POCUS Case of the Week
50 yo F hx of Roux-en-Y Gastric Bypass presents for AMS.
■Hypoglycemic enroute. EMS gives D50 with normal glucose in ED but no change in mental status
■Vitals – HR 90s, SBP 100s, RR 30s, Temp: 35.4C Rectal
■GCS 11 – combative
■Abd omen – diffuse tenderness
■FAST Performed…
Diagnosis: Perforated Viscus!
(Specifically perforated marginal (gastrojejunalanastomosis) ulcer
(Specifically perforated marginal (gastrojejunalanastomosis) ulcer
■Treatment:
–Emergent General Surgery consultation with disposition immediately to the OR for emergent exploratory laparotomy
■ABCs
–Intubation for airway protection 2/2 to altered mental status and expected course
–Fluid resuscitation!
–Type and cross
–Broad spectrum Abx
–Hemodynamic monitoring and support.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
