Critical Pathway: Pancreatitis, Acute Essay

3720 words - 15 pages

I. Introduction
Mr. B is a 33 year old Caucasian, non-Hispanic male who presented to the emergency department with severe abdominal pain that began after returning home from a party where he consumed hot wings and ten beers. The pain is constant, located in the epigastric and right upper quadrant area, and radiates to his back. Approximately 2-3 hours after the pain began, the patient stated he vomited a large amount but it did not alleviate his pain.
Mr. B is married with no children with his wife at bedside. He is complaining of intermittent pain over the last several months that has been relieved with vomiting. He states tonight vomiting has not help. He admits to consuming approximately two to four alcoholic beverages daily after coming home from work. His diet consists of fast food or skipping meals during the day but his wife prepares meals in the evening. He does state that on weekends he may overeat and he enjoys spicy meals. He also states he has tried to quit but continues to smoke one pack of cigarettes a day.
Mr. B ambulated to the exam room bent over holding abdomen. He is unable to lie down due to increased pain and appears to be more comfortable sitting up in bed with knees pulled up to his chest. Upon arrival to the emergency department, Mr. B’s vital signs were initially:
Height – 6 ft 1 in
Weight – 250 lbs
BMI – 33
Pain – 10/10
Blood Pressure – 110/70
Pulse – 110
Respirations – 28
Oxygen Saturation – 98% (room air)
Temperature – 101.8 F
Initial examination of Mr. B revealed epigastric distention, severe abdominal tenderness and guarding with hypoactive bowel sounds, shallow respirations and complaints of severe nausea. An EKG was obtained and showed normal sinus rhythm. Mr. B was instructed he would not be given anything by mouth until the cause of pain and vomiting was identified. IV access was established and 0.9% Normal Saline was initiated at 250ml/hr. Laboratory test were obtained including a urine sample. Zofran 4mg and Hydromorphone 1mg was given IV for nausea and pain. Oxygen at 2L/min nasal cannula was placed to assist with increased oxygen demands with tachycardia, tachypnea and fever. Plain films of the chest and abdomen were ordered to exclude the presence of free air and identify small-bowel obstruction.
After twenty minutes, Mr. B stated his pain was 8/10 and nausea was relieved. Hydromorphone 1mg IV was repeated which decreased his pain level to 5/10. Chest radiography showed a small pleural effusion and abdominal films were negative. Abdominal ultrasonography revealed an inflamed pancreas but no signs of gallstones. CT scan of the abdomen revealed an inflamed, swollen pancreas without signs of necrosis. Lab results were:
Complete Blood Count
WBC - 17 3.8-11.0 K/mm3
RBC -5.0 4.2-5.6 M/L
Hematocrit -45 39-54%
Hemoglobin -17 14-18 g/dL
Platelets -200 150-450 U/L
MCH -28 27-35 pg
MCHC -33 31-37%
MCV -80 78-98 fL
PT -12 10-14 seconds
INR...

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