RESUMEN
BACKGROUND: Hyperglycemia is a common finding in patients presenting to the emergency department (ED). Recommendations addressing uncomplicated hyperglycemia in the ED are limited, and the management of those without a prior diagnosis of diabetes presents a challenge. OBJECTIVE: This narrative review will discuss the ED evaluation and management of hyperglycemic adult patients without a history of diabetes who do not have evidence of a hyperglycemic crisis, such as diabetic ketoacidosis or hyperosmolar hyperglycemic state. DISCUSSION: Many adults who present to the ED have risk factors for diabetes and meet American Diabetes Association (ADA) criteria for diabetes screening. A new diagnosis of type 2 diabetes can be established in the ED by the ADA criteria in patients with a random plasma glucose ≥ 200 mg/dL (11.1 mmol/L) and symptoms of hyperglycemia. The diagnosis should be considered in patients with an elevation in random blood glucose > 140 mg/dL (7.8 mmol/L). Treatment may begin in the ED and varies depending on the presenting severity of hyperglycemia. Treatment options include metformin, long-acting insulin, or deferring for close outpatient management. CONCLUSIONS: Emergency clinician knowledge of the evaluation and management of new-onset hyperglycemia and diabetes is important to prevent long-term complications.
Asunto(s)
Diabetes Mellitus Tipo 2 , Cetoacidosis Diabética , Hiperglucemia , Adulto , Humanos , Diabetes Mellitus Tipo 2/complicaciones , Glucemia , Hiperglucemia/complicaciones , Hiperglucemia/diagnóstico , Cetoacidosis Diabética/complicaciones , Cetoacidosis Diabética/diagnóstico , Servicio de Urgencia en HospitalRESUMEN
Although surgical hand antisepsis is paramount to surgical infection prevention, adherence to correct technique may be suboptimal. We conducted direct observations and semistructured interviews to identify barriers and facilitators to appropriate surgical hand antisepsis in a tertiary care hospital. Only 18% (9 out of 50) surgical hand antisepsis observations were fully compliant with the recommended application techniques. Most surgical staff members considered lack of organizational oversight, monitoring, and direct hands-on training as important barriers to adherence.