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When Should A Diabetic Go To The Emergency Room

Dka (diabetic Ketoacidosis): Real Life In The Emergency Room

Dka (diabetic Ketoacidosis): Real Life In The Emergency Room

This is the first in a series from Susan Dupont RN BSN who is an Emergency Room Nurse and contributor at NRSNG.com . . . Click to View All Articles in the “Real Life in the ER Series” Every patient is a mystery that needs to be solved. Some are easy, some are complex, some aren’t solvable, but the thrill of a good challenge is what keeps me coming back for more. The emergency room is full of unsolved mystery’s. Every once in a while a mystery worth writing about comes along. Altered Mental Status? It was like any normal shift. I had just discharged a patient and walked them out of the ER to turn around and see an EMS stretcher waiting to enter my room. I hadn’t even cleaned the room yet. I grabbed a piece of paper and pen and walked into my favorite type of patient, Altered Mental Status. This patient, a 20-year-old female, had been found wandering around the streets and stumbling around. She didn’t know her name and when she attempted to talk, random words were coming out of her mouth. She would only respond to a sternal rub and her breath was fruity. Vital signs: BP 80/48 mmHg Respirations of 32 Heart rate 125 bpm (sinus tachycardia on her EKG). After getting a reading of >500 blood glucose on the glucometer, we started the search for an IV. This was the challenge of the night. This little girl had absolutely tiny veins that were hidden. Her first IV gave us blood but after starting a bolus of normal saline the line infiltrated, causing a grape sized lump on her forearm. The next IV was in her hand and it worked but was only a 22 gauge. We needed better IV access. After using the infrared goggles and ultrasound we got 2 IV’s, one in each antecubital. Suspicious of Diabetic Ketoacidosis, her lab work confirmed the diagnosis. Her blood work showed: Glucose Continue reading >>

Diabetes - When You Are Sick

Diabetes - When You Are Sick

Check your blood sugar more often than usual (every 2 to 4 hours). Try to keep your blood sugar at less than 200 mg/dL (11.1 mmol/L). There may be times when you need to check your blood sugar every hour. Write down all your blood sugar levels, the time of each test, and the medicines you have taken. If you have type 1 diabetes, check your urine ketones every time you urinate. Eat small meals often. Even if you are not eating as much, your blood sugar can still get very high. If you use insulin, you may even need extra insulin injections. DO NOT do vigorous exercise when you are sick. If you take insulin, you should also have a glucagon emergency treatment kit prescribed by your doctor. Always have this kit available. Drink plenty of sugar-free fluids to keep your body from getting dried out (dehydrated). Drink at least twelve 8-ounce (oz) cups (3 liters) of fluid a day. Fluids you can drink if you are dehydrated include: Water Club soda Diet soda (caffeine-free) Tomato juice Chicken broth If your blood sugar is less than 100 mg/dL (5.5 mmol/L) or falling quickly, it is OK to drink fluids that have sugar in them. Try to check their effect on your blood sugar in the same way you check how other foods affect your blood sugar. Fluids you can drink if your blood sugar is low include: Apple juice Orange juice Grapefruit juice Gatorade or other sports drink Tea with honey Lemon-lime drinks Ginger ale If you throw up, DO NOT drink or eat anything for 1 hour. Rest, but DO NOT lie flat. After 1 hour, take sips of soda, such as ginger ale, every 10 minutes. If vomiting persists call or see your provider. When you have an upset stomach, try to eat small meals. Try carbohydrates, such as: Bagels or bread Cooked cereal Mashed potatoes Noodle or rice soup Saltines Gelatin (such as Je Continue reading >>

