D10
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Symptom improvement
|
Patient
|
PH-Paramedic
|
Hurtubise M, Stirling J, Greene J, Carter AJ, Swain J, Brown R, et al. Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review. Prehosp Disaster Med 2021; 36(6):730–8. Medline
|
|
I
|
Supportive (Green)
|
Time to GCS recovery
|
Process
|
|
Moore C., Wollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emerg Med J 2005; 22:512-515 Medline
|
|
II
|
Supportive (Green)
|
Resoration of BGL without re-administation
|
Patient
|
PH-Paramedic
|
Weant KA, Deloney L, Elsey G, Combs D, French D. A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting. J Pharm Pr 2021; 34(4):606–11. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
|
Hern HG., Kiefer M., Louie D., Barger J., Alter HJ. D10 in the Treatment of Prehospital Hypoglycemia: A 24 Month Observational Cohort Study. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors ;21(1):63-67. Medline
|
|
III
|
Supportive (Green)
|
Feasibility
|
Process
|
|
Kiefer MV., Gene HH, Alter HJ., Barger JB. Dextrose 10% in the treatment of out-of-hospital hypoglycemia. Prehosp Disaster Med 2014;29(2):190-4. Medline
|
D50W
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Time until full recovery
|
Patient
|
ED-MD
|
Carstens S., Sprehn M. Prehospital treatment of severe hypoglycemia: A comparison of intramuscular glucagon and intravenous glucose. Prehos Dis Med 1998; 13(2):114-25. Medline
|
|
I
|
Supportive (Green)
|
Satey
|
Process
|
PH-Paramedic
|
Hurtubise M, Stirling J, Greene J, Carter AJ, Swain J, Brown R, et al. Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review. Prehosp Disaster Med 2021; 36(6):730–8. Medline
|
|
I
|
Supportive (Green)
|
Time to GCS resolution
|
Patient
|
PH-Paramedic
|
Moore C., Wollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emerg Med J 2005; 22:512-515 Medline
|
|
I
|
Supportive (Green)
|
Restoration of normal level of consciousness
|
Patient
|
ED-MD
|
Patrick AW., Collier A., Hepburn DA., Steedman DJ., Clarke BF., Robertson C. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department. Arch Emerg Med 1990; 7(2):73-7. Medline
|
|
II
|
Supportive (Green)
|
Time to full orientation
|
Patient
|
PH-Paramedic
|
Howell MA., Guly HR. A comparison of glucagon and glucose in prehospital hypoglycemia. J Accid Emerg Med 1997; 14:30-2. Medline
|
|
II
|
Supportive (Green)
|
Efficacy of restoring normoglycemia
|
Patient
|
PH-Paramedic
|
Weant KA, Deloney L, Elsey G, Combs D, French D. A Comparison of 10% Dextrose and 50% Dextrose for the Treatment of Hypoglycemia in the Prehospital Setting. J Pharm Pr 2021; 34(4):606–11. Medline
|
|
III
|
Supportive (Green)
|
Success
|
Patient
|
PH-Paramedic
|
Weston C., Stephens M. Hypoglycemic attacks treated by ambulance personnel with extended training. Br Med J 1990; 300:908-909. Medline
|
|
III
|
Neutral (Yellow)
|
Response to D50W, appropriate diagnosis
|
Patient
|
PH-Paramedic
|
Hoffman JR., Schriger DL., Votey SR., Luo JS. The empiric use of hypertonic dextrose in patients with altered mental status: A reappraisal. Ann Emerg Med 1992; 21(1):20-4. Medline
|
Glucagon
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
I
|
Supportive (Green)
|
Time until full recovery
|
Patient
|
ED-MD
|
Carstens S., Sprehn M. Prehospital treatment of severe hypoglycemia: A comparison of intramuscular glucagon and intravenous glucose. Prehos Dis Med 1998; 13(2):114-25. Medline
|
|
I
|
Supportive (Green)
|
Restoration of normal level of consciousness
|
Patient
|
ED-MD
|
Patrick AW., Collier A., Hepburn DA., Steedman DJ., Clarke BF., Robertson C. Comparison of intramuscular glucagon and intravenous dextrose in the treatment of hypoglycaemic coma in an accident and emergency department. Arch Emerg Med 1990; 7(2):73-7. Medline
|
|
II
|
Supportive (Green)
|
Time to full orientation
|
Patient
|
PH-Paramedic
|
Howell MA., Guly HR. A comparison of glucagon and glucose in prehospital hypoglycemia. J Accid Emerg Med 1997; 14:30-2. Medline
|
|
II
|
Supportive (Green)
|
Increase in BGL
|
Patient
|
PH-Paramedic
|
Vermeulen MJ., Klompas M., Ray JG., Mazza C., Morrison LJ. Subcutaneous glucagon may be better than oral glucose for prehospital treatment of symptomatic hypoglycemia. Diabetes Care 2003; 26(8):2472-2473. Medline
|
|
III
|
Supportive (Green)
|
ED LOS
|
Patient
|
PH-Paramedic
|
Ferrazzi S., Waltner-Toews D., Abernathy T., et al. The effects of prehospital advanced life support drug treatment on patient improvement and in-hospital utilization. Prehosp Emerg Care 2001; 5(3):252-60. Medline
|
|
III
|
Supportive (Green)
|
Correction of hypoglycemia
|
Patient
|
PH-Paramedic
|
Haamid A, Christian E, Tataris K, Markul E, Zaidi HQ, Mycyk MB, Weber JM. Prehospital Intranasal Glucagon for Hypoglycemia. Prehosp Emerg Care 2022:1–4. Medline
