Scribd Logo
Upload

Welcome to Scribd!

  • 43 views

    ESTORNINOS Case4.1 Surgery

    Uploaded by

    Joanna Carla Marmonejo Estorninos-Walker
    This is my personal output during my Surgery rotation (online) during COVID-19 days. TOPIC: Abdominal Trauma.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    ESTORNINOS Case4.1 Surgery

    Uploaded by

    Joanna Carla Marmonejo Estorninos-Walker
    43 views2 pages
    This is my personal output during my Surgery rotation (online) during COVID-19 days. TOPIC: Abdominal Trauma.

    Original Title

    ESTORNINOS-Case4.1-Surgery

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This is my personal output during my Surgery rotation (online) during COVID-19 days. TOPIC: Abdominal Trauma.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    43 views2 pages

    ESTORNINOS Case4.1 Surgery

    Uploaded by

    Joanna Carla Marmonejo Estorninos-Walker
    This is my personal output during my Surgery rotation (online) during COVID-19 days. TOPIC: Abdominal Trauma.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ESTORNINOS, JOANNA CARLA M.

    NMD 4TH YEAR CLERK


    Batch April 6-May 31, 2020

    CLINICAL CASE 4.1

    1. Present assessment.
    As ordered yesterday, patient was admitted and must be monitored closely
    especially the pain scale level and vital signs. Few hours after admission, patient showed
    stable condition.
    Currently, the patient is still hemodynamically stable however, the sudden rise of
    temperature to 39.8C, increased abdominal pain, presence of involuntary muscle
    guarding and rebound tenderness are impending signs and symptoms of abdominal
    sepsis that must be prevented.

    2. Imaging procedures requests and findings.


    After knowing the present condition of the patient, I will repeat abdominal
    ultrasound and will be expecting to find free fluid in Douglas’ and Morrison pouches, which
    are the dependent portions of the intraperitoneal cavity where blood is high likely to
    accumulate.
    Moreover, if the patient has a poor score in Blunt Abdominal Trauma in Children
    scoring and since she is still hemodynamically stable, I will request abdominal contrast
    enhanced CT scan as this can give clearer picture of injured organ and its extent of
    damage. I am expecting to find free fluid of high density in the peritoneal cavity around
    the hepato-renal pouch and localized free gas in retroperitoneum around second part of
    duodenum. Duodenal perforations expected findings are retroperitoneal collection of
    contrast medium, extra-luminal gas and lack of continuity of the duodenal wall.

    3. Present therapeutic plans.


    With the abdominal sepsis forthcoming, I am planning to schedule the patient for
    laparoscopy. One of the advantage of performing laparoscopy over contrast-enhanced
    CT scan is to be able to immediately locate the injury and can be treated immediately and
    accordingly.
    In addition, the patient will still continue to be in NPO diet and on her antibiotics.
    There will still be continuous monitoring of the patient’s condition until the family can
    decide which management they would choose.

    4. Preparations for the patient.


    In preparing the patient, the family and the patient must be informed first hand of
    the plan procedures for the patient. They should be aware of the pros, cons and possible
    complications of each procedure planned. If they can already decide for their best choice,
    the patient must be maintained of NPO diet, all meds should be given, follow-up pending
    laboratory, refer to anesthesiologist and continue monitoring.

    References:
    1. Schwartz 11th edition
    2. Provided study material
    3. Dhua, A.K., Joshi, M. An isolated duodenal perforation in pediatric blunt abdominal
    trauma: a rare but distinct possibility. Burn Trauma 3, 4 (2015).
    https://doi.org/10.1186/s41038-015-0008-6

    You might also like