Find Diabetes Management At Emergency Rooms Near Me In Rockville Md

Find Diabetes Management At Emergency Rooms Near Me In Rockville Md

This is a great place that takes care of your needs!!! Thank you Evelin and Jury! We use physicians urgent care when we cant get into our primary physician and they are always very professional and caring. Very convenient to make [make a reservation] online and see estimated wait time. Highly recommend. Dr. Olisemeka was very professional yet personable. He evaluated and treated both my daughter and myself in this very busy flu season. He also pointed out a specific pharmacy for us to go to in order to find a specific form of a certain medication which saved us time instead of going to another pharmacy to find that they did not have what we needed. He is very thoughtful and thorough! Overall it was a very good experience. The staff was engaging and committed to making your visit comfortable. Dr. O was very professional and diligent. He exhibited behaviors of confidence and professionalism. Although there were many patients he was attending to, he did not rush through the examination and treatment plan. I went there few times. I always been satisfied by the service. Clean place and friendly staff. Great doctor with great bedside manor. Really did like him and would definitely come back. Very friendly had no problem answering any questions I had. The office on Shady Grove is phenomenal!!! I, like most people, am really limited with time and had but 20 mins. I called and made an appointment for 10 mins out. Meghan in particular was exceptional! She had everything ready for me when I arrived and had someone ready to assisted me. By the looks of it, Meghan was helping 2-3 clients at once and had full control of everything needed to be done. Once I was assisted and taken to be seen, I was in and out with great information. The overall experience was 5 star! They completely u Continue reading >>

Family Doc Vs. Urgent Care Vs. Er: How To Know Where To Go

Family Doc Vs. Urgent Care Vs. Er: How To Know Where To Go

Family Doc vs. Urgent Care vs. ER: How to Know Where to Go With the increase in urgent care facilities, it can be easier than ever for patients to access healthcare conveniently. With a number of facility choices, however, it can be challenging to know whether to visit the family physician, urgent care clinic or the emergency room at the hospital when illness or injury occurs. Heres how to decide. If an individual develops illness and injury that requires immediate care when his or her doctor is available, this should be the first line of treatment. Examples of minor illnesses, conditions, and injuries that can be treated by a primary care physician include: -Treatment of minor allergic reactions and allergy attacks -Minor burns, cuts, lacerations, or bites The family doctor should also be visited for regular checkups, wellness visits, and vaccinations. Urgent care is the ideal resource to rely on for any of the conditions listed above when one is not able to see their regular doctor. Unlike most primary care offices, urgent care facilities often have night, weekend, and holiday hours. In other cases, a doctor may recommend an urgent care center if he or she has no available appointments for that day. The emergency room is best reserved for real emergencies. Medical conditions that require immediate attention should be seen at the ER, including: Continue reading >>

Tia (mini Stroke) Symptoms: A Trip To The Er Doctor's View By Dr. Wedro On Medicinenet.com

Tia (mini Stroke) Symptoms: A Trip To The Er Doctor's View By Dr. Wedro On Medicinenet.com

The doctor advises the woman that there is a need to rush to medical care because if the symptoms do not resolve, there is a very narrow window of time to use alteplase ( Activase , TPA), a clot busting drug, to reverse the stroke . Within three hours of the onset of stroke symptoms , the patient needs to get to the hospital, have the initial diagnosis made, have blood tests drawn, a CT scan done to insure that bleeding is not the cause of the stroke, a neurologist needs to be consulted, and the drug given. The earlier the patient is given TPA for stroke, the better the potential outcome and the lower the risk of complications. Quick GuideStroke Causes, Symptoms, and Recovery A TIA is a stroke that resolves. Most symptoms get better on their own within minutes, but by definition, it may take up to 24 hours for the neurologic deficits to resolve. Because there is no way of knowing when a stroke begins, or whether it will resolve on its own, the EMS system (Emergency Medical Services) or 911 needs to be activated at the first sign of stroke. These symptoms of stroke include: weakness or paralysis on one side of the body, due to circulation problems at the base of the brain, loss of coordination and balance and falling without notice. Unfortunately, many patients do not qualify for TPA because they or their family do not recognize the symptoms of stroke and wait too long at home. The three hour window is very narrow. In some large hospitals, the window can be extended a couple of additional hours, if the hospital has the capability of injecting the drug directly into the blocked artery in the brain. This requires both a radiologist with special skills to thread a catheter or tube into the brain blood vessels and a hospital with the necessary equipment to do the procedure. Continue reading >>

When Should You Go To The Er When Your Child Is Sick?

