Case discussion: why acidosis?
i did a robot nephrectomy and i kept my patient intubated at the end due to respiratory acidosis. she is elderly with the usual hypertension, DM on insulin, but also with bad pulmonary disease, a component of COPD and severe reduced dlco. on home o2 2L. room air saturation 79-84%
surgery uneventful. 400 ebl. 6 hour case in lateral position. 2.5L fluid.
On emergence, following instructions, having minute ventilation of ~5L, (RR 16, TV ~350-400), with no vent support, thru a 7.0 tube...
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Source: Student Doctor Network - April 11, 2024 Category: Universities & Medical Training Authors: waterbottle10 Tags: Anesthesiology Source Type: forums
Consequences of "overbilling"
I see a lot of variety in critical care billing practices. For example, I see some docs are routinely billing critical care time for anyone in the ICU even if stable and going to floor or home that day or totally hemodynamically stable just there for q1h glucose checks for DKA with insulin gtt.
Is it recommended to just err on the side of billing for critical care and if it doesn't meet criteria the coders or insurance company will just change it to non-critical care? If lots of physicians...
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Source: Student Doctor Network - March 5, 2024 Category: Universities & Medical Training Authors: Student3322 Tags: Critical Care Source Type: forums
Vincent Marks: More than a pioneering researcher into insulin and hypoglycaemia and sought after expert witness
(Source: BMJ Comments)
Source: BMJ Comments - December 10, 2023 Category: General Medicine Source Type: forums
Re: Insulin: Eli Lilly cuts price to $35 a month in US after pleas from patients and president
(Source: BMJ Comments)
Source: BMJ Comments - March 12, 2023 Category: General Medicine Source Type: forums
Poly pharmacy and falls
Long story short, I had an older patient on sedating meds which I had been working to minimize. Last time I saw her she was having poor PO intake and I focused on enhancing that and getting her to be medically evaluated in the ER because she is also diabetic on insulin (which she did not follow through on, and it was telemedicine so I could not arrange direct transport). In hindsight I should have probably lowered her meds because blood levels could have been going up. She then proceeded to...
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Source: Student Doctor Network - February 20, 2022 Category: Universities & Medical Training Authors: meow1985 Tags: Psychiatry Source Type: forums
Hyperkalemia, Compartment Syndrome
One of my on-call cases from the past year:
Middle aged guy without any known medical history who passed out after taking heroin, alcohol and cocaine woke up less than 12 hours later unable to move his left leg and right arm. Brought to ER by ambulance. Found to have potassium level over >10, tall peaked T-waves and widened QRS. In the ER received aggressive IV hydration, calcium gluconate, insulin/glucose, lasix, mannitol, albuterol, bicarbonate, was also briefly on pressors for...
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Source: Student Doctor Network - February 3, 2021 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
Example of pharmacy getting fined for improper OTC insulin sales
https://azbop.igovsolution.net/docs/AZBOPDOCS/2018/8/e651f263e69443af940a0bef3d706d408162018.pdf
How many times have you discussed U40 vs U100 insulin/syringes with cat owners? Do you ever document that ****? LMAO
None of these pharmacies in Mohave County AFAIK got hit with discipline over the last 10-20 years for helping to fuel white American drug-addled angst but this one got hit for some sales associate giving out wrong OTC insulin/syringes. (see...
Example of pharmacy getting fined for improper OTC insulin sales (Source: Student Doctor Network)
Source: Student Doctor Network - August 16, 2020 Category: Universities & Medical Training Authors: Sine Cura Tags: Pharmacy Source Type: forums
Cvs Change to broken pack insulin pen policy
Just gonna leave this here (Source: Student Doctor Network)
Source: Student Doctor Network - July 24, 2020 Category: Universities & Medical Training Authors: FarmD711 Tags: Pharmacy Source Type: forums
Codes in known hyperkalemia - best initial approach?
So you have a patient with known hyperkalemia in the admission, lets say it was running in the high 6s with some EKG changes and you have a good reason to think that's why he arrested.
