Isther
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78 yo F. Presenting with tonic-clonic convulsions. At ER relatives refer she had abdominal pain and distention for 3 days. Have history of HTN, CAD, and hyperlipidemia for several years. BP 100/70, HR 65, T 37.5 C., RR 16. Meds are nitro, atenolol, amlodipin. What is the best next management step:
- Rectal exam
- Electrolytes
- CT abdomen
- CT head
- US abdomen
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| jvo_md
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CT Head 
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| jvo_md
Forum Senior
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Sorry CT of the ABD
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| mesh
Forum Guru
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2?
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| jvo_md
Forum Senior
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Why electrolites Mesh...ptc is still stable...
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| mesh
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i am not sure but electrolyte abnormality could be the cause of seizure ??thats why i picked 2...
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| jvo_md
Forum Senior
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true man...good answer...but wouldnt you need a blood sample first?
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| achilles
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2-electrolytes
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| jvo_md
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why electrolites achilles?
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| Isther
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the answer is 1...rectal exam
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| msyamp
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hmmm this is how we get ,isleaded."pappu lo kaalu" we have to do per rectal before anything else. good question isther
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| Isther
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old patient with CAD and risk factors for arterial disease that presents abd pain + abd distention... should perform a rectal exam for occult or gross blood to asses for mesenteric ischemia. Diagnosis and treatment should be fast to save as much gut as possible.
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| Isther
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electrolytes disturbances are indeed the cause of the seizures, but as a consequence of the ileus and fluid sequestration caused by the mesenteric ischemia.
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| guayoman
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Good Q Isther! I won´t forget this one!
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| seri
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neat q
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