When Should You Go To The Er When Your Child Is Sick?

When Should You Go to the ER When Your Child is Sick? By Dr. Byron Whyte October 26, 2016 2 Comments Dr. Whyte, is Jacob* gonna be okay? this was asked of me by the mother of a school-aged child several years ago as he laid pale and listless on the exam table. He had high fevers, fatigue, abdominal pain, headaches, muscle aches, frequent vomiting and was dehydrated. Jacob had the flu. We call lots of illnesses the flu, when we dont know what they are. Jacob didnt have the generic, nondescript, the kids sick so Im calling it the flu sort of illness. My man had the real deal, having tested positive on his nasal swab in the office the day before. Jacobs mom had never seen him this sick before and she was scared. She did the right thing and brought him in. With aggressive antiviral therapy and close follow-up, Jacob recovered nicely at home. Had his mom decided not seek medical attention, however, Im not sure that things would have turned out so rosy. Jacob, quite likely, could have been hospitalized for complications from influenza, or worse. Deciding if a child is sick-enough to need a doctors visit is something moms, dads, grannies and aunties have argued about forever. I hear it all the time in the office, I didnt want to bring her in for nothing. It doesnt have to be the flu like in Jacobs case, parents wonder all the time if their child needs to see the doctor for an ugly sore throat, a GI bug/stomach flu , or an ear ache that wont go away. Then there are the times when the parents bring a child in and theyre so sick I send them to the emergency room instead. With kids sick becomes real sick, fast, especially when theyre babies. Emily* was in the office for her nine month Well Child Check and she was cute as a button. She had developed a fever the night before but he Continue reading >>

When To See The Doctor About Sprained Ankles, Concussions & Other Sports Injuries

When To See The Doctor About Sprained Ankles, Concussions & Other Sports Injuries

When to See the Doctor About Sprained Ankles, Concussions & Other Sports Injuries Uh-oh. Your child was playing soccer and hurt his ankle. Its starting to bruise and you arent sure if your childs ankle is sprained or possibly even broken. Or, did you fall down during volleyball and hit your head and youre feeling a little hazy? Could it be a concussion? Sports injuries are common and some can be cared for at home, but there are some that require the attention of a medical professional. Its with these injuries when you ask yourself, do I need to visit my doctor or is it serious enough to go to the emergency room? A sprained ankle is one of the most common sports injuries. Approximately 25,000 people sprain their ankle each day in the United States . A sprain happens when the foot rolls or turns beyond its normal range of motion. This injury can occur while taking part in sports or simply by stepping on an uneven surface. However, do you know when you need to make a doctors appointment, visit urgent care or go to the emergency room when you sprain an ankle? Make an appointment with your primary care provider if: there is pain and swelling in the ankle but you are able to walk and you believe there is the possibility that it is a sprain. Go to urgent/express care if: you are experiencing significant pain and swelling and it is difficult to bear weight or walk without assistance. Go to the emergency room if: there is immediate bruising on the foot, significant deformity, or you are unable to walk or put any pressure on the affected ankle as it could be a fracture or broken bone. A concussion is more than just a bump on the head. It is a brain injury that alters the way the brain functions and can be traumatic. While most concussions are mild, it is important to understand Continue reading >>

