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2 results

  • LO067: Emergency department management of diabetic ketoacidosis and hyperosmolar hyperglycemic state: national survey of attitudes and practice

  • A. Hamelin, J. Yan, I.G. Stiell
  • Journal:
    Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
    Published online by Cambridge University Press:
    02 June 2016, p. S53
    Print publication:
    May 2016
    • Article
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  • Introduction: The 2011 Canadian Diabetes Association (CDA) Clinical Practice Guidelines were developed in order to help physicians manage hyperglycemic emergencies in the emergency department (ED), including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). The goal of this study was to determine physician attitudes towards these guidelines and to identify potential barriers to their implementation in the ED. Methods: We distributed an online, cross sectional survey to 500 randomly selected members of the Canadian Association of Emergency Physicians (CAEP) who were currently practicing physicians. A total of 3 email notifications were distributed on days 1, 7 and 14. The survey consisted of 23 questions relating to physician management of DKA and HHS in the ED. The primary outcome was overall physician familiarity and usage of the guidelines using a 7-point Likert scale. Secondary outcomes included physician attitudes towards the guidelines as well as any perceived barriers to their implementation in the ED. Simple descriptive statistics were used to illustrate the survey results. Results: The survey response rate was 62.2% (311/500) with the following participant characteristics: male (62.6%), CCFP(EM) training (46.1%) and working in major academic centers (50.5%). The overall awareness rate of the CDA guidelines was 22.9% (95% CI = 18.3%, 27.5%). 58.9% (95% CI = 53.3%, 64.3%) reported the CDA guidelines being useful. The most frequently reported barriers to CDA guideline implementation were concerns about education issues (56.0%), lack of time and disruption of flow (23.9%), staffing and human resource issues (26.7%) and poor policy adherence (25.5%). Physician’s ideal changes to optimize the management of these patients included improved coordination for follow-up with family physicians (79.9%), increased diabetes education for patients (73.9%) and increased availability to diabetes specialists (47.5%). Conclusion: In this study, although Canadian ED physicians were generally supportive of the CDA guidelines, many were unaware that these guidelines existed and barriers to their implementation were reported. Future research should focus on strategies to standardize DKA and HHS management by ensuring physician awareness and education to ensure the highest quality of patient care.

  • Chapter 40 - Anaphylactoid syndrome of pregnancy (amniotic fluid embolus)

  • from Section 5 - Serious problems related to pregnancy
  • Edited by Marc van de Velde, Helen Scholefield, Lauren A. Plante
  • Book:
    Maternal Critical Care
    Published online:
    05 July 2013
    Print publication:
    04 July 2013, pp 454-461

  • Summary

    There is little evidence base for pregnancy-specific management of endocrine crises, and in the majority of cases the underlying condition should be treated as it would be outside of pregnancy, with no need for immediate delivery. Thyroid storm is associated with an increased risk of preterm labor, and staff in the critical care setting should be aware of this, along with the signs and symptoms of labor. Myxedema coma is a challenge to diagnose because of its insidious onset and lack of classic signs and symptoms. Acute adrenal crisis in the pregnant patient, if left untreated, is associated with high risk of maternal and fetal mortality. If labor coincides with pituitary apoplexy, steroid administration and correction of electrolyte imbalances are essential. In pregnancy, diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) typically occur in the second and third trimesters, affecting an estimated 1-2 percentage of pregnancies.