King Sugar

It’s been my week for diabetics. Actually where I work, as I’ve written before, is a diabetic town. Some towns are trauma towns or heroin towns. I work the streets of a diabetic town. Lots of African-Americans and Jamaican-Americans with diabetes. I’m constantly going into dark cluttered homes or into nursing homes for the unresponsive. Today was a private home. Old woman on diaylsis, a good shunt in one arm, a defunct shunt in the other, edema in her extremities. I tried once in the house to get an IV in the arm with the defunct shunt with no success, and then told my partners the only way I was going to get it was in the ambulance. My eyes were also screwed up from going from the bright snow glare of the outside to the dark no lightbulb in the lamp inside. Her sugar was 31, and I admitted some defeat by giving her glucagon. I like to give D50 in the event they are going through a brittle period and need recusitation again the next day as sometimes happens with diabetics. After twenty minutes she was only up to 41 and still out of it. I was still searching for a vein and not seeing or feeling anything. I had tried twice based on anatomy and come up empty. I’m always looking. I hate to be defeated. I did an EJ on the diabetic earlier in the week, but she was really out of it and had aspirated to boot. I wasn’t going to do an EJ on this patient today, but I still wanted a line. Then just as we approached the hospital I saw a tiny little bump in her thumb, and thought what the hell. I used a 24, and got a flash. I only advanced the catheter a slight bit for fear I would blow it. It flushed fine. I taped it carefully around the thumb and slowly pushed in D50 diluted to D25. Got an amp in and flushed it with some more saline. Her sugar came up to 160 and she was talking and giving me an ever so sweet smile.

I haven’t done a shooting for the longest time and probably would fumble and stumble my way through what I was once slick at — I am no Trauma King these days — but working where I do, I am getting to be known as King Sugar to the diabetic ladies of my fair town.

2 Comments

  • Anonymous says:

    whats an EJ

  • PC says:

    An EJ is an external jugular vein found on both sides of the neck. It is a very large vein, but it is in the neck. One problem with giving Dextrose (D50 – 50%sugar in water) into the neck is if you are not properly in the vein, you can empty the entire amp of D50 and not realize you are not in the vein. What I do is periodially pull back on the needle, when I get blood flow back, I know I am still in, and so I continue to advance the dextrose. Plus just sticking a needle into someone’s neck is sort of creepy. We usually do it only when the patient is in extremis — a cardiac arrest, is the most common usage for EJ — and you can’t find a peripheral vein.

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