American family physician
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Diabetic emergencies include diabetic ketoacidosis, insulin-induced hypoglycemia, hyperosmolar coma and lactic acidosis. By determining the blood pressure, observing for evidence of dehydration or sweating and making a rapid qualitative assessment of blood glucose and ketonemia, the physician can usually identify the condition promptly. When adequate facilities are available, continuous intravenous insulin infusion is preferred for treatment of diabetic ketoacidosis. The nonketotic hyperosmolar state should be corrected gradually, not rapidly, in order to avoid cerebral edema.
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Hypoxia must be prevented in the newborn. It causes atelectasis, acidosis and pulmonary vasoconstriction, which leads to further hypoxia and, ultimately, brain damage. ⋯ Administered oxygen must be humidified and heated, and the oxygen concentration must be monitored with each delivery system. It is not enough to know the oxygen flow rate; an oxygen analyzer is essential.
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Blunt or penetrating trauma to the chest can cause several life-threatening conditions: open or closed pneumothorax, each with or without hemothorax; flail chest; pericardial tamponade, and injury to other structures in the chest--the esophagus, trachea or great vessels. Any trauma sufficient to compromise function of thoracic organs must also be suspect for extrathoracic injuries, especially to the spleen and other abdominal viscera.