sweetybokhari
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A 75 year old man comes to the emergency room with a history of pain in the abdomen and back.He is found to be hypotensive,with a pulsatile,tender abdominal mas.the correct immediate management of this patient consists of which one of the following?
1) transfer to the operating room
2) transfer to the x-ray department for abdominal ultrasound
3) transfer to the x-ray department for CT scan
3) resuscitation in the ER with intravenous fluids
5) workup in the ER to rule out myocardial infarction
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| nadiabarati
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2
ultrasound
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| 92306
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1) transfer to the operating room
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| FATIN
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3) resuscitation in the ER with intravenous fluids )
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| doc_clotaire
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3 ) Hypotensive px ............give fluids first
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| Aashi
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Key word---->'TENDER' pulsatile mass--->aneursyms which are small and are not intending to rupture anytime in near future are ASYMTOMATIC, tenderness,backpain,hypotensive--->means impending rupture(within secs or within mins) and if already ruptured----> mortality is gr8ly increased,once ruptured and then taking him for REPAIR....so repair shld be done before its ruptures so as to inc the survival rate.
U/S can be done,if there was one in the OT,so tht u can have a glance and then open him...sending this ticking time bomb to an XRAY dept for an U/S or for CT will be wastage of precious time...NEVER SEND AN UNSTABLE PT Which requires urgent surgical intervention to the radiology dept..The IV fluids can go with him to the OT,and it will run during the procedure as well..
So I go for-------->1
Edited by Aashi on 03/16/07 - 06:32 PM
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| Diego Casali
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According to USMLE World, when a patient presents with a pulsatile mass and hypotension, a presumptive diagnosis of ruptured abdominal aortic aneurysm must be entertained and the patients should be taken straight to the operating room.
So I definitely go for 1.
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| mjl1717
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a mistake with this q is a BIG mistake!!!------I think Aashi and Casali may be surgeons anyway.
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