A 35 yr old sewage worker was brought to the hospital with history of feeling of exhaution, abdominal pain, vomiting, fever and shock. On examination, his heart rate was 120/min, respiratory rate was 30/min, and blood pressure was 100/70 mm Hg. He had per abdominal signs of peritonitis. What should be the next step of management?
A. Shift the patient to OT immediately for laparotomy under G
|B||Shift the patient to OT for diagnostic laparoscopy and then for exploratory laparotomy.|
|C||Insert an abdominal drain under LA and then shift the patient to OT for exploratory laparotomy.|
|D||Resuscitate the patient with IV fluid and Oxygen and then shift the patient to OT for exploratory laparotomy.|
a. Regardless of the patient's severity of illness, all patients require some degree of preoperative preparation. IV access is obtained and any fluid or electrolyte abnormalities corrected. Nearly all patients will require antibiotic infusions.
b. The bacteria common in acute abdominal emergencies are gram-negative enteric organisms and anaerobes. Infusion of antibiotics to cover these organisms is started after a presumptive diagnosis is made.
c. Foley catheter bladder drainage to assess urine output, a measure of adequacy of fluid resuscitation, is indicated in most patients.
d. Preoperative urine output of 0.5 mL/kg/hour, along a with systolic blood pressure of at least 100 mm Hg and a pulse rate of 100 beats/minute or less, is indicative of adequate intravascular volume.
e. A common electrolyte abnormality requiring correction is hypokalemia. If significant potassium repletion is necessary, a central venous line is required.
f. The ability to give potassium through a peripheral line is limited by the development of phlebitis. Preoperative acidosis may respond to fluid repletion and IV bicarbonate infusion.
g. Acidosis due to intestinal ischemia or infarction may be refractory to preoperative therapy. Significant anemia is uncommon, and preoperative blood transfusions are usually unnecessary.
h. However, most patients should have blood typed and crossmatched and available at operation.
i. Deciding when the maximum benefit of preoperative therapy in these patients has been achieved requires good surgical judgment.