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Podcast 711: Insulin Pumps

Emergency Medical Minute

Release Date: 09/07/2021

Podcast 816: Ventilator Management in Asthmatics show art Podcast 816: Ventilator Management in Asthmatics

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: The management of severe asthma or COPD exacerbation is complex, especially when the patient requires intubation/ventilation Asthma is an obstructive airway disease that can cause air trapping and hyperinflation of the lungs To avoid worsening hyperinflation patients typically require slower respiratory rates, lower tidal volumes, and increased expiratory time when on a ventilator Patients on a ventilator require very close monitoring to prevent worsening hyperinflation and associated complications including barotrauma and...

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Podcast 815: Fluid Resuscitation in Pancreatitis show art Podcast 815: Fluid Resuscitation in Pancreatitis

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Historically, pancreatitis has been treated with aggressive IV fluid rehydration. Recently published data shows this may not be appropriate. A randomized, controlled, multi-hospital trial evaluated outcomes for patients with acute pancreatitis receiving lactated Ringer’s solution    Aggressive fluid resuscitation group received 20ml/kg bolus + 3ml/hour  Moderate fluid resuscitation groups received either 10 ml/kg bolus if hypovolemic or no bolus if normovolemic. Both moderate resuscitation groups received...

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Podcast 814: Post-concussion Treatment show art Podcast 814: Post-concussion Treatment

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Recent study looked at the impact of screen time on duration of post-concussive symptoms 125 patients aged 12-25 diagnosed with a concussion were randomized to either abstain from or have unrestricted screen time for 48 hours after injury Patients with unrestricted screen time averaged approximately 5 hours/day of screen time Patients in the no screen time group averaged approximately 1 hour/day of screen time Statistically significant difference in duration of post-concussive symptoms Unrestricted screen time cohort averaged 8 days of...

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Podcast 813: Pulse Oximetry show art Podcast 813: Pulse Oximetry

Emergency Medical Minute

Contributor: Travis Barlock, MD Educational Pearls: Most oxygen in the body is bound to hemoglobin, forming oxyhemoglobin. Less than 1% of the oxygen in the body is dissolved in plasma.  Pulse Oximeters (Pulse Ox) function by emitting wavelengths of light from one side, and capturing the amount absorbed on the opposite side. A calculation determined the amount of saturation.  Pulse Ox relies on pulsations in arterial flow to create a photoplethysmogram (pleth) for measurements  Patients with poor peripheral perfusion may have unreliable pulse ox. Patient with an LVAD have...

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Podcast 812: PO Medications show art Podcast 812: PO Medications

Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: PO medications are less frequently used in the ED due to their longer onset of action        The position the patient is in when given PO medications may affect how quickly the medication is absorbed The quicker the medication passes through the stomach into the small intestine, the quicker it can be absorbed and metabolized Recent study used in silico gastric biomechanics model to compare the length of time it took PO medications to pass through the stomach based on the patient’s positioning Compared the...

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Podcast 811: Ketamine for Pain show art Podcast 811: Ketamine for Pain

Emergency Medical Minute

Contributor: Lessen, Aaron MD Educational Pearls: Ketamine can be given at 0.2-0.3 mg/kg as subdissociative doses for pain control in the ED Ketamine coadministered with Haldol may reduce agitation A recent study in Iran compared subdissociative Ketamine given with 2.5 mg Haldol to 1 mg/kg Fentanyl for pain control in the ED Ketamine with Haldol had better pain control than Fentanyl at 5, 10, 15 and 30 minutes  Ketamine with Haldol less frequently required rescue medication  Ketamine with Haldol did have increased agitation at only the 10 minute mark Of note, there was not a...

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Podcast 810: Tooth Replantation show art Podcast 810: Tooth Replantation

Emergency Medical Minute

Contributor: Jarod Scott, MD Educational Pearls: There is a 1-hour window for tooth replantation in ED Cold milk is often best transport media unless there is access to specialized solutions (Hank’s Balanced Solution) Goal is to preserve periodontal ligament Soaking in tap water should be avoided as it will lyse cells of periodontal ligament     If oral surgeon is rapidly available, have them perform replantation Do not delay replantation to wait for an oral surgeon to become available Steps in tooth reimplantation Disturb the socket as little as possible Handle...

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Podcast 809: Achilles Tendon Rupture show art Podcast 809: Achilles Tendon Rupture

Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Achilles tendon rupture usually presents in younger, healthy patients after a sports injury Patients typically present complaining of an abrupt onset ankle pain after feeling a “pop” Pain can be localized to posterior ankle and patient’s lack the ability to plantarflex Achilles rupture is a clinical diagnosis and does not usually require imaging in the ED Thompson test Having patient lay on their stomach and squeezing the calf on the injured side should result in plantarflexion  If the Achilles is ruptured, no plantarflexion...

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Podcast 808: BVM and PEEP Valve show art Podcast 808: BVM and PEEP Valve

Emergency Medical Minute

Contributor: Dylan Luyten, MD Educational Pearls: Positive End Expiratory Pressure (PEEP) is positive pressure within the lungs and maintained throughout the entire respiratory cycle. It is the pressure preventing alveoli from collapsing at the end of exhalation.  When using a bag valve mask (BVM) to ventilate patients, always attach the PEEP valve to prevent intrathoracic pressure from returning to atmospheric pressure which would allow alveoli collapse.     A BVM with a good seal to patients face and with an attached PEEP valve provides the same support as BiPAP or...

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Podcast 807: Ring Removal Tricks show art Podcast 807: Ring Removal Tricks

Emergency Medical Minute

Contributor: Jared Scott, MD Educational Pearls: If a patient is in significant pain, a digital block can be helpful. Pain management alone may allow for manual ring removal.  Ring cutters and trauma shears with specialized ring cutters can be attempted but will destroy the ring and some materials may be resistant to cutting.  2 alternative options are presented which aim to reduce edema above the ring to assist removal:  Move the ring as proximally as possible. Wrap large size suture from the ring distally beyond PIP joint. Slide the ring over the suture and off the...

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More Episodes

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Insulin pumps provide a continuous infusion of fast-acting insulin using a basal rate and bolus prior to meals
  • Some connect to a continuous glucometer but often blood glucose needs to be checked manually
  • Hypoglycemia is rarely due to a malfunctioning pump - there is usually an another external factor
  • Hyperglycemia can be caused by underdosing, illness, pump malfunction or expired insulin
  • The pump can be used to give a bolus of insulin in the emergency department if necessary
  • Stopping the  device can be done manually on the device or disconnecting it from the tubing attachment - do not remove the tubing from the skin site if possible

References

Nimri R, Nir J, Phillip M. Insulin Pump Therapy. Am J Ther. 2020;27(1):e30-e41. doi:10.1097/MJT.0000000000001097

Sora ND, Shashpal F, Bond EA, Jenkins AJ. Insulin Pumps: Review of Technological Advancement in Diabetes Management. Am J Med Sci. 2019;358(5):326-331. doi:10.1016/j.amjms.2019.08.008

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

 

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