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CASE 1
Initial Ix
BMP
Urianalysis
Mx –
NPO
IV rd Gen Chephalosporin
Sx
Mx –
NOP
IV fluids / IV antibiotics
CT scan
CASE 2 .
Problem with breathing. After RTA. BP l10 /70 , pulse 115 , RR 30.
Inital IX –
ABCE
CBC
12 lead ECG
BMP
Amylase
Blood alcohol
Pulse oxy
NG tube
Further Ix :
Urine analysis
Rx –
Admit to ICU
Serial CBC
NPO
Echo
Orthopedic consult.
Mx –
If reduced level of consciousness for any cause : even if they have head
trauma or alcohol ::::: do CT abdomen because they cant tell if anything
goin in the abdomen.
If any signs for cervical fracture/ patients may not tell anything but do
the CT neck or MRI to confirm if some suspiciousness , X rays are not very
sensitive.
CASE 2.
Ix –
Ix –
EKG/ ECHO
CXR
Immedicate Iv heparin.
Left angiogram if time permits { critical ischemia from onset of pain , <
4 h presentation} , if not angio at the theatre}
Rx
Heparinise
CASE 4
Ix – -
BMP
Amylase
USS abdomen : stones ? , thickened gall bladder wall , edema , dilated
ducts }
For free air best test is Upright CXR {if not left lateral decubitus
abdomen X ray}
Urinanalysis
Urine HCG
Rx – admit
NPO
IV antibiotics/ iVF
If resolves :>>>> earlier cholecystectomy was done after 6-8 weeks / but
since patients are not compliant do Sx on this admission
Murphys sign + / very sick ; WBC very high / Low BP /altered mental signs
{ sepsis}