How do you administer oral glucose to a patient who requires spinal immobilization?
(This question comes from an Emergency Medical Responder perspective where IV is outside the scope of practice and oral glucose is the only option for hypoglycemic emergencies. Furthermore the question originates out of BC where local protocol states you can only obtain a capillary blood glucose sample/administer anti-hypoglycemics in known diabetics, with a decreased LOC attributable to hypo/hyperglycemia)
Ok, so how many of you said "turn the board sideways or package in the lateral position!" And yes that is most obvious (and flippant) answer but is it the only one? Well, let's look at this in more detail :
The issue here is Airway management – how do you safely administer oral glucose to a patient with a decreased LOC who has to be held supine.
First let us examine the call - What is it about the scene/situation that makes the patient eligible for both spinal management and the diabetic protocol.
The major area of overlap is decreased LOC/head injury. You will need to determine if the patients decreased LOC is because of the head injury or the diabetes. In the vast majority of cases it will be head injury related. If you have sufficient information to suspect hypo/hyperglycemia and a spinal injury i.e. a diabetic who took insulin, missed breakfast, cycled to work and fell off hitting their head (stranger things have happened) then yes, best patient care would require both.
As the issue is one of Airway management you have a couple of options:
You could administer the oral glucose in small quantities with a tongue depressor i.e. lightly rubbing it in to the buccal mucosa or small doses sublingually and allowing them to dissolve. The down side to this is that it is both time consuming and labour intensive.
In a non-traumatic patient you could place them ¾ prone (recovery) and administer the oral glucose into the buccal pouch on the lower side without risk to the airway. You could try to replicate this in a trauma patient with lateral packaging.
I would suggest you package the patient supine and the angle the board on the main cot, then support the board using blankets, towels etc before securing the cot straps. That way you will be able to administer oral glucose into the buccal pouch on the lower side thus avoiding an airway issue.