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    Noetic Science

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    Miguel Domingo
    The patient presented with a 3 week history of epigastric pain and vomiting which worsened over the past day. Physical exam revealed signs of acute pancreatitis which was confirmed on abdominal ultrasound. The patient's condition deteriorated over 15 hours despite treatment with antibiotics, analgesics, and supportive care. Laboratory results showed worsening anemia, leukocytosis, and coagulopathy. The patient suffered cardiopulmonary arrest and died.

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    Noetic Science

    Uploaded by

    Miguel Domingo
    79 views3 pages
    The patient presented with a 3 week history of epigastric pain and vomiting which worsened over the past day. Physical exam revealed signs of acute pancreatitis which was confirmed on abdominal ultrasound. The patient's condition deteriorated over 15 hours despite treatment with antibiotics, analgesics, and supportive care. Laboratory results showed worsening anemia, leukocytosis, and coagulopathy. The patient suffered cardiopulmonary arrest and died.

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    NOETIC SCIENCE

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    NOETIC SCIENCE

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    The patient presented with a 3 week history of epigastric pain and vomiting which worsened over the past day. Physical exam revealed signs of acute pancreatitis which was confirmed on abdominal ultrasound. The patient's condition deteriorated over 15 hours despite treatment with antibiotics, analgesics, and supportive care. Laboratory results showed worsening anemia, leukocytosis, and coagulopathy. The patient suffered cardiopulmonary arrest and died.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    79 views3 pages

    Noetic Science

    Uploaded by

    Miguel Domingo
    The patient presented with a 3 week history of epigastric pain and vomiting which worsened over the past day. Physical exam revealed signs of acute pancreatitis which was confirmed on abdominal ultrasound. The patient's condition deteriorated over 15 hours despite treatment with antibiotics, analgesics, and supportive care. Laboratory results showed worsening anemia, leukocytosis, and coagulopathy. The patient suffered cardiopulmonary arrest and died.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    SURGICAL PATHOLOGY

    Clinical Abstract

    History of Present Illness:

    3 weeks prior to admission, patient claimed to have an on & off tolerable epigastric pain, associated
    with occasional nausea & vomiting. Sought consult to a private physician and was given unrecalled
    medications which offered temporary relief.

    1 day prior to admission, pain became persistent, increasing in severity, associated with several episodes
    of vomiting. Patient was admitted at a district hospital and was subsequently referred to this hospital.

    Past Medical History:

    No previous hospitalizations
    No known medical illnesses
    Non diabetic, non hypertensive

    Family History:

    (+) Bronchial asthma

    Personal and Social History:

    Alcoholic drinker
    Smoker (10 pack years)

    Physical Examination:

    BP= 110/80, CR=140/min, RR=27/min


    Cold, clammy skin
    Conscious, coherent, oriented, not in cardiopulmonary distress
    Anicteric sclera, pinkish conjunctivae
    Symmetrical chest expansion, harsh breath sounds, no rales, no wheezes
    Regular cardiac rate & rhythm, (-) murmur

    Admitting Impression: Acute Pancreatitis


    Diabetes Mellitus

    Admitting Orders:
    Diabetic diet
    Capillary Blood Glucose (CBG)= 210mgs%
    Trop-T
    Lee White Clotting Time q 6H
    Urinalysis with ketone determination
    FBS, Lipid Profile, BUN, Creatinine
    S. Amylase, S Na, K STAT
    CXR- PA view
    Hepatobiliary Ultrasound
    ECG- 12 leads

    Referred to Dept. of Surgery:


    Subjective/Objective: (+) epigastric on & off with vomiting
    (+) flatus, (+) bowel movement
    Assessment: T/C PUD R/O Acute Pancreatitis
    Plan: Abdominal Ultrasound (Result: Edematous pancreas consistent with Pancreatitis)

    Meds:
    Famotidine 20 mg IVTT q 12H
    Insulin sliding scale on the following CBG:
    <150 no coverage
    151-200 2 u subcutaneous
    201-250 4
    251-300 6
    301-350 8
    351-400 10
    401-500 12
    > 500 Refer to Attending

    Verapamil 2.5 mgs IVTT


    Dopamine 200 mgs/250mL at 60 gtts/min
    Dobutamine drop: D5W 500cc + 2 amps Dobutamine at 60 gtts/minute
    Aspilet 80 mgs/tab, 4 tabs now, then 1 tab after meals
    Heparin 5000 u IV now, then 1000 u q 9 hours as drip

    2 hours after admission: complained of severe abdominal pain, cold clammy skin.
    BP= palpatory 80
    CR= 105/min
    RR= 24/min
    Started with cefuroxime 750 mgs q 8 hours
    Buscopan 20 mgs IVTT

    10 hours after admission: Generalized abdominal pain


    BP= 110/90
    CR= 110/min
    RR= gasping
    CVP 7 cm
    Patient was intubated
    Started with Tramadol
    11 hours after admission: Cold, clammy skin, Cyanosis
    BP= palpatory 50
    CR=98/min
    CVP= 6-7 cm

    15 hours after admission: Cardiopulmonary arrest

    Laboratory:

    CBC On Admission After 6 hours


    Hemoglobin 22.4 g/dL 15.6 g/dL
    Hematocrit 0.46% 0.66%
    WBC 6.3 X 109 /L 17.2 X 109 /L
    Neutrophils 90% 88%
    Segmenters 90% 88%
    Lymphocytes 10% 11%
    Monocytes 0% 1%
    Platelet Count 268 x 109/L 350 X 109 /L

    Clotting Time: 2 minutes


    Bleeding Time: 2 minutes 30 seconds

    Lee White Clotting Time: 8 min 30 sec

    Troponin T Negative

    Serum Na 140.4 mmol/L


    Serum K 4.19 mmol/L

    Urinalysis: Normal

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