SQuID Protocol for DKA: Impact on ED Length-of-Stay

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SQuID Protocol for DKA: Impact on ED Length-of-Stay

With the advent of fast-acting subcutaneous insulin analogs over the past 20 years, multiple studies have demonstrated that subcutaneous insulin protocols for treatment for treatment of mild-to-moderate severity DKA are safe and cost-effective when compared to intravenous insulin infusion protocols in non-ICU settings. In the context of increasing ED and hospital crowding as well as limited ICU availability, this study aimed to evaluate the impact of a subcutaneous insulin (SQuID) protocol in the treatment of DKA on emergency department length-of-stay (EDLOS) and ICU admissions

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Grand Rounds Recap 9.28.22

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Grand Rounds Recap 9.28.22

This week we had a tour de force of education goodness. We started off with Dr. Mullen presenting Morbidity and Mortality Conference. This was followed with an updated DKA QI/KT protocol developed by Dr. Shaw and Dr. Glenn. More great faculty Core Content was brought by Dr. Irankunda elucidating high pressure injection injuries. We wrapped up the day with some research nuggets with Dr. Freiermuth.

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Hyperglycemia in the ED

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Hyperglycemia in the ED

In 2016, a total of 16 million ED visits were reported with diabetes listed as a diagnosis, with 224,000 of these being for hyperglycemic crisis (1). In this post, we will explore the evaluation and treatment of various hyperglycemic etiologies in the ED through a series of clinical scenarios.

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Grand Rounds Recap 10/14

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Grand Rounds Recap 10/14

Reviewing our own neuroimaging just got a little easier with expertise shared by Dr. Knight. Trauma resuscitations just got a little more evidence-based with Journal Club covering VL>DL, IO>IV, and arginine vasopressin administration. Our kindness, attitude, and desire to take breaks all can improve with the help of Dr. Li’s R4 Capstone. Finally, Quarterly Sim/Oral Boards covered the spectrum of pediatric DKA with cerebral edema, to PTA, to trauma in the elderly, highlighting the breadth and depth of emergency medicine.

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Grand Rounds Recap 07.22.20

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Grand Rounds Recap 07.22.20

This week’s Grand Rounds was full of teamwork, sports medicine, fast-paced lecturing, and just a little rivalry. Whether you’re a fan of the R2 CPC format or the R4 Case Follow-Up, this week’s summary is sure to be a crowd pleaser. Also including Dr. Benoit’s lit of practice changing EM articles of the last year - with links!

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Air Care / B Pod Series: Intravenous Fluid Resuscitation

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Air Care / B Pod Series: Intravenous Fluid Resuscitation

Normal saline has taken hold as the de facto resuscitative fluid in the majority of health care institutions in the developed world. Walk through the recent data with Dr. Christopher Shaw which suggests that balanced fluids may provide benefit to patients suffering from a wide array of critical illnesses.

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Grand Rounds Recap 9.11.19

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Grand Rounds Recap 9.11.19

Drs. Winslow and Habib started the Grand Rounds off with a case-based discussion on the Centor Criteria and testing for strep pharyngitis. Drs. Walsh and Sabedra led an interesting discussion about a case of TTP. In his R4 Case Follow Up lecture, Dr. Nagle presented about DKA and family presence during resuscitation. Dr. Hogan, one of the EMS Fellows, gave a great presentation about the current controversies in cardiac arrest management. Finally, the week wrapped up with some great simulation and cases from our PEM fellows about post T&A bleeds, PTA, and acute chest syndrome.

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Grand Rounds Recap 7.31.19

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Grand Rounds Recap 7.31.19

This week Dr. Kathryn Banning led us in our first Morbidity and Mortality conference of the year. Dr. Banning led us through robust discussion about concurrent pathology presentations, biases and more. Air Care Grand Rounds followed, in which we reviewed aircraft operations and logistics with the Air Care team and went through a simulation case that highlighted the importance of stress inoculation.

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Grand Rounds Recap 1.24.18

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Grand Rounds Recap 1.24.18

This week's Grand Rounds started off with our monthly Morbidity and Mortality conference with Dr. Titone.  This was followed by a lecture on pediatric bloody diarrhea with Dr. Shan Modi.  Dr. Claire O'Brien then gave her Clinical Soap Box lecture on cost and waste within the healthcare system.  Dr. Kreitzer then gave an evidence based lecture on current research in sepsis and refractory septic shock, followed by our consultant of the month lecture with Dr. Anthony Blanchard from podiatry discussing foot wounds and osteomyelitis.

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Grand Rounds Summary 9.27.17

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Grand Rounds Summary 9.27.17

Dr. Titone held a great in-depth M&M this month with cases from tuberculosis to typhilitis (which is a thing). Drs. Baez and Goel took us through cases of coding Torsades and coding Pine Sol ingestions, followed by Dr. Skrobut who delicately closed the day with a discussion of testicular complaints in the ED.

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Grand Rounds Recap 8.30.2017

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Grand Rounds Recap 8.30.2017

This week Dr. Gorder led us off with August's M&M cases, followed by Dr. Betz giving us great in-depth example of a proper joint exam from the perspective of sports medicine. Dr. Makinen gave us a talk of accidental hypothermia, Dr. Ludmer examined the link between chronic pain and depression and how concurrent treatment can help our patients quality of life. Dr. Wright gave us an update on UCEM Global Health and Dr. Colmer gave us a look into the critical care management of a DKA case.

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Grand Rounds Recap 8.9.17

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Grand Rounds Recap 8.9.17

This week's Grand Rounds began with Quarterly Sim led by Dr. LaFollette who walked us through a case of cardiogenic shock and neutropenic fever. Dr. Curry led us through an oral boards triple case with an unstable MCC, a FB ingestion and perforated viscous. Dr. Hill presented an eOrals case of thyroid storm. Lastly was PEM-EM combined conference, led by Dr. Wurster Ovalle, which focused on the treatment of pediatric DKA with a special focus on cerebral edema. 

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Grand Rounds Recap 3.1.17

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Grand Rounds Recap 3.1.17

This week Dr. Axelson took us through great DKA in pregnancy, hyponatremia tips, and prioritization in UGIB in this month's M&M. Critical Care bound Dr. Renne laid out some intra-arrest tips and Dr. Brown from Cincinnati Children's talked about Adult Congenital Heart Disease. Small groups covered everything from ACLS logistics to shoulder US to Minnesota tube insertion. 

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Grand Rounds Recap 9.28.2016

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Grand Rounds Recap 9.28.2016

Dr. Axelson kicked off Grand Rounds this week with a look at DKA, hypercalcemia, suicide in the ED and more during M&M. Then we learned about Hereditary Angioedema, Thyroid Emergencies, Concussions, NIPPV and got a chalk talk about setting end goals of resuscitation from Dr. Dave Norton.  

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Grand Rounds Recap 12/9/15

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Grand Rounds Recap 12/9/15

Glucose Emergencies

Remember the "I's" when looking for cause of DKA/HHS: Infection, Insulin lack, Infarction (MI, CVA, Ischemic gut), Indiscretion (EtOH, cocaine), Infant (pregnancy).

After 2L NS fluid bolus in the hemodynamically stable patient, the corrected sodium should guide fluid choice for further therapy.

Venous pH, HCO3 and base excess have sufficient agreement to be interchangeable with ABG in the ED.

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