Posted by: medicblog999 | September 12, 2009

What would you do – My decision and rationale

BloodSugarTesting[5]Oh the joys of clinical decision making!!

Its been fascinating to read the comments coming in. The poll results also show the same split, not far off a 50:50 for performing a blood glucose test in the back of the ambulance as apposed to waiting until we get the child to the A&E.

So heres what I did….Its neither right or wrong, but its what I did and why I did (or didnt) do it.

As I got on the ambulance, my partner for the shift was just about to take a BM from the child. In our vehicles, we only have a one size fits all lancet, not a choice of adult or paed lancets. He looked at me with those eyes we all know, the ones that say ‘should I be doing this’.

We had a very quick discussion which went something like…..

  • Dad says baby is almost back to normal now
  • Baby doesnt look sweaty
  • baby is maintaining eye contact, moving all four limbs and is a good colour
  • Baby is showing no lasting neurological deficits
  • Baby was post ictal but seems to be returning to her norm
  • Baby has a history of fits (although cause undetermined)
  • Are we likely to try for an IV/IO even if we found hypoglycaemia (the answer to that would be yes if the patient required it, i.e. if they had altered mental status, looked diaphoretic etc, but in this case, I would say no)
  • Our hospital will most definitely check the blood sugar again in approximately 10 minutes with a paediatric lancet device
  • Baby and Dad have just settled.

However, I can see both sides of the argument, and I believe it is my role when working with a new member of staff to ‘guide’ them with relevent information but let them make the final decision (as long as it is safe). In this case, if he had wanted to do this BM test I would have let him, as it is very much open to personal clinical decision making (as is evident in the comments and the poll).

We decided together to leave the BM test for the hospital. Baby travelled peacefully up to the hospital, where they dutifully pricked her to get her blood, which came back as within normal ranges.

These sort of decisions we make day in and day out. The one thing that I always consider when making a clinical decision is purely –

‘If I end up being questioned about this decision, do I have sufficient sound clinical rationale for my course of action?’

If I am happy with my reasons for doing what I do and deciding about what I did, then that is what I will go with. Paramedics are far more than ambulance men and women who follow protocol. We should be seen to be thinking, reasoning, healthcare professionals who consider all aspects of the patient and their ill health episode whilst within our care.

So, what ever you choose to do, you were right (as long as your reasoning was more than ‘the book tells me to do it’)

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