You start ACLS and he has no central access or anything. What's the ideal timing and sequence of pushing meds? Immediately giving calcium gluconate (3g) with insulin/dextrose (5 and 25) followed by 100 bicarb? And re-dose calcium subsequently if no success while addressing other possible causes as acls continues? (Source: Student Doctor Network)
Source: Student Doctor Network - April 27, 2020 Category: Universities & Medical Training Authors: MedicineZ0Z Tags: Critical Care Source Type: forums
Walgreens paying $209M settlement for Not Opening Insulin Pen Boxes
Looks like this should clear up any confusion.. lol
Walgreens to pay $269 million on claims it overcharged federal programs
Wall Street Journal (01/23/19) Thomas, Patrick
Walgreens Boots Alliance has agreed to pay more than $269 million to settle federal and state lawsuits that accused it of overbilling federal health care programs. Two separate settlements involving Walgreens were unsealed Tuesday in which the company accepted responsibility for conduct the government...
Walgreens paying $209M settlement for Not Opening Insulin Pen Boxes (Source: Student Doctor Network)
Source: Student Doctor Network - March 3, 2020 Category: Universities & Medical Training Authors: Heroic Combo Tags: Pharmacy Source Type: forums
Is Pharmacy still a good choice with Bernie?
Well aware of the problems in pharmacy, but can't this be cured by electing Bernie Sanders? I am fine with making less money out of the gate if I have my loans wiped out. And as far as not finding a job, I will certainly be less stressed in between jobs if I have universal healthcare and am not worried about going bankrupt from my insulin. (Source: Student Doctor Network)
Source: Student Doctor Network - February 24, 2020 Category: Universities & Medical Training Authors: PharmLover234 Tags: Pharmacy Source Type: forums
Ramification of selling insulin syringes?
I am in the camp who believes that we should always sell insulin syringes to anyone; regardless if they using it legitimately or 'shooting' it since we want them to use clean needles..
However, I was talking to my colleague who is really anal about this. He says that since our state law specifically mentions that pharmacist has to make sure about the validity of the syringe transaction (or something to that effect), pharmacy board can come behind you if they find out.
Is this true? I...
Ramification of selling insulin syringes? (Source: Student Doctor Network)
Source: Student Doctor Network - February 13, 2020 Category: Universities & Medical Training Authors: Chrish Tags: Pharmacy Source Type: forums
Upcoming DAT - Type 1 Diabetic
I hope everyone is doing great!
As I prep for the DAT, I've been looking into the 'processes' involved for me taking the exam as a type 1 diabetic and what I need to do to make sure all is okay with items such as insulin pump/having a juice for potential low blood sugar, etc. I know they have to be pretty tight on rules (no phones etc.) but I just want to make sure all would be okay if for instance my insulin pump was alerting me on an upcoming low blood sugar and I had to click the button...
Upcoming DAT - Type 1 Diabetic (Source: Student Doctor Network)
Source: Student Doctor Network - February 5, 2020 Category: Universities & Medical Training Authors: tmatt1212! Tags: DAT Discussions Source Type: forums
Challenging Case Coming Up
Hey all, I have a challenging case coming up and wanted to see how people would approach it:
76yo HTN, CAD (DES in LAD 7yrs ago), iCMY EF: 30-35% (anterior, anteroseptal, apical akinesis on TTE), Severe MR, pHTN w/ PAP 83 but Normal RV and RVSF (This was based on TTE that was obtained as outpatient 3 months ago, so presumptively not in heart failure at the time. No RHC data available. Assuming its from severe MR. systemic BP appears to be normotensive), Mild COPD, DM on insulin, ESRD on PD...
Challenging Case Coming Up (Source: Student Doctor Network)
Source: Student Doctor Network - February 1, 2020 Category: Universities & Medical Training Authors: soccerboy2288 Tags: Anesthesiology Source Type: forums
Hyperglycemia In PACU
How are people managing hyperglycemia in PACU.
A lot (Obviously not all) of the attendings I work with are very hesitant to give insulin to patients that are hyperglycemic post-op and usually either just discharge them and tell them to resume home medications for outpatients or just let primary team manage it once the patient leaves PACU and gets to the floor.
Just wondering how people at other institutions are approaching this: insulin-naive/not naive, blood sugar cut-offs, treatment...
Hyperglycemia In PACU (Source: Student Doctor Network)
Source: Student Doctor Network - December 1, 2019 Category: Universities & Medical Training Authors: Beeftenderloin Tags: Anesthesiology Source Type: forums
