Saturday, February 11, 2006
Primperan + Ketorolac
Recently I encountered a case of 22 female patient c/o abd pain came to ED 3 days ago and discharged. The patient came back again due to persisted abd pain and later fever up to 39.3C.
2/3 2043 c/o epigastric pain BT 37.6C WBC 16500 Seg 87 B1
Primperan + Keto (resident routine treatment for abd pain)
MBD but still complained of abd cramping pain. WBC 9800 Seg 79 B2
Primperan + Keto (resident routine treatment again) then MBD.
2/6 0702 c/o lower abd pain with rebound pain WBC 17600 Seg 81 CRP 12.2
Transfer to fever ward due to fever 38.6 C>>39.3C
Abd CT report--
CT scan of whole abdomen with and without contrast enhancement:1. A tortuous tubular structure with wall thickening and increased enhancement in right pelvic cavity may be due to dilated fallobian tube. Fat stranding in the pelvic cavity as well as fluid accumulation are also noted, suggesting PID with possible pyosalpinx.(Radiologist said appendicitis is not likely by imaging)
Consult GYN- RLQ pain R/O acute appendicitis
Consult GS- Clinically acute appendicitis is not likely at present.
GYN prepare for lapraoscope- appendicitis rupture with ascites>> Consult GS to take over>> retrocecal appendicitis with rupture.
Discussion:
1. Is primperan + Keto a routine treatment protocol for abd pain by resident, even senior resident?
2. After the first NSAID given, is it necessary to survey the patient before one order the second NSAID injection?
2/3 2043 c/o epigastric pain BT 37.6C WBC 16500 Seg 87 B1
Primperan + Keto (resident routine treatment for abd pain)
MBD but still complained of abd cramping pain. WBC 9800 Seg 79 B2
Primperan + Keto (resident routine treatment again) then MBD.
2/6 0702 c/o lower abd pain with rebound pain WBC 17600 Seg 81 CRP 12.2
Transfer to fever ward due to fever 38.6 C>>39.3C
Abd CT report--
CT scan of whole abdomen with and without contrast enhancement:1. A tortuous tubular structure with wall thickening and increased enhancement in right pelvic cavity may be due to dilated fallobian tube. Fat stranding in the pelvic cavity as well as fluid accumulation are also noted, suggesting PID with possible pyosalpinx.(Radiologist said appendicitis is not likely by imaging)
Consult GYN- RLQ pain R/O acute appendicitis
Consult GS- Clinically acute appendicitis is not likely at present.
GYN prepare for lapraoscope- appendicitis rupture with ascites>> Consult GS to take over>> retrocecal appendicitis with rupture.
Discussion:
1. Is primperan + Keto a routine treatment protocol for abd pain by resident, even senior resident?
2. After the first NSAID given, is it necessary to survey the patient before one order the second NSAID injection?
# posted by ER Palm @ 3:29 AM 
