06-03-2017, 10:11 PM
72 yr old M comes to ER with C/O 2 days of abdominal pain which is worse at night with eating. He also notes constipation and some nausea with eating for past 6 months. PMH of Coronary bypass 3yrs ago, obstructive sleep apnea, Emphysema, Caludication and gout. S/P R inguinal hernia repair, Cholecystectomy and multiple podiatry procedures within last 30 yrs. Temp now is 100.6 F, BP=150/100, RR=12 and PR=100. PE= Obese M in moderate epigatric distress and LLQ pain. The is suggestion of LLQ pulsitile mass, no rebound tenderness. X'ray upright, decubitus and supine of Abdomen are normal. EKG is NSR with L ventr hypertrophy. The next step in ER is....
A) Start Cipro and Ampicillin
B) Start Cipro and Metronidazole
C) Oder CT abdo/Pelvis
D) Prepare for immediate Laprotomy
E) Send for USG abdo and appendix
A) Start Cipro and Ampicillin
B) Start Cipro and Metronidazole
C) Oder CT abdo/Pelvis
D) Prepare for immediate Laprotomy
E) Send for USG abdo and appendix