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BACKGROUND:Hyperglycemia is often overlooked and unaddressed in hospitalized patients, and early and intensive management may improve outcomes.OBJECTIVE:To evaluate communication and early management of emergency department (ED) hyperglycemia.METHODS:This was a retrospective cohort study of patients with an initial serum glucose ≥140 mg/dL at an urban, academic institution. We randomly selected cases from a consecutive sample of ED visits with at least 1 serum glucose result during a 1‐year period. We recorded clinical data and compared the content of inpatient and ED‐written discharge instructions.RESULTS:Of the 27,688 initial ED glucose results during the study period, 3517 (13%) were 140‐199 mg/dL, and 2304 (8%) values were ≥200 mg/dL. In our sample of 385 patients, 293 (76%) patients were hospitalized. Inpatient or ED discharge instructions informed 36 (10%) patients of their hyperglycemia and 23 (6%) of a plan for further evaluation and management. There was no difference between inpatient and ED instructions for either of these variables (P = 0.73 and 0.16, respectively). Overall, 107 (55%) patients with glucose values 140‐199 mg/dL and 31 (16%) patients with glucose ≥200 mg/dL had no prior diabetes diagnosis. Only 61 (16%) received insulin in the ED for their hyperglycemia, and hyperglycemia was charted as a diagnosis in 36 (9%) cases.CONCLUSIONS:Most ED patients with even mild hyperglycemia were hospitalized. Recognition, communication, and management of ED hyperglycemia were suboptimal and represent a missed opportunity to identify undiagnosed diabetes and to initiate early glycemic control for hospitalized patients. Journal of Hospital Medicine 2009;4:45–49. © 2009 Society of Hospital Medicine.

The Undersea and Hyperbaric Medical Society includes "select problem wounds" as an accepted indication for the use of hyperbaric oxygen (HBO 2 ), however, the treatment of diabetic foot ulcers (DFUs) has dominated any discussions of problem wounds because of the prevalence of DFUs in today's patient population and the reimbursement available for their treatment. Other wound types (eg, calciphylaxis ulcers, sickle cell ulcers, and pyoderma gangrenosum) that have well-deserved reputations as problem wounds have been infrequently treated with HBO 2 . While there are sound fundamental reasons why additional oxygen may have benefits in the treatment of these wounds, the challenge is finding enough high quality evidence to support routine use of HBO 2 .

The degree of neurologic and cardiovascular toxicity seen in this case are novel and illustrate the potential for severe sodium channel blockade after massive LTG poisonings. Drug levels are not clinically relevant in the acute setting due to the time delay in obtaining results, and recurrent seizure activity may be the only clinical finding that precedes severe cardiac toxicity.

The SARS-Cov-2 (COVID-19) pandemic remains a major worldwide public health issue. Initially, improved supportive and anti-inflammatory intervention, often employing known drugs or technologies, provided measurable improvement in management. We have recently seen advances in specific therapeutic interventions and in vaccines. Nevertheless, it will be months before most of the world’s population can be vaccinated to achieve herd immunity. In the interim, hyperbaric oxygen (HBO2) treatment offers several potentially beneficial therapeutic effects. Three small published series, one with a propensity-score-matched control group, have demonstrated safety and initial efficacy. Additional anecdotal reports are consistent with these publications. HBO2 delivers oxygen in extreme conditions of hypoxemia and tissue hypoxia, even in the presence of lung pathology. It provides anti-inflammatory and anti-proinflammatory effects likely to ameliorate the overexuberant immune response common to COVID-19. Unlike steroids, it exerts these effects without immune suppression. One study suggests HBO2 may reduce the hypercoagulability seen in COVID patients. Also, hyperbaric oxygen offers a likely successful intervention to address the oxygen debt expected to arise from a prolonged period of hypoxemia and tissue hypoxia. To date, 11 studies designed to investigate the impact of HBO2 on patients infected with SARS-Cov-2 have been posted on clinicaltrials.gov. This paper describes the promising physiologic and biochemical effects of hyperbaric oxygen in COVID-19 and potentially in other disorders with similar pathologic mechanisms.

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Background: Hyperbaric oxygen therapy has been demonstrated to lower blood glucose levels in patients with diabetes. Continuous glucose monitoring (CGM) allows glucose monitoring in real time. Battery-operated CGM transmitters have yet to be formally tested and given safety approval for use in a hyperbaric environment. Materials and Methods: We evaluated and tested commercially available Dexcom. G6 CGM transmitters under hyperbaric conditions. Each transmitter contains a 3V, 130-mAh (0.39 Wh) lithium manganese dioxide battery (IEC CR1632) and circuit board that are fully encapsulated in epoxy. Each transmitter is pressurized to 90 pounds per square inch (psi) in an autoclave at 40ÅãC for up to 72 hours during manufacturing to ensure that all enclosed air spaces are eliminated from the epoxy. We compared the CGM components against section 14.2.9.3.17.5 of the 2018 National Fire Protection Association 99 (NFPA 99) Health Care Facilities Code requirements. Six CGM transmitters attached to estimated glucose value generators (EGVGs) underwent 11 pressurization cycles to 45 feet of seawater (fsw). All transmitters were returned to the manufacturer to assess post-exposure structural integrity. G6 sensors, which contain no electrical components or compressible air spaces, do not pose a risk in the hyperbaric environment. Results: There was no observed change in preset EGVG readings during hyperbaric exposures. Post-exposure testing revealed no structural compromise after repeated hyperbaric exposures. Conclusions: The CGM transmitter meets section 14.2.9.3.17.5 of the 2018 NFPA 99 requirements for battery-operated devices allowed for use in a hyperbaric environment. This analysis revealed no significant safety concerns with subjecting Dexcom G6 CGM transmitters to hyperbaric environments.

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