Noon Report: In-Flight Emergencies, Insulin Orderset for Diabetes, Constrictive Pericarditis
/We had some great noon reports this week, including both didactics and a case-based report. Below is a recap on the high yield learning points and some of the articles referenced
The inpatient chiefs took the change day as an opportunity to cover an off-the-beaten trail topic, and one they’ve been thinking about a lot with all the fellowship interview traveling. Here are some high yield points on in-flight emergencies
Take away Points:
More than half of the “emergencies” include lightheadedness/syncope, GI symptoms, and shortness of breath. Cardiac arrest during flight is exceedingly uncommon making up <0.5% of incidents.
All flights include an in-flight medical kit which includes a stethoscope, BP cuff, IV kit, CPR mask and bag, oropharyngeal airway, and an automated ICD. Medications include epinephrine, atropine, aspirin, nitro, and a few others
All flight attendants get regular drills including training in CPR. All flights have ground-based medical consultation services which you can speak with and use for assistance via the pilot.
References:
AUTHORED/EDITED BY: GREG WIGGER, MD
Dr. Cogorno discussed the changes that are being made to our diabetic insulin orderset in the EMR. Here are some of the things he referenced
Take away Points:
Bedtime insulin is no longer an option as studies have shown its use results in NO IMPROVEMENT in glycemic control
An excellent resource to discuss different management option for diabetes is the Mayo Clinic Diabetes Medication Choice Decision Aid
References:
AUTHORED/EDITED BY: GREG WIGGER, MD
The Cardiology team presented the case of a 29 year-old female with a history of a pericardial effusion who presented with anasarca and weight gain, found to have a constrictive pericarditis
Take away Points:
Constrictive pericarditis occurs as the result of scarring and consequent loss of the normal elasticity of the pericardial sac. Pericardial constriction is typically chronic, but variants include subacute, transient, and occult constriction
Common causes of constrictive pericarditis include prior infection (viral, bacterial, TB), prior cardiac surgery, radiation, and connective tissue diseases
Pericardiectomy is treatment option with good survival in idiopathic constrictive pericarditis. If a patient is hemodynamically stable, NSAIDs are first-line option in patients with constrictive pericarditis related to cardiac surgery.
References:
Bertog, S et al. Constrictive Pericarditis: Etiology and Cause-Specific Survival After Pericardiectomy. Journal of ACC. 2004: 43(8); 1445-52.
Welch, T. D. (2018). Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart, 104(9), 725-31.
AUTHORED BY: MATT CORTESE, MD; YOUSEF AHMAD, DO; MARY ROBERTS, MD
EDITED BY: GREG WIGGER, MD
