본문으로 건너뛰기
cccskills
무료GitHub에 공개

es-pump-revert-to-manual

If CGM fails or is removed, revert the insulin pump to manual mode provided basic criteria for pump use in hospital are still met. Trigger phrase: "CGM failed, should we switch pump to manual mode?

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL
설치 방법 보기

포함된 파일(1)

  • SKILL.md2.7 KB

SKILL.md(원문)

설치하기 전에 에이전트에게 전달되는 지시 내용을 확인할 수 있습니다.

Revert insulin pump to manual mode if CGM fails or is removed

STEP 1 — Gather Information

  • Confirm CGM failure or removal (sensor error, dislodgement, patient report).
  • Assess patient ability to self-manage pump (alert, competent, no impaired consciousness).
  • Verify absence of contraindications to pump use: not in ICU, no DKA/HHS, no severe hypoglycemia unawareness.
  • Ensure pump supplies (infusion sets, reservoirs, insulin) are available for duration of hospitalization.
  • Check hospital policies and availability of expertise for pump management.

STEP 2 — Rule In / Rule Out

  • Is CGM failed or removed?
    • Yes → proceed to Step 3.
    • No → continue pump with CGM-guided automation and routine POC-BG confirmation.

STEP 3 — Classify or Stratify

  • Are basic criteria for pump use in hospital still met?
    • Yes → proceed to Step 4 (revert to manual mode).
    • No → transition to scheduled subcutaneous basal bolus insulin therapy (see Table 3 for conversion).

STEP 4 — Decide

  • If criteria met: switch pump to manual mode (disable automated features, use pre-set basal rates and manual bolus calculations).
  • Order frequent POC-BG monitoring (e.g., every 4–6 hours or per institutional protocol) to guide manual dosing.
  • Document mode change and notify nursing/pharmacy.

Clinical Guardrails / Mimics / Pitfalls

  • Do not revert to manual mode if patient cannot safely adjust pump settings (e.g., altered mental status, delirium).
  • Avoid manual mode in patients with active DKA, HHS, or requiring vasopressors; transition to IV insulin instead.
  • Ensure backup glucose monitoring is in place; reliance on CGM alone is unsafe after failure.
  • Do not assume pump function is intact; verify infusion set integrity and insulin potency.
  • Pitfall: continuing automated pump modes with erroneous CGM data can cause hypoglycemia or hyperglycemia.

Concrete Clinical Example

A 62-year-old woman with type 1 diabetes on hybrid closed-loop pump admitted for cholecystectomy. On postoperative day 1, her CGM displays persistent "sensor error" alerts. She is alert, able to troubleshoot pump, has spare supplies, and no ICU stay. The team confirms CGM failure, verifies she meets pump-use criteria, reverts the pump to manual mode, and orders POC-BG checks every 6 hours.

Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278

리뷰

아직 리뷰가 없습니다. 사용해 본 소감을 남겨 주세요.

댓글

로그인 없이 쓸 수 있습니다. 사용 후기, 질문, 작동하지 않은 환경 등을 편하게 남겨 주세요.

아직 댓글이 없습니다. 첫 댓글을 남겨 보세요.

보내면 바로 공개됩니다. 이메일 주소나 전화번호 같은 개인 정보는 쓰지 마세요. URL은 2개까지입니다.

0 / 1,000자

이 양식은 reCAPTCHA로 보호되며 Google 개인정보처리방침 및 서비스 약관이 적용됩니다.

같은 저장소의 스킬

780g-pump-adjustment

무료

Guide pump setting adjustments for the MiniMed 780G system based on CareLink data, using Medtronic's 3-step follow-up workflow. Use when a clinician has CareLink data for a 780G patient and wants to know what to change — which setting, by how much, and how to program it. Triggers include: "what do I adjust", "how to fix high TIR", "how to reduce hypos", "adjust ICR/ISF/basal", "SmartGuard settings", "780G pump settings review", or any question about optimising 780G therapy after reviewing a download.

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL142026년 10월 20일 업데이트

ata-acth-stim-test-interpretation

무료

Performs corticotropin stimulation test to diagnose adrenal insufficiency when morning cortisol is indeterminate (3-15 µg/dL). Triggers include morning cortisol 3-15 µg/dL requiring further AI testing.

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL142026년 10월 20일 업데이트

ata-adrenal-crisis-treatment

무료

Administers immediate parenteral injection of 50–100 mg hydrocortisone for suspected adrenal crisis secondary to adrenal insufficiency. Triggers include hypotension, hypoglycemia, or acute illness in a patient with known adrenal insufficiency.

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL142026년 10월 20일 업데이트

ata-aed-ai-education

무료

Clinicians educate adrenal insufficiency patients taking nondexamethasone glucocorticoids who initiate enzyme-inducing antiepileptic drugs about early signs of adrenal insufficiency. Trigger when an AI patient on nondexamethasone GC starts an enzyme-inducing AED such as phenytoin, carbamazepine, or oxcarbazepine.

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL142026년 10월 20일 업데이트

ata-aed-lt4-monitoring

무료

In central hypothyroidism patients receiving levothyroxine who initiate enzyme‑inducing antiepileptic drugs, the guideline recommends checking free T4 at least 6 weeks after AED start and increasing the levothyroxine dose if free T4 falls below the target range. Triggers include: central hypothyroidism patient on levothyroxine starting antiepileptic drug such as phenytoin, carbamazepine, or oxcarbazepine.

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL142026년 10월 20일 업데이트

ata-cortisol-cutoff-ai-diagnosis

무료

Applies serum cortisol cutoffs (<3 μg/dL indicates central adrenal insufficiency; >15 μg/dL likely excludes it) when evaluating morning cortisol for suspected adrenal insufficiency. Triggers include morning cortisol measurement in suspected AI and use when interpreting morning cortisol levels for adrenal insufficiency workup.

한국어 요약은 준비 중입니다. 원문 설명을 표시하고 있습니다.

dromlakhani/MD2SKILL142026년 10월 20일 업데이트

dromlakhani의 스킬 모두 보기

이 스킬의 문제 신고