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Critical Care Mailbag – DKA

Anand Swaminathan, MD FAAEM and Scott Weingart, MD
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18:00
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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05:08

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EMRAP 2018 07 July Vol.18 V2 Written Summary 390 KB - PDF

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Dean B., M.D. -

Hi EMRAP

Great segment. Can I enquire as to what P.O./NG K supplements Dr Weingart is using and in what doses/frequencies to supplement the patient’s K?
Potassium chloride?

Anand S., M.D. -

Hey Dean. Here's the answer from Scott:

usually using 20 meq instant release liquid q1 hr
if mild sometimes i'll just give one 40 meq sustained release

Jason J. F. -

OK...so 30 minutes to 6 hours for a STAT insulin drip, 30 minutes is an “enormous win,” and in most hospitals a “STAT” order guarantees in less than an hour? If that’s the norm at most hospitals, then there’s a serious problem with the art of efficiency in pharmacy.

On the overnight shift, it’s myself and a technician. We’re a 300-bed hospital, major burn unit, CCU, NICU and ER. Our ER does not get a majority of the trauma, but the overnights are a still a continuous flow of activity.

From the time I get an insulin drip order until you get it on the unit...10 to 15 minutes. Less than 10 minutes, most instances.

Either your pharmacists are taking way too many unnecessary phone calls, thus slowing the process down, or they have a poor concept of what constitutes STAT (I really hope this is not the case.).

How soon before you get antibiotics for a septic patient?

Dallas Holladay, DO -

At my hospital only the ICU can do insulin drips. We manage DKA with subq insulin in the ED.

Matt K. -

Scott mentions following/targeting the fall in glucose as well as the anion gap but a number of people have told me throughout my training that they don’t care what the glucose is.

I’m curious as to why Scott follows the glucose and actually adjusts his insulin drip to facilitate a steady decrease? Does he feel that it acts as another marker of insulin sensitivity or simply that a patient with a normal glucose and normal gap is farther out of the woods so to speak?

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EM:RAP 2018 July Full episode audio for MD edition 229:23 min - 319 MB - M4AEM:RAP 2018 July German Edition Deutsche 120:44 min - 166 MB - MP3EM:RAP 2018 July Spanish Edition Español 90:31 min - 124 MB - MP3EM:RAP 2018 July Australian Edition Australian 35:17 min - 48 MB - MP3EM:RAP 2018 July Canadian Edition Canadian 24:10 min - 33 MB - MP3EM:RAP 2018 July French Edition Français 27:05 min - 37 MB - MP3EM:RAP 2018 07 July Individual MP3 Files 293 MB - ZIPEMRAP 2018 07 July Individual Summaries 742 KB - ZIPEMRAP 2018 07 July Spanish Summary 1 MB - PDFEMRAP Board Review Answers 2018 07 July Vol.18 07 116 KB - PDFEMRAP 2018 07 July Vol.18 V2 Written Summary 390 KB - PDFEMRAP Board Review Questions 2018 07 July Vol.18 07 407 KB - PDF

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