Hyperglycemia and insulin resistance are common in critically ill patients even if they did not have diabetes before their illnesses. Hyperglycemia in the intensive care unit (ICU) setting has been shown to be associated with an increased mortality, and restoration of nor-moglycemia using intensive insulin therapy has decreased mortality for the following populations:myocardial infarction, burn, […]
For managing Diabetes in ICU, maintaining euglycemia (defined as glucose <110 mg/dL in intensive care unit settings and <180 mg/dL in non intensive care unit settings by American College of Endocrinology Consensus Guidelines) has been shown to greatly reduce morbidity and mortality. This has created a paradigm shift in the inpatient setting where the goal
Erythromycin is a macrolide antibiotic that inhibits bacterial protein synthesis and is effective against the same organisms as penicillin G. The drug is commonly used to treat community-acquired pulmonary infections in penicillin-allergic patients. Erythromycin also has prokinetic effects on the gastrointestinal system. At low doses, erythromycin prokinetic agent induces activity in the gastric antrum, which
Gastrointestinal , gi prophylaxis guidelines in the intensive care unit (ICU) is important in the prevention of stress gastritis. The incidence of clinically significant bleeding in critically ill patients is 2% to 15%. However, it is important to understand the actual indications for prophylaxis. Most experienced clinicians feel it should be limited to patients at
In general, patients initiated on ACE inhibitors in myocardial infarction (MI) have demonstrated a reduction in overall mortality by about 20% to 30%. This benefit is most profound in patients with symptomatic congestive heart failure and their therapy should be continued indefinitely. The renin-angiotensin-aldosterone system (RAAS) regulates aldosterone release in the body via the action
Hyperglycemia, defined as blood glucose levels >110 mg/dL, has been shown in multiple studies to adversely impact outcomes in critically ill patients. Patients who are diabetic are at an increased risk for developing hyperglycemia postoperatively. With the harm of hyperglycemia in ICU now known, it is important to search out patient factors that can contribute
Trauma patients are at high risk of deep venous thromboembolism, with the majority of patients exhibiting no symptoms. Although meta-analyses report the overall incidence of deep vein thrombosis, DVT in trauma patients to be approximately 12%, the incidence of DVT in patients receiving no prophylaxis has been reported to be as high as 58%. Although
The power of a study, usually presented as a percentage, is a measure of the probability that the null hypothesis is rejected when it is false. When interpreting study results it is important to understand what is referred to as power as well as types of errors that may be encountered. Power of a study
I was asked this question on Ask a Doctor that How Clinicians Judge a Test. Sensitivity and specificity are characteristics of diagnostic tests. They inform the provider how the test will behave among people with or without disease. The sensitivity of a test is a measure of how often the test will be positive when testing
Shaping a differential diagnosis is a process of categorizing the probabilities of various diseases associated with the patient history and exam. The probability that a patient has the disease before any diagnostic testing is done is known as the prior probability of disease. Diagnostic testing increases or decreases the likelihood that a person has the
