Management of diabetic ketoacidosis

Mainstay of treatment are: fluid therapy, insulin therapy, potassium replacement and antibiotics for precipitating infections.
Typical requirement of fluid is 6 litres in 1st 24 hours, ideally with a central line. Start with 1 litre normal saline in 1st 30 minutes. Caution is needed in cardiac and renal impairment.
Aims of insulin therapy: reduce lipolysis and ketone body formation; reduce hepatic glucose output, increase peripheral glucose utilization. Low dose, IV, regular insulin. Subcutaneous and intra muscular insulin may not be absorbed well. Reduce the dosage when blood sugar …

IPPV is invasive and non-physiological, and hence reserved for cases where non-invasive ventilation is not suitable.

Terminology

PEEP: positive end expiratory pressure
Cycling: change from inspiration to expiration or the reverse. It can be volume cycled, pessure cycled, time cycled or flow cycled.
Modes of ventilation: controlled mode, assist controlled mode, assist mode
Controlled mode – every breath by the ventilator; even if the subject wants breath spontaneously, it is not permitted. Volume and pressure controlled modes are available.
Assist control mode – IMV and SIMV (synchronized intermittent mandatory ventilation). SIMV removes the chance of fighting …

Checking for airway patency may be life saving in certain situations which may be mistaken for other conditions like an acute coronary syndrome. Usual cause of airway obstruction in an uncoscious patient is falling back of the tongue. Head tilt and chin lift / jaw thrus will help in this situation. But head tilt should not be used in trauma.
If the oropharyngeal reflexes are not adequate, an oropharyngeal airway is useful. If oropharyngeal airway is not suitable, a nasopharyngeal airway can be used. Advanced airways are considered if even this …

Oxygen therapy can be normobaric or hyyperbaric. During oxygen therapy, ventilation and airway maintenance should be adequate so that oxygen reaches the lung for gas exchange. Reserve of oxygen in the body is 1.5 litres, which lasts for about 6 minutes in circulatory arrest assuming a consumption of 250 ml/min. Hb contains 800 ml and alveoli contains about 400 ml of oxygen. Pre-oxygenation prior to induction of anaesthesia leads to denitration and increase in the alveolar oxygen content, enabling tolerance of longer period of apnea.
Circulatory gradient of oxygen: Oxygen …

Skin lesions are classified into 3 major types. They are:

Primary lesions
Secondary lesions
Special lesions

The primary skin lesions are:

Macule
Patch
Papule
Plaque
Nodule
Vesicle
Bullae
Pustule
Wheal
Cyst

The secondary skin lesion are:

Scale
Crust
Excoriation
Erosion
Ulcer
Fissure
Lichenification
Induration
Sclerosis
Atrophy

The special skin lesions are:

Burrow
Comedone
Telangectasia
Poikiloderma
Milium
Target lesions
Alopecia

Normal Saline: 9 gram of NaCl in 1 litre of water
Definition

DEXA: (acronym) Dual Energy X-ray Absortiometry
DEXA scanning, is currently the most widely used method to measure bone mineral density.

Continuos diaphragm sign in pneumomediastinum
Continuos left hemidiaphragm sign in lateral view
Air anterior to heart in pneumomediastinum
Halo sign in pneumopericardium