Inpatient management of steroid induced hyperglycemia

While each child and adolescent’s treatment is individualized, this treatment occurs in a therapeutic milieu, which relies heavily on the social interactions with peers and adults. This therapeutic milieu is constructed differently depending on the nature of the program, but it generally consists of rapid and comprehensive assessment, crisis management, and treatment that is heavily structured. The overall goal of our inpatient treatment program is to provide stabilization, which allows each child and adolescent entrusted in our care to move on to a lower level of care. Some of the specific treatment methods implemented in our acute inpatient program include the following:

Multiply fractured ribs or flail chest can significantly compromise respiratory function. Pneumonia is often the common pathway to acute respiratory failure resulting from rib fractures, and prevention offers the best means to avoid potentially preventable deaths [ 3 ]. The main goal of treatment is to prevent pneumonia and other complications of rib fractures (eg, nonunion), and conservative treatment includes pain control and aggressive supportive pulmonary care to avoid the need for intubation. For some patients in whom these conservative measures are not adequate, rib fracture stabilization may be beneficial.

When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible. [5] Scandals in the UK, such as the Stafford Hospital scandal and the Winterbourne View hospital abuse scandal, have shown the dangers of silencing the voice of patients. Investigations into these, and similar scandals, have recommended that the health service put patient experience at the heart of what it does, and especially, that the voice of patients is heard loud and clear within the health services. [6]

In general, imaging such as x-rays, CT’s, and ultrasounds can be performed on these patients but MRIs require special attention. MR imaging other than brain imaging is contraindicated due to risk of diathermy. However, Medtronic Inc. has provided good safety data in performing MR imaging of the brain using specific settings. In order to perform MR Brain imaging, the MRI should be a -Tesla MR machine with a receive-only head coil. Also, the head SAR value should not exceed W/kg and the gradient switching (dB/dt) should be limited to ≤ 20T/ sec. These are details that can be worked out through the radiology department and MRI technicians. Older devices such as Kinetra or Soletra devices should be programmed to 0 volts and turned off prior to the MRI and reset to the original settings after the study. Newer devices such as the Activa PC, Activa RC, and Activa SC do not need to be set to 0 volts prior to the study but do need to be turned off prior to the study and on after the study. With the newer devices, the patient can turn the device off and on with their handheld patient controller.

Micronutrient recommendations were largely based on expert opinion, although three randomized trials 23 – 25 directly supported two of the recommendations made in the 2013 update: low-dose vitamin A administration, reserving high-dose vitamin A for those with eye signs of deficiency or measles. 4 Collectively, the trials demonstrated that either dose of vitamin A was superior to placebo, and that high-dose vitamin A offered no benefit compared with low-dose and might be associated with nosocomial diarrhoea and pneumonia. The 2013 update also recommended that HIV-infected children receive the same zinc and vitamin A doses as uninfected peers. 4 This recommendation was supported by a systematic review of studies among HIV-infected children and adults without malnutrition, which indicated that HIV infection should not alter zinc requirements. 26 Specific recommendations on the broader micronutrient package, which have remained constant for over 20 years, are all based on expert opinion.

Inpatient management of steroid induced hyperglycemia

inpatient management of steroid induced hyperglycemia

In general, imaging such as x-rays, CT’s, and ultrasounds can be performed on these patients but MRIs require special attention. MR imaging other than brain imaging is contraindicated due to risk of diathermy. However, Medtronic Inc. has provided good safety data in performing MR imaging of the brain using specific settings. In order to perform MR Brain imaging, the MRI should be a -Tesla MR machine with a receive-only head coil. Also, the head SAR value should not exceed W/kg and the gradient switching (dB/dt) should be limited to ≤ 20T/ sec. These are details that can be worked out through the radiology department and MRI technicians. Older devices such as Kinetra or Soletra devices should be programmed to 0 volts and turned off prior to the MRI and reset to the original settings after the study. Newer devices such as the Activa PC, Activa RC, and Activa SC do not need to be set to 0 volts prior to the study but do need to be turned off prior to the study and on after the study. With the newer devices, the patient can turn the device off and on with their handheld patient controller.

Media:

inpatient management of steroid induced hyperglycemiainpatient management of steroid induced hyperglycemiainpatient management of steroid induced hyperglycemiainpatient management of steroid induced hyperglycemiainpatient management of steroid induced hyperglycemia