Medic 11 · 15 min · ground

DKA — she was breathing for a reason

Match MV, then 6 mL/kg · 92–96% (trainer band — avoid hyperoxia) · 6 mL/kg — may sit 7–8 until pH ≥7.20, then wean to 6 · Pplat ≤30 · ΔP ≤14 (trainer) · Match pre-intubation MV; do not park at 40

24-year-old woman, new DKA, Kussmaul, pH 6.92, HCO3 4, K 3.1 after 2 L. Tired, GCS slipping, tubed before you arrived.

Handoff

They bagged her at 12. That is not enough. If you 'protect' her with 6 mL/kg and a rate of 14 she will get more acidotic and arrest. Match her pre-intubation minute ventilation.

1
Match pre-intubation MV — then wean to 6 mL/kg
Rate 24–30. 7–8 mL/kg only until pH ≥ 7.20, then 6.
2
Don't cause autoPEEP chasing rate
Young lungs can take rate. Watch the flow return to zero.
3
Arrive without a deeper acidosis
This is a ventilation problem more than an oxygen problem.

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