How do I install the Es Cgm Contraindication Check skill?

Run npx skillmds@latest add dromlakhani/es-cgm-contraindication-check in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Es Cgm Contraindication Check safe to use?

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Which AI agents work with Es Cgm Contraindication Check?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Es Cgm Contraindication Check free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Es Cgm Contraindication Check?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Es Cgm Contraindication Check by dromlakhani

Name: Es Cgm Contraindication Check
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Cgm Contraindication Check

This skill checks for contraindications or sources of inaccuracy that may affect continuous glucose monitoring (CGM) reliability in hospitalized adults. It is triggered when clinicians ask, “Are there factors that could make CGM unreliable?” or when assessing for skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, or medications such as acetaminophen >4 g/day, dopamine, vitamin C, or hydroxyurea.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Check for CGM contraindications or inaccuracies

STEP 1 — Gather Information

Collect data on skin integrity (extensive infection or lesions), signs of hypoperfusion (e.g., cool extremities, delayed capillary refill), hypovolemia (orthostatic hypotension, low urine output), current vasoactive or pressor therapy (e.g., norepinephrine, epinephrine, dopamine infusion), and medication list focusing on acetaminophen >4 g/day, dopamine, vitamin C supplements, or hydroxyurea.

STEP 2 — Rule In / Rule Out

If any of the following are present: extensive skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, acetaminophen >4 g/day, dopamine, vitamin C, or hydroxyurea → rule in (CGM may be inaccurate); otherwise → rule out (CGM likely accurate).

STEP 3 — Classify or Stratify

Classify CGM as unreliable when any rule‑in factor is present; classify as reliable when no rule‑in factors are identified.

STEP 4 — Decide

If CGM is unreliable, do not use CGM readings for insulin dosing adjustments; rely on point‑of‑care blood glucose (POC‑BG) monitoring. If CGM is reliable, proceed with real‑time CGM use accompanied by confirmatory POC‑BG checks before making insulin adjustments.

Clinical Guardrails / Mimics / Pitfalls

Do not assume CGM accuracy in critically ill patients (this guideline applies to noncritical care). Do not overlook transient hypotensive episodes that may intermittently affect perfusion. Remember that even without listed factors, CGM still requires POC‑BG calibration for safety. Never rely solely on CGM for insulin decisions without confirmatory POC‑BG. Check for over‑the‑counter acetaminophen contributions to total daily dose.

Concrete Clinical Example

A 68‑year‑old admitted for pneumonia is started on norepinephrine 0.1 µg/kg/min for septic shock and takes acetaminophen 1 g every 6 hours (total 4 g/day) plus an extra 500 mg PRN for fever. The skill identifies vasoactive pressor therapy and acetaminophen >4 g/day → classifies CGM as unreliable → directs the team to use POC‑BG for all insulin adjustments.

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

---name: es-cgm-contraindication-checkdescription: This skill checks for contraindications or sources of inaccuracy that may affect continuous glucose monitoring (CGM) reliability in hospitalized adults. It is triggered when clinicians ask, “Are there factors that could make CGM unreliable?” or when assessing for skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, or medications such as acetaminophen >4 g/day, dopamine, vitamin C, or hydroxyurea.---# Check for CGM contraindications or inaccuracies## STEP 1 — Gather InformationCollect data on skin integrity (extensive infection or lesions), signs of hypoperfusion (e.g., cool extremities, delayed capillary refill), hypovolemia (orthostatic hypotension, low urine output), current vasoactive or pressor therapy (e.g., norepinephrine, epinephrine, dopamine infusion), and medication list focusing on acetaminophen >4 g/day, dopamine, vitamin C supplements, or hydroxyurea.## STEP 2 — Rule In / Rule OutIf any of the following are present: extensive skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, acetaminophen >4 g/day, dopamine, vitamin C, or hydroxyurea → rule in (CGM may be inaccurate); otherwise → rule out (CGM likely accurate).## STEP 3 — Classify or StratifyClassify CGM as unreliable when any rule‑in factor is present; classify as reliable when no rule‑in factors are identified.## STEP 4 — DecideIf CGM is unreliable, do not use CGM readings for insulin dosing adjustments; rely on point‑of‑care blood glucose (POC‑BG) monitoring. If CGM is reliable, proceed with real‑time CGM use accompanied by confirmatory POC‑BG checks before making insulin adjustments.## Clinical Guardrails / Mimics / PitfallsDo not assume CGM accuracy in critically ill patients (this guideline applies to noncritical care). Do not overlook transient hypotensive episodes that may intermittently affect perfusion. Remember that even without listed factors, CGM still requires POC‑BG calibration for safety. Never rely solely on CGM for insulin decisions without confirmatory POC‑BG. Check for over‑the‑counter acetaminophen contributions to total daily dose.## Concrete Clinical ExampleA 68‑year‑old admitted for pneumonia is started on norepinephrine 0.1 µg/kg/min for septic shock and takes acetaminophen 1 g every 6 hours (total 4 g/day) plus an extra 500 mg PRN for fever. The skill identifies vasoactive pressor therapy and acetaminophen >4 g/day → classifies CGM as unreliable → directs the team to use POC‑BG for all insulin adjustments.**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, DOI: 10.1210/clinem/dgac278

Frequently asked questions