Unconcious homeless patient - Diabetic ketoacidosis - USMLE Forums
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Old 07-25-2011
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Arrow Unconcious homeless patient - Diabetic ketoacidosis

Unconcious homeless patient - Diabetic ketoacidosis on labs
………………………………………………………………………………………..
ER:
Suction airways
Head elevation
Immobilize neck
Pulse oximetry
Oxygen
IV access
IV saline if BP is low
Cardiac monitor
BP Cuff monitor
Aspiration precaution
Finger stick glucose
EKG

…………………………………………………..

Focused physical exam: General, Skin, head n neck, lungs, chest, Abdomen, extremities, neuro

…………………………………………………………………………………………
Finger stick glucose is 600…………………
Lab:
CBC
BMP
LFT
Blood drug level
Magnesium
Phosphate
Serum ketone
Serum osmolarity
Amylase
Lipase
LDH
AXR
CXR
ABG
UA
Insulin IV continue
IV phenegen one dose
Advance clock 30 Minute!!!
Interval history
Patient is feeling better……..
…………………………………………………………………………………..
Shift the patient to ICU……
Bed rest
NPO
Vitals q6h
CBC q4
BMPq4
Accucheck q2h
HbA1c
KCL oral
Elevate the head
Compression stockings
Omeprazole
Advance the clock for 4 hours and check the patient
…………………………………………………………………………….
Interval history
Feeling better…. Suppsoe glucose is still 350 then advance more 2 hours…..
When blood glucose is 250 then
Dextrose IV
Stop Saline
KCL oral
Regular insulin S/c
Stop IV insulin

Shift to ward:
Continue the same treatment
Stop NPO
Diabetic diet
CBCq8h
BMPq8h
Accucheck q4h

Advance clock for 12 hours

……………………………………………………………………………………
5 minute screen
Reassurance
Stol illegal drugs if taking
Limit alcohol
Exercise
Stop smoking
Diabetic diet
Seat belt
Educate patient
Safe sex
Bracelet
Immunization if not given
Screen pap if female 21 +
Stop subcutaneous insulin
NPH regular
Home glucose monitoring
Home glucose monitoring instructions
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