UTSW/BioTel EMS ALERT June 8, 2016  EMS Alert 16-002     PDF Here

Change to Adult Glucagon Dose Range & “Minimum Carry” Requirement

Purpose:

To notify UTSW/BioTel EMS Providers that, effective immediately, the adult dosage range for glucagon shall be changed to 1 to 2 mg IV/IO/IM/IN.

Background:

  1. Prehospital indications for glucagon administration include: second- or third-line treatment for symptomatic hypoglycemia and cardiac dysrhythmias/cardiac arrest due to beta-blocker toxicity.
  2. The current UTSW/BioTel EMS System Guidelines for Therapy necessitate a “minimum carry” of five unit doses, in order to meet the adult dosing range of up to 5 mg for adult patients
  3. . This creates an excessive cost burden for EMS agencies, especially since few patients will benefit from more than two doses prior to hospital arriva

Critical Points, Effective Immediately:

  1. For the relevant treatment guidelines, the adult dosage range shall be changed to 1 to 2 mg, reducing the ALS apparatus “minimum carry” to two unit doses
    1. Unless otherwise specified*, the change affects ONLY ADULT dosing guidelines, not pediatric.
Page Topic Old New
20  Altered LOC Bullet 7 Adult: 1 mg,
may repeat once
Bullet 11 Adult: 1 - 5 mg		 Bullet 7 Adult : No change
Bullet 11 Adult: 1– 2 mg
23  Asystole/PEA Bullet 4g Adult: 1 - 5 mg Bullet 4g Adult: 1 - 2 mg
26  Bradycardia Bullet 8 Adult: 1 - 5 mg Bullet 8 Adult: 1 - 2 mg
51  Seizure Bullet 7 Adult: 1 - 5 mg Bullet 7 Adult: 1 - 2 mg
68  VF/Pulseless VT Bullet 6 Adult: 1- 5 mg Bullet 6 Adult: 1- 2 mg
152  Glucagon

Adult dose for hypoglycemia: "additional doses"

Adult dose for bradycardia or cardiac arrest (beta-blocker overdose) 1 - 5 mg

Pediatric dose*: "additional doses"

Adult dose for hypoglycemia: "an additional dose"

Adult dose for bradycardia or cardiac arrest (beta-blocker overdose) 1 - 2 mg

Pediatric dose*: "an additional dose"

 

Resources: UTSW/BioTel EMS Guidelines for Therapy

UTSW/BioTel EMS Providers may contact BioTel or the EMS Medical Direction Team at any time with questions or concerns about this Alert, or about any aspect of patient care.