GOGETA
Trying to get in PGY1
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47 y/o woman with a Hx of similar attacks of epigastric abdominal pain in the past was admitted to the hospital with a Dx of gallstone pancreatitis. She was NPO and IV fluid started. On the evening of admission day, the patient is noted to have T=103.4 F. Her BP & HR are within normal range. Her abdomen is diffusely tender to palpation with guarding. What’s the most appropriate management at this time?
A. draw blood cultures and await results
B. draw blood cultures and initiate ampicillin, gentamicin, and metronidazole therapy
C. draw blood, urine, and sputum cultures and await results
D. obtain an urgent abdominal CT scan
E. start ampicillin, gentamicin, and metronidazole therapy
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| Vietnamese
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D
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Nothing is impossible.
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| mikky
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d?
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it is our choices that show what we truly are, far more than our abilities!!!!
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| arlete
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B
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| guangyu
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D
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| goldencreeper
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high fever, so blood culture, but emperic antibiotics should be started as wee, so i think, B
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| peter90036
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not sure what they're implying, but if ac pancreatitis does not resolve(but thats about 24h?) --> CT or if suspecting necrosis (but necrosis is ~2wks after)
no jaundice?
can it be cholecystitis/ cholangitis- for which initial tx includes antibiotics?
perforated cholecyst?
you got answer to this one Gogeta?
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| GOGETA
Trying to get in PGY1
Topics: 375
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The correct answer is B. The most appropriate management at this time is to draw blood cultures and initiate ampicillin, gentamicin, and metronidazole therapy. Intravenous antibiotics are only indicated if there is evidence of pancreatic necrosis or if the patient develops a fever after the diagnosis of pancreatitis is made. There is a substantial amount of clinical literature validating this approach to treating pancreatitis. The appropriate sequence of events is to draw blood cultures prior to initiating therapy in order to maximize chances of detecting an organism.
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As a general rule, the better it felt when you said it, the more trouble it's going to get you into.
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