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Not sweet on treatment for hypoglycemia

In "Severe Hypoglycemia" (Action Stat, April 2010),* the nurse learns the patient has type 1 diabetes and then establishes an I.V., starts nasal oxygen, and obtains a 12-lead ECG before checking a finger-stick blood glucose. Why not use the simplest solution first?

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Severe hypoglycemia can lead to seizures, coma, and even death. Upon learning the woman had diabetes, I would have first checked her blood glucose, then started treatment for hypoglycemia. The extra interventions were unnecessary and contribute to the high cost of healthcare.




Macon, Ga.


Editor's response: In hindsight, the finger-stick blood glucose level should probably have been obtained much earlier so that the immediate threat of hypoglycemia could have been identified and managed. But who's to say the patient wasn't also having a stroke, pulmonary embolism, dysrhythmia, or other emergent problem? Many disorders have signs and symptoms similar to those of hypoglycemia. Although the extra interventions appear unnecessary in retrospect, ED practitioners must err on the side of caution.


Zero tolerance for disruptive behavior

As a healthcare professional for over 10 years, I've witnessed and experienced many forms of abusive behavior from physicians and coworkers as described in "Nurse-Physician Relationships: Abusive Behavior Still Disrupts Hospital Care" (Clinical Rounds, February 2010).* I found the results of the American College of Physician Executives astonishing: 85% of survey participants had experienced some form of abuse in the last year. Disruptive behavior is one reason for increased stress leading to job change or even change of profession. Most importantly, this behavior disrupts patient care and leads to unsafe practice.


As a new employee in a private setting, I complained several times about bullying by coworkers. I was told by management to toughen up or quit-so I toughened up for fear of losing my job.


Management needs to step up and protect workers from bullying in the workplace. Facilities should enforce zero-tolerance policies and cite or suspend disruptive physicians. Violators should be required to attend anger management classes. Working in the healthcare setting requires concentration. It shouldn't be disrupted by abusive behaviors, harassment, or bullying.




Brooklyn, N.Y.


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