What To Expect In The Hospital

What To Expect In The Hospital

“The wish for healing has ever been the half of health.” —Seneca the Younger Most people experience a stay in the hospital at least once in their lives, and for some, it is much more often than that. No matter what the reason for your admission to the hospital, it is imperative that your blood glucose levels be controlled while you are there. More and more research shows that maintaining optimal blood glucose control in the hospital improves a person’s chances of having the best possible medical outcome. However, achieving optimal control in the hospital is a challenge. Stress tends to raise blood glucose level, and in the hospital, the stresses are many: Illness itself is a physical stress, as are pain, surgery, and other medical procedures such as having blood drawn for tests. Simply being in the hospital is a physical and mental stress with all of the changes in routine. And worrying about the reason you’re in the hospital, whether your diabetes is being controlled properly, how much the hospitalization is going to cost you, how your family or job is making out without you, etc., simply adds to it. If your hospital admission is not an emergency, you and your health-care provider have more time to prepare so that some of the stress of being in the hospital can be minimized. For example, you can establish ahead of time whether your personal physician will be overseeing your care while you’re in the hospital or, if not, who will. You can also discuss how your diabetes will be controlled and whether and when to stop taking any medicines you may currently take. And you can make plans for dealing with such personal responsibilities as child care or pet care during your hospital stay. If you are admitted to the hospital through the emergency room, it is standard Continue reading >>

Diabetes In The Emergency Department And Hospital: Acute Care Of Diabetes Patients

Diabetes In The Emergency Department And Hospital: Acute Care Of Diabetes Patients

Go to: Hyperglycemic Crisis: DKA and HHS Diabetic ketoacidosis (DKA) accounts for more than 110,000 hospitalizations annually in the United States, with mortality ranging from 2 to 10%4–6. Hyperglycemic hyperosmolar state (HHS) is much less common but confers a much greater mortality7. Patients with DKA classically present with uncontrolled hyperglycemia, metabolic acidosis, and increased total body ketone concentration. On the other hand, HHS is defined by altered mental status caused by hyperosmolality, profound dehydration, and severe hyperglycemia without significant ketoacidosis6,8. Initial evaluation In the Emergency Department, the primary goals are rapid evaluation and stabilization. All patients with severe hyperglycemia should immediately undergo assessment and stabilization of their airway and hemodynamic status, with consideration of administration of naloxone for all patients with altered mentation to reverse potential opiate overdose, and thiamine for all patients at risk for Wernicke’s encephalopathy. In cases requiring intubation, the paralytic succinylcholine should not be used if hyperkalemia is suspected as it may acutely further elevate potassium. Immediate assessment should also include placing patients on oxygen, measure O2 saturation and cardiac monitoring as well as obtaining vital signs, a fingerstick glucose, intravenous (IV) access, and a 12-lead electrocardiogram to evaluate for arrhythmias and signs of hyper-and hypokalemia. Emergency Department evaluation should include a thorough clinical history and physical examination, as well as a venous blood gas,9,10 complete blood count, basic metabolic panel, and urinalysis; a urine pregnancy test must be sent for all women with childbearing potential. An important goal of this evaluation is id Continue reading >>

Diabetic Ketoacidosis In Dogs

Diabetic Ketoacidosis In Dogs

My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>

Patient Education: Hypoglycemia (low Blood Sugar) In Diabetes Mellitus (beyond The Basics)

Patient Education: Hypoglycemia (low Blood Sugar) In Diabetes Mellitus (beyond The Basics)

