Table of contents

     

    1. Interpretation of blood gasses.

     

    nFor Lobar Consolidation:
    •Pulmonary Effusion:  ↓transmission of breath & vocal sounds to the chest wall
    •Consolidation(seen in pneumonia): ↑ transmission of breath & vocal sounds to the chest wall
    n4 Maneuvers bring out the effect of increased transmission…
    n
    1.Tactile fremitus:  is ↑transmission of palpable fremitus to the chest wall  while ptrepeats “99”
    2.Bronchophony: is enhanced transmission of spoken words such as “99”
    3.Egophony: is a change from an “ee”to an “ay”sound over affected area while ptsustains an “ee”sound
    4.Whispered Pectoriloquy:  is a marked increase in audibility through the chest wall over affected area while ptwhispers the words “99”or “1-2-3”.
     

    DKA Bare Bones

    nFoley
    nIV
    nLytes
    nGlucose
    nABG
    nSerum Ketones
    nSeptic work-up:
    •CBC
    •CXR
    Blood Cultures
    •Urinalysis
    •ECG if K is critically elevated
    n1 L NS per hour x 2-3 hours or until Tachycardia & BP normalize, then 500 cc/hrx 2 hours, then 250 cc/h x 5 hours
    nInsulin 10 U IV push, then drip at 2 U/hr
    nCheck glucose and lytesq2h
    nWhen glucose drops to 15àswitch fluids to maintenance 2/3-1/3 D5W/NS + 20 mEqKCl/L (4:2:1 rule)
    nBegin diet and regular insulin regimen
    nIf the DKA was the result of non-complianceàclose follow-up & education such as diet & diabetes management counseling with a dietitian are required
     
     
    BleedingDisorders.png
     
     

    NOTES:

    • Respirology: Disc 5 (occupational lung dz), 9, 10
    • Hematology
    • Infectious Diseases
    • Rheumatology
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