|
|
III
|
Supportive (Green)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Vukmir RB., Paris PM., Yealy DM. Glucagon: Prehospital therapy for hypoglycemia. Ann Emerg Med 1991; 20(4):375-379. Medline
|
Option to treat and release
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
II
|
Supportive (Green)
|
Bounce back
|
Patient
|
PH-Paramedic
|
Anderson S., Hogskilde PD., Wetterslev J., et al. Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: A retrospective study. Acta Anaesthesiol Scand 2002; 46(4):464-8. Medline
|
|
II
|
Supportive (Green)
|
Repeat ambulance call, recurrence of hypoglycemia
|
Process
|
PH-Paramedic
|
Cain E., Ackroyd-Stolarz S., Alexiadia P., Murray D. Prehospital hypoglycemia: the safety of not transporting treated patients. Prehospital Emergency Care 2003; 7:458-65. Medline
|
|
II
|
Supportive (Green)
|
Relapse within 3 days
|
Process
|
PH-Paramedic
|
Carter AJ., Keane PS., Dreyer JF. Transport refusal by hypoglycemic patients after on-scene intravenous dextrose. Acad Emerg Med 2002; 9(8):855-7. Medline
|
|
II
|
Supportive (Green)
|
Relapse
|
Patient
|
PH-Paramedic
|
Socransky SJ., Pirrallo RG., Rubin JM. Out-of-hospital treatment of hypoglycemia: Refusal of transport and patient outcome. Acad Emerg Med 1998; 5(11):1080-1085. Medline
|
|
III
|
Supportive (Green)
|
Transport to hospital
|
Patient
|
PH-Paramedic
|
Khunti K., Fisher H., Paul S., Iqbal M., Davies MJ., Siriwardena AN. Severe hypoglycaemia requiring emergency medical assistance by ambulance services in the East Midlands: A retrospective study. Prim Care Diabetes 2013; 7(2):159-65. Medline
|
|
III
|
Supportive (Green)
|
Safety
|
Process
|
PH-Paramedic
|
Lerner EB., Billittier AJ 4th., Lance DR., Janicke DM., Teuscher JA. Can paramedics safely treat and discharge hypoglycemic patients in the field? Am J Emerg Med 2003; 21(2):115-20. Medline
|
|
III
|
Supportive (Green)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Mattila Elina M., Kuisma Markku J., Sund Kaj P., Voipio-Pulkki. Out-of-hospital hypoglycaemia is safely and cost-effectively treated by paramedics. European Journal of Emergency Medicine 2004; 11(2):70-4. Medline
|
|
III
|
Supportive (Green)
|
Recurrence of symptoms
|
Patient
|
PH-Paramedic
|
Mechem CC., Kreshak AA., Barger J., Shofer FS. The short-term outcome of hypoglycemic diabetic patients who refuse ambulance transport after out of hospital therapy. Acad Emerg Med 1998; 5(8):768-72. Medline
|
|
III
|
Supportive (Green)
|
Patient preference
|
Patient
|
PH-Paramedic
|
Steinmetz J., Nielsen SL., Rasmussen LS. Hypoglycaemia in patients with diabetes: do they prefer prehospital treatment or admission to hospital? Eur J Emerg Med 2006; 13(5):319-320. Medline
|
|
III
|
Supportive (Green)
|
Triage
|
Process
|
PH-Paramedic
|
Strote J., Simmons R., Eisenberg M. EMT treatment of hypoglycemia without transport. Am J Emerg Med 2008; 26:291-5. Medline
|
|
III
|
Supportive (Green)
|
Success
|
Patient
|
PH-Paramedic
|
Weston C., Stephens M. Hypoglycemic attacks treated by ambulance personnel with extended training. Br Med J 1990; 300:908-909. Medline
|
|
III
|
Neutral (Yellow)
|
Risk of repeat hypoglycemic events
|
Patient
|
PH-Paramedic
|
Fitzpatrick D., Duncan EA. Improving post-hypoglycaemic patient safety in the prehospital environment: A systematic review. Emerg Med J 2009; 26(7):472-8. Medline
|
Point of Care Blood Glucose Monitoring
| Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
|
II
|
Supportive (Green)
|
Accuracy of rapid glucose testing
|
Patient
|
PH-Paramedic
|
Holstein A., Kuhne D., Elsing HG., et al. Practicality and accuracy of prehospital rapid venous blood glucose determination. Am J Emerg Med 2000; 18(6):690-4. Medline
|
|
II
|
Supportive (Green)
|
Detection of hypoglycemia
|
Process
|
PH-Paramedic
|
Lavery RF., Allegra JR., Cody RP., Zacharias D., Schreck DM. A prospective evaluation of glucose reagent test strips in the prehospital setting. Am J Emerg Med 1991; 9(4):304-8. Medline
|
|
II
|
Supportive (Green)
|
Sensitivity and specificity
|
Process
|
ED-MD
|
Scott PA., Wolf LR., & Spadafora MP. Accuracy of reagent strips in detecting hypoglycemia in the emergency department. Ann Emerg Med 1998; 32(3):305-309. Medline
|
|
III
|
Supportive (Green)
|
Glucose value
|
Process
|
PH-Paramedic
|
Jones JL., Ray VG., Gough JE., Garrison HG., Whitley TW. Determination of prehospital blood glucose: A prospective, controlled study. J Emerg Med 1992; 10(6):679-82. Medline
|
|
III
|
Supportive (Green)
|
Triage
|
Process
|
PH-Paramedic
|
Strote J., Cloyd D., Rea T., Eisenberg M. The influence of emergency medical technician glucometry on paramedic involvement. Prehosp Emerg Care 2005; 9(3):318-321. Medline
|