Ann Acad Med Singap
-
Ann Acad Med Singap · Oct 1983
ReviewCurrent concepts of the pathogenesis and management of diabetic ketoacidosis (DKA).
Diabetic ketoacidosis (DKA) is the commonest endocrine emergency encountered in clinical practice. Although in the last 3 decades the average worldwide immediate mortality has decreased from 10% to 5%, survival has not improved strikingly. The pathogenesis of DKA is currently attributed to a combination of two hormonal abnormalities--a relative insulin insufficiency and stress hormone excess (glucagon, catecholamines, cortisol and growth hormone). ⋯ Current acceptable treatment of DKA include the following: adequate fluid replacement: low dose insulin therapy at frequent intervals; adequate potassium replacement from time of first insulin therapy with ECG monitoring; bicarbonate replacement if pH less than 7.1; broad spectrum antibiotics if infections is suspected and other supportive measures. The role of phosphate and magnesium replacement is still controversial. An awareness of the complications during the treatment of DKA including cerebral edema (paradoxical acidosis), altered central nervous system oxygenation, vascular thrombosis, shock, myocardial infarction, pancreatitis, infection, inhalation of vomitus , overhydration, underhydration , hypoglycaemia, hyperkalemia and hypokalemia all certainly help improve the morbidity and mortality of DKA.
-
The authors wish to document the experience of the Burns Unit, Singapore General Hospital in the management of burns of the upper limb. Fifty-six patients with post-burn deformity of the upper limb seen during a five year period (July 1978-July 1983) were reviewed. The cases were analysed and there were no significant differences in age, sex and race distribution. ⋯ When both surfaces were burned the prognosis depended upon the burns depth. Digital burns treated surgically had fewer residual contractures. The role of occupational therapy, scar control, splinting and secondary surgery in relation to the rehabilitation of the burned upper limb is discussed in some detail.(ABSTRACT TRUNCATED AT 250 WORDS)
-
Ann Acad Med Singap · Jul 1983
Experiences in the management of chest injuries and a review of current management.
Eleven cases of chest trauma managed in the Intensive Care Unit (ICU), Alexandra Hospital were reviewed. Common manifestations were: rib fractures, haemothorax, pneumothorax, pulmonary contusion and flail chest. Nine patients had fractures on other sites of the body and three patients had associated abdominal injuries requiring laparotomy. ⋯ Respiratory failure in chest trauma is often the result of damage to the parenchyma, atelectasis and infection. Whilst the extent of parenchyma lung damage is dependent upon the severity of the injury and therefore not medically preventable, atelectasis and infection can be avoided. Patients with significant chest trauma should therefore be admitted directly to the Intensive Care Unit and the 'Expectant Therapy' instituted.
-
Ann Acad Med Singap · Jul 1983
Case ReportsPsychological aspects of spinal cord injuries--an important point in the outcome of rehabilitation.
With modern management of spinal cord injury, the mortality rate has reduced and life expectancy increased, and psychological and social counselling have become an integral part of the total rehabilitation process. Observation and exploration as well as some additional tests form the basis for a proper evaluation of the individual coping mechanism. Typical behaviour patterns are discussed and therapeutic approaches with specific indications, analysed. The most important issue, however, is the willingness of the family and the community to accept the disabled cocitizen as an equal partner in all activities concerned.
-
Maxillo-facial injuries have increased in incidence in Singapore due mainly to road traffic accidents. Approximately 450 cases are seen annually in the Singapore General Hospital. ⋯ The significant associated injuries occurred in the limbs (32%), the head (30%) and in the chest (8%). The emergency management of maxillo-facial trauma is discussed in some detail and some of the problems in the treatment of severe or multiple facial fractures are also highlighted in this paper.