LOW BLOOD SUGAR OVERVIEW Hypoglycemia, also known as low blood sugar, occurs when levels of glucose (sugar) in the blood are too low. Hypoglycemia is common in people with diabetes who take insulin and some (but not all) oral diabetes medications. WHY DO I GET LOW BLOOD SUGAR? Low blood sugar happens when a person with diabetes does one or more of the following: Takes too much insulin (or an oral diabetes medication that causes your body to secrete insulin) Does not eat enough food Exercises vigorously without eating a snack or decreasing the dose of insulin beforehand Waits too long between meals Drinks excessive alcohol, although even moderate alcohol use can increase the risk of hypoglycemia in people with type 1 diabetes LOW BLOOD SUGAR SYMPTOMS The symptoms of low blood sugar vary from person to person, and can change over time. During the early stages low blood sugar, you may: Sweat Tremble Feel hungry Feel anxious If untreated, your symptoms can become more severe, and can include: Difficulty walking Weakness Difficulty seeing clearly Bizarre behavior or personality changes Confusion Unconsciousness or seizure When possible, you should confirm that you have low blood sugar by measuring your blood sugar level (see "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)"). Low blood sugar is generally defined as a blood sugar of 60 mg/dL (3.3 mmol/L) or less. Some people with diabetes develop symptoms of low blood sugar at slightly higher levels. If your blood sugar levels are high for long periods of time, you may have symptoms and feel poorly when your blood sugar is closer to 100 mg/dL (5.6 mmol/L). Getting your blood sugar under better control can help to lower the blood sugar level when you begin to feel symptoms. Hypoglyc Continue reading >>

When You Need To Go To The Emergency Room With High Blood Sugars

When You Need To Go To The Emergency Room With High Blood Sugars

My uncle, like all his family, was a bit of a cheapskate. He hated to spend money unless it was absolutely necessary. He was thin and active, having only recently given up a career as a singer and dancer performing weekly on a nationally televised variety show. So when he felt unwell one weekend night, he turned down his wife's suggestion that she drive him to the emergency room and told her he'd wait til Monday when he could see his family doctor. Why waste all that money on an ER visit that was probably unnecessary? As it turned out, he didn't need to see his doctor on Monday. He died that night. He was a few years younger than I am now and the fatal heart attack he experienced was the first symptom he had of our family's odd form of inherited diabetes. But this is why, even though I've inherited the family "cheap" gene, if there's any possibility something dangerous is going on, I head for the ER. Usually it is a waste of money. I was in a small car accident a few weeks ago that left me with nerve pain running up and down my arms and legs. I sat for four hours at our local ER, saw the doctor for five minutes, and was sent home. The diagnosis, whiplash. The treatment, wait and see if it gets worse. The bill? Over $900. I went to the ER because I'd called my family doctor's office and they told me to. Whiplash usually resolves on its own, but occasionally it can cause swelling in your neck that can kill you. I'm not equipped to judge what kind I had, and unlike my uncle, I wasn't about to gamble. So with this in mind, you can understand my reaction when a stranger contacted me recently, after reading my web page, and told me that his blood sugar, which had been normal until very recently, was testing in the 500s on his meter except when his meter wasn't able to give hi Continue reading >>

When To Go To The Emergency Room

When To Go To The Emergency Room

Whenever an illness or injury occurs, you need to decide how serious it is and how soon to get medical care. This will help you choose whether it is best to call your doctor, go to an urgent care center or go to an emergency department right away. If you have a problem that is not life-threatening or leads to risk of disability, but you are concerned and you cannot see your doctor soon enough, go to an urgent care center. The kinds of problems an urgent care center can treat include: Common illnesses, such as colds, the flu, earaches, sore throats, migraines, low-grade fevers, rashes, allergies, bladder or urinary tract infections, and eye infections. Minor injuries, such as back pain, minor cuts and burns, minor broken bones, minor eye injuries, sprains, and strains. Generally, an emergency is a condition that may threaten an individual's life or cause impairment. If your medical problem is life-threatening, call 911 immediately and care will be provided at the nearest emergency room. However, ER visits should be reserved for true emergencies, such as life-threatening accidents or chest pain. A visit to the ER without an actual emergency can be costly and inefficient, and detract medical care from individuals who truly need emergency care. Common situations needing emergency care: Call 911 to have the emergency team come to you right away for choking, difficulty breathing, unconsciousness, severe head injury, severe injury to the neck or spine, seizures, severe burns, electric shock, etc. Go to an emergency department or call 911 for help for problems such as chest pain or pressure, trouble breathing, fainting, poisoning or overdose, severe bleeding, loss of limb or severe broken bone, pain in the arm or jaw, sudden weakness or drooping on one side of the body, coughi Continue reading >>

