03-22-2007, 01:08 PM
A 32-year-old man is admitted to the hospital following a motor vehicle accident. He was driving a car at 70 miles per hour and was involved in a head-on collision. He was wearing a seat belt at the time of the accident. Initial evaluation in the emergency department by means of physical examination, cervical spine, and chest and pelvic x-rays did not reveal any abnormalities. A complete blood count and metabolic panel were within normal limits. Urine analysis does not show evidence of blood or RBCs. He is admitted to the hospital because of suspected contusion to the brain and because of the death of the passenger sitting in the front seat in the same accident. Twelve hours after admission, he complains of severe abdominal pain. His vital signs are within normal limits except for tachycardia. His abdomen is soft, slightly distended with absent bowel sounds. Repeat laboratory investigation shows a stable hematocrit, leukocyte count of 16,000/mm3, and a serum amylase of 4000 U/L. The most appropriate next step in the management of this patient is
A. analgesics
B. CT scan of the abdomen and pelvis with IV contrast
C. diagnostic peritoneal lavage
D. observation
E. ultrasonography
A. analgesics
B. CT scan of the abdomen and pelvis with IV contrast
C. diagnostic peritoneal lavage
D. observation
E. ultrasonography