ToDo

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…

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