95%CI: 210.9, 274.5). The mean rate of infusion was: ACP 22.7 ml/min (95%CI: 17.6, 27.8) PCP 15.7 ml/min (95%CI 13.2,18.1). Percentage of cases where &gt;250 ml was infused: ACP 74.6%, PCP 44.1%. Percentage of cases where at least 10 ml/kg of fluid was given: ACP 17.0%, PCP 2.9%. Percentage of cases reaching the maximum 20 ml/kg of fluid: ACP 0.5%, PCP 0%. IV cannula size: 18G-ACP 57.4%, PCP 33.3%; 20G ACP 37.0%, PCP 56.8; 22G ACP 0.6%, PCP 9.8%. Conclusion: Paramedics rarely gave the amount of IV fluid they were authorized to give to hypotensive patients. On average, Advanced Care Paramedics administered significantly more fluid and gave it significantly faster than Primary Care Paramedics. ACPs were more likely than PCPs to use 18G cannulas and rarely used 22G cannulas whereas PCPs preferred to use 20G IV cannulas. Further training is required to clarify and improve the paramedic practice of IV bolus administration.

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