Scribd Logo
Unggah

Selamat datang di Scribd!

  • Ugib Sem 6

    Diunggah oleh

    FioNa Fii
    52 tayangan18 halaman
    This patient is a 47-year-old Malay man who presented with vomiting blood and melena stool. He has a history of gastritis. On examination, he was found to be hypotensive and tachycardic, consistent with hypovolemic shock from upper gastrointestinal bleeding. Initial management included IV pantoprazole, IV fluids, and blood pressure support. Due to ongoing hypotension, the patient was upgraded to the red zone and a RUSH protocol was initiated. He was admitted for further management including endoscopy and surgery. A chest X-ray subsequently revealed pneumoperitoneum.

    Deskripsi Asli:

    SEM 6 PPP

    Judul Asli

    UGIB SEM 6

    Hak Cipta

    © © All Rights Reserved

    Format Tersedia

    PPTX, PDF, TXT atau baca online dari Scribd

    Apakah menurut Anda dokumen ini bermanfaat?

    Apakah konten ini tidak pantas?

    Laporkan Dokumen Ini
    This patient is a 47-year-old Malay man who presented with vomiting blood and melena stool. He has a history of gastritis. On examination, he was found to be hypotensive and tachycardic, consistent with hypovolemic shock from upper gastrointestinal bleeding. Initial management included IV pantoprazole, IV fluids, and blood pressure support. Due to ongoing hypotension, the patient was upgraded to the red zone and a RUSH protocol was initiated. He was admitted for further management including endoscopy and surgery. A chest X-ray subsequently revealed pneumoperitoneum.

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai PPTX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    52 tayangan18 halaman

    Ugib Sem 6

    Diunggah oleh

    FioNa Fii
    This patient is a 47-year-old Malay man who presented with vomiting blood and melena stool. He has a history of gastritis. On examination, he was found to be hypotensive and tachycardic, consistent with hypovolemic shock from upper gastrointestinal bleeding. Initial management included IV pantoprazole, IV fluids, and blood pressure support. Due to ongoing hypotension, the patient was upgraded to the red zone and a RUSH protocol was initiated. He was admitted for further management including endoscopy and surgery. A chest X-ray subsequently revealed pneumoperitoneum.

    Hak Cipta:

    © All Rights Reserved
    Unduh sebagai PPTX, PDF, TXT atau baca online dari Scribd
    Tandai sebagai konten tidak pantas
    dari 18

    Upper GastroInstenstinal

    Bleeding (UGIB )

    By FioNa Dived
    Male/47yearsold/malay
    NKMI

    PRIMARY TRIAGE
    C/o vomiting blood x 1/7, cough x 1/52
    SECONDARY TRIAGE
    C/o
    1. giddiness x 2/7
    - body weakness after vomiting blood
    - still able to ambulate
    2. Maleena stool today 2 episode.
    3. Vomit blood at 6pm
    - 2 episode
    - food + fresh blood
    - 1 cup amount fresh blood
    4. h/0 abdominal pain 2/7
    - epigastric region
    - burny sensation
    - slidly relive by food intake

    H/o gastritis, No endoscope done before


    h/o cough x 1/52 and fever x 5/7
    - on/off, resolved yesterday
    - Very painful when lie down, relive when sitting
    - LOA but still can tolerate with food
    - No chest pain, no surgery history of heart disease
    - Denied aspirin, steroid, cap kaki tiga
    - Stop dringking 1 year ago
    - Stop smoking 1 year ago
    Examination
    G/c walkin, alert, conscious, mild dehydrate
    - CRT < 2 sec
    Time Bp Pulse spo2 RR Temp Gcs Pain
    score
    9.00am 70/38 77 99 22 36.2 15/15 6/10
    9.15am 73/39 70 99 21 36.2 15/15 6/10

    Yellow zone
    Examination
    CVS
    - DRNM
    Lungs
    - Clear
    - A/E equally
    Abdoman
    - soft, non tender, no mass palpable
    PR ( pemeriksaan rectum)
    - malena stool
    - No fresh blood
    - No mass
    Investigasi
    Full Blood count
    - Rbc : 5.07 ( Normal range 4.5 6.5)
    - Hb : 13.0 (Normal range 13.5 17)
    - Wbc : 14.07 ( Normal range 4 10)
    - Platlet : 345 (Normal Range 150 400)

    BUSE/CREAT/LFT
    -
    Protombin time/ partial thrombopladtin time
    - PT/APTT/INR : 12.5/29.6/0.9
    Electrocardiogram (ECG)
    - Normal ECG
    Chest X- ray
    - No air under Diaphgram
    GXM
    - type of ABO & Rh grouping
    Management at ETD
    Yellow zone
    - Bp : 73/39 HR: 62 spo2 100%
    - Recheck : 92/59
    Iv bolus pantoprazole 80mg stat then IvI pantoprazole 8mg/hours
    Chest x-ray sitting in red zone
    Monitoring Bp , to Red zone if BP still Low after 1pine N/s
    Upgrade to red zone due to low Bp , low Hr
    Impression Hypovolumik shock 2 to UGIB
    BP : 70/38mmHg Pr:77bpm
    After 1 pine n/s given Bp : 91/53
    Iv bolus pantoprazole 80mg stat then
    IvI pantoprazole 8mg/hours
    On going 2nd pine n/s
    Red Zone
    RUSH protocol (Rapid Ultrasound for Shock and Hypotension)
    Plan
    - Refer surgery
    - insert NG tube and CBD
    - take UFEME
    - continue IVF pantoprazole, infusion 8mg/hours
    - continue N/s + keep NPO
    - monitoring/keep Bp >90mmHg
    Recheck BP: 113/63, PR :83bpm, spo2 :