The American journal of medicine
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Comparative Study
Frequency of diabetic ketoacidosis and hypoglycemic coma during treatment with continuous subcutaneous insulin infusion. Audit of medical care.
The frequency of diabetic ketoacidosis and hypoglycemic coma in a large series of patients with insulin-dependent diabetes treated by long-term continuous subcutaneous insulin infusion was compared with the frequency of these events in a matched group of patients treated by conventional insulin injections at the same hospital over the same period of time. Ketoacidosis and hypoglycemic coma occurred no more frequently in continuous subcutaneous insulin infusion-treated patients. Therefore, intensified insulin therapy achieved by continuous subcutaneous insulin infusion does not appear to be associated with a greater risk of ketoacidosis or hypoglycemic coma than does conventional insulin therapy.
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Influence of electrocardiographic findings on admission decisions in patients with acute chest pain.
This study prospectively evaluated the influence of current electrocardiograms obtained at the time of emergency department presentation, as well as that of previous comparison electrocardiograms, on decision-making regarding coronary care unit admission of patients presenting with a chief complaint of chest pain or chest pain equivalent. Emergency department physicians were asked to commit themselves to recommending either coronary care unit admission or some other disposition, both before and after evaluating current comparison electrocardiographic findings. They were also asked, prior to reviewing these results, whether they thought information gained from the electrocardiograms would have any affect on their decision. ⋯ Thus, electrocardiographic findings are rarely if ever helpful in determining the need for admission to a coronary care unit in patients presenting to the emergency department with chest pain, and seem to have particularly little value in patients in whom myocardial infarction is considered clinically unlikely. Although physicians at all levels of training often feel a need to rely on electrocardiograms in patients they ultimately admit, greater experience allows more senior physicians to be comfortable in correctly discharging patients with no clinical evidence of disease without obtaining an electrocardiogram. Routine ordering of electrocardiograms in patients with chest pain in whom likelihood of significant acute ischemic pain is clinically low should be reconsidered.