Episode Chapters
- June Introduction10:20Airway Corner - The PART Trial20:34Cardiology Corner - ACEP Clinical Policy on NSTEMI16:55Medicolegal Briefs - The Case of the Wrist Injury18:40EGLS - Echo-Guided Life support19:11Pediatric Pearls - Pediatric Mild Traumatic Brain Injury10:03Heat StrokeFree Chapter21:49Pharmacology Rounds -Newer Medications for Diabetes and Euglycemia DKA10:57Antibiotic Stewardship7:33Critical Care Mailbag - Dexmedetomidine15:20Trauma Surgeons Gone Wild - Kenji's Top 8 Tips on Chest Tube Insertion17:20Child Abuse15:31June Mailbag8:21June MegaSummary35:09EMRAP 2019 June Canadian Edition17:11EMRAP 2019 June German Edition1h, 32mEM:RAP 2019 June Spanish Edition1h, 18mEM:RAP 2019 June French Edition30:59EM:RAP 2019 June Farsi Edition2h, 12mEM:RAP 2019 June Aussie Edition57s
Pharmacology Rounds -Newer Medications for Diabetes and Euglycemia DKA
Anand Swaminathan, MD FAAEM and Bryan Hayes, PharmD, DABAT
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Nurses Edition Commentary
Kathy Garvin, RN and Lisa Chavez, RN
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EMRAP 2019 June Written Summary 367 KB - PDF
EM:RAP 2019 June Full episode audio for MD edition 227:40 min - 317 MB - M4AEMRAP 2019 June Canadian Edition Canadian 17:11 min - 24 MB - MP3EMRAP 2019 June German Edition Deutsche 92:42 min - 127 MB - MP3EM:RAP 2019 June Spanish Edition Español 78:44 min - 108 MB - MP3EM:RAP 2019 June French Edition Français 30:59 min - 43 MB - MP3EM:RAP 2019 June Farsi Edition Farsi 132:49 min - 182 MB - MP3EM:RAP 2019 June Aussie Edition Australian 0:57 min - 1 MB - MP3EMRAP 2019 06 June Individual MP3s 294 MB - ZIPEMRAP 2019 June Board Review Answers 131 KB - PDFEMRAP 2019 June Board Review Questions 177 KB - PDFEMRAP 2019 June Spanish Written (SPA) 4 MB - PDFEMRAP 2019 June Written Summary 367 KB - PDF
James C. - June 15, 2019 6:53 AM
What about when these patients present hypoglycemic? Are there any special considerations? (Ex: Recurrent hypoglycemia with the longer acting glimpiride type meds)
Bryan H. - June 17, 2019 6:35 AM
Thanks for the question. If a patient presents hypoglycemic with one of the longer acting meds, we should expect it could last about 24 hours. This could be the result of an overdose, an extra dose, or taking the medication without eating. Subcutaneous octreotide should be used (I recommend q6 hours), with supplemental glucose if needed, until the hypoglycemia resolves.
Miguel N. - June 18, 2019 8:20 PM
Typo on the insulin infusion dose. You probably meant insulin infusion rate of 0.1 units/kg/hr instead of 1 unit/kg/hr.
Anand S., M.D. - June 19, 2019 5:41 AM
Thanks for catching this! We will be fixing the written summary shortly
Luke T., Dr - July 2, 2019 10:26 PM
i can imagine it may be a bit difficult to resist CT- scanning a middle aged or older male with significant abdominal pain but only mildly elevated ketones and acidemia. Even if i saw that he was on a SGLT2 inhibitor, it'd be tricky to start treating as a dKA without first imaging? Any thoughts?
Anand S., M.D. - July 3, 2019 1:05 PM
Luke - always challenging in any patient with DKA to know if the abdominal pain is from the ketosis or something else. I don't think anyone would blame you if you scanned particularly since infection is the number 1 (or 2 depending on your population) cause of DKA and intra-abdominal infection can easily be missed.
If I'm not impressed with the tenderness on my initial exam, I'll often treat and do serial abdominal exams. If the pain is worsening or not improving, I have a low threshold to scan.
Hope that helps