Emdocs.net Emergency Medicine Educationthe Adult Hypoglycemic Patient: Tips For Emergency Department Management - Emdocs.net - Emergency Medicine Education

Emdocs.net Emergency Medicine Educationthe Adult Hypoglycemic Patient: Tips For Emergency Department Management - Emdocs.net - Emergency Medicine Education

The Adult Hypoglycemic Patient: Tips for Emergency Department Management Authors: Erica Simon, DO, MHA (@E_M_Simon, EM Chief Resident at SAUSHEC, USAF) and Daniel Sessions, MD (Medical Toxicologist, South Texas Poison Center / Associate Program Director at SAUSHEC, USA) // Edited by: Jamie Santistevan, MD (@Jamie_Rae_EMdoc, Admin and Quality Fellow at UW, Madison, WI) and Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW Medical Center / Parkland Memorial Hospital) A 55 year-old female with a previous medical history of hypertension, hyperlipidemia, and diabetes, presents to the emergency department with slurred speech and dysarthria. As you enter the room, an anxious family member hands you a list detailing the following medications: lisinopril, clopidogrel, and glimepiride. VS: HR 110, RR 14, BP 132/88, T 99.3. Accucheck: 48 mg/dL. A 37 year-old male presents for the evaluation of recurrent nausea and diaphoresis. Review of systems is notable for a recent diagnosis of gout with initiation of indomethacin. The patient reports visiting an urgent care facility 48 hours prior for similar symptoms where he was discharged after consuming a container of orange juice. Current VS: HR 123, RR 16, BP 137/92, T 98.9. Accucheck: 51 mg/dL. The first case above illustrates a commonly encountered scenario: the diabetic patient with possible sulfonylurea toxicity, but what about the second, our 37 year-old male? What could be causing his hypoglycemia? If there are questions in your mind regarding his evaluation and treatment, read on. Well review a number of tip and tricks for addressing your next hypoglycemic patient. In 2009, the CDC reported 298,000 emergency department visits by diabetic patients assigned the primary diagnosis of hypoglycemia.1 A relatively recent study o Continue reading >>

When Is A Diabetic Foot Problem An Emergency?

When Is A Diabetic Foot Problem An Emergency?

Diabetes is the leading cause of non-traumatic amputations in the United States and the San Francisco Bay Area. Although the number of diabetic foot amputations continues to rise, you can take steps to make sure it doesn’t happen to you. The fact is that most diabetes related amputations begin as a small problem. Usually a little blister or callus on the bottom of the foot is ignored because it doesn’t hurt. Or an ingrown toenail goes unnoticed. Or maybe you step on a splinter or tiny sliver of glass that has been stuck in the carpet for years. I have actually personally performed amputations on diabetics in each of these cases. And in every case, the amputation could have been prevented with earlier treatment. As a diabetic foot surgeon, I do something that most doctors don’t do anymore. I give diabetic patients my cell phone number. I tell my patients to call me anytime they think they have a diabetic foot problem. The reason I do this is very simple. Early treatment of diabetic foot sores and infections is always best and easier than if it is delayed. The longer the foot problem is left untreated the more likely it becomes that hospitalization or amputation will be necessary. But even in spite of this, many of my patients have often still waited too long. “It was Thanksgiving.” “I had family in town that week.” “I didn’t want to wake you in the middle of the night.” “I didn’t want to bother you on the weekend.” There’s always an excuse for not calling. But never a good one. So I think if you can understand the more common “minor” problems that turn into an infected diabetic foot that needs surgery, you will be more likely to seek help earlier. So here they are… “Minor” Diabetic Foot Emergencies that Need Immediate Treatment: Ingr Continue reading >>

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