DKA…some insights into it’s management

  1. A VBG is adequate for the diagnosis and ongoing management of patients with DKA. ABGs offer no added benefit and are associated with increased pain and complications.
  2. Patients with DKA may present with a weak or absent nitroprusside assay reaction on urinalysis for ketones as this test only checks for acetoacetate (the minor ketone body produced in DKA). Serum beta-hydroxybutyrate testing may be helpful in certain cases in making the diagnosis.
  3. There is no established role for administration of sodium bicarbonate to patients with DKA regardless of their pH. Sodium bicarbonate administration is associated with more complications including hypokalemia and cerebral edema.
  4. Insulin should not be started in patients with DKA until the serum potassium level is confirmed to be > 3.5 mEq/L. The use of an insulin bolus prior to infusion has not been shown to improve any patient centered outcomes or surrogate markers and is associated with an increased rate of hypoglycemic episodes.

 

read-more

Facts About Ebola

With regards to the Ebola virus spreading through direct contact with bodily fluids, if an infected person’s blood or vomit gets in another person’s eyes, nose or mouth, the infection may be transmitted. The current mortality rate is 60%.

Chosing Wisely Master List

  1. Don’t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.
  2. Don’t prescribe antibiotics for URTIs
  3. Don’t order antibiotics for adenoviral conjunctivitis (pink eye).
  4. CT scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
  5. Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.
  6. CT scans are not necessary in the routine evaluation of abdominal pain.
  7. In the evaluation of simple syncope and a normal neurological examination, don’t obtain brain-imaging studies (CT or MRI).
  8. Don’t do imaging for uncomplicated headache.
  9. Avoid imaging studies (MRI, CT, or X-rays) for acute low back pain without specific indications.
  10. Do not order CT of the cervical spine after trauma for patients who do not meet the National Emergency X-ray Utilization Study (NEXUS) low-risk criteria or the Canadian C-Spine Rule.
  11. Do not order CT to diagnose pulmonary embolism without first risk-stratifying for pulmonary embolism (pretest probability and D-dimer tests if low probability).
  12. Do not order magnetic resonance imaging of the lumbar spine for patients with lower back pain without high-risk features.
  13. Do not order CT of the head for patients with mild traumatic head injury who do not meet New Orleans Criteria or Canadian CT Head Rule.
  14. Do not order coagulation studies for patients without hemorrhage or suspected coagulopathy (eg, with anticoagulation therapy, clinical coagulopathy).