Keywords: Glucometer, Accuracy (PubMed Search)
The glucometer is one of the devices that we quickly reach for in the management of our unresponsive patients, diabetics and in the critically ill. Recently, I noticed that our Roche Accu-Check has a big sticker on the case stating that results could be affected by therapies that alter the metabolism of galactose, maltose, and xylose. Since this was a big hole in my fund of knowledge I decided to look up what else affects the accuracy of glucometers.
Now, Dr. Winters already warned used about the inaccuracy of bedside glucometer readings in the critically ill, but what about the patient that is not septic and/or in shock.
Substances/Drugs that have been reported to affect the accuracy of glucometers are:
Anemia also results in higher values, and a capillary blood sample can differ from venous blood by as much as 70mg/dL.
Most errors are more significant when dealing with hypoglycemia.
So the moral of the story is be careful with a bedside glucometer when the reading is low, as the venous blood sample sent to the lab may return even lower. Error on the side of treating the patient with glucose.
Fahy BG, Coursin DB. Critical glucose control: the devil is in the details. Mayo Clin Proc. Apr 2008;83(4):394-397.
Keywords: high altitude illness (PubMed Search)
High altitude illnesses is typically called Acute mountain sickness (AMS) and is associated with two major complications high altitude pulmonary edema (HAPE) and high altitude cerebral edema (HACE).
Symptoms associated with AMS are headache, fatigue, nausea and vomiting, anorexia and insomia. Cough, Cyanosis, hypoxia, and dyspnea are associated with HAPE. HACE is associated with progressive neurologic symptoms and can lead to ataxia and coma.
Factors that increase your risk for altitude illnesses are:
Keywords: Hypothyroidism, Myxedema, Treatment (PubMed Search)
Severe Hypothyroidism or Myxedema Coma
Keywords: superior vena cava, svc syndrome (PubMed Search)
Superior Vana Cava Synrome....when to suspect
Two common causes of SVC syndrome include thrombus (secondary to CV catheters) and lung tumors/lymphoma
Consider this diagnosis in patients with a history of cancer and/or who have a central line in place and the complaint of facial swelling. Patients may not look swollen to you.
In addition, make sure to look at their necks and chest wall-presence of asymmetric, prominent veins should prompt consideration for this diagnosis.
A useful clinical tool is to look at the patient's driver's license (assuming they have one) and compare to their appearance on presentation.
Workup in most cases will involve a CT of the chest.
Clinical Oncology, 2007
Keywords: Leukemia (PubMed Search)
Suspected Acute Leukemia in the ED
Key ED Interventions for patients with astronomically high WBC counts:
Keywords: Fever (PubMed Search)
A few pearls about neutropenic fever:
IDSA Guidelines on Neutropenic Fever, 2002. New Guidelines coming Summer 2008!
Keywords: Oncologic, Emergency, SVC Syndrome (PubMed Search)
Clinical Presentation of SVC Syndrome
SVC syndrome (caused either by tumor or thrombosis of the SVC) classically presents with facial swelling, arm swelling, and dilated chest wall veins. The problem in the real world is that often times the manifestaions are a bit more subtle.
Some SVC syndrome pearls:
Keywords: Coding, Billing, Reimburshment (PubMed Search)
The insurance companies are always trying to down code our visits so that they can save money, and unless we diagnosis the patients with the appropriate jargon it can cost us a lot of money. Here are some coding suggestions as written by Sharon Nicks, President and CEO of Nicks & Associates in EP Monthly .
|Diagnosis ||Consider Diagnosising It this, if the condition fits|
|Flu/Viral Ilness|| |
|Musculoskeletal Pain|| |
|Otitis Media|| |
The moral of this pearl is try to use words like Acute, Severe, Sudden, Serious, Distress, Pain, or Fever so that it is clearer to the insurance companies that the patient warranted a visit to a physician (i.e.: an ED) before their PCP could see them in a week.
Keywords: administrative, notice, admin, tech (PubMed Search)
Notes to authors
Keywords: Ureteral, stone, tamsulosin, management (PubMed Search)
Keywords: Listserv, mailing list, test (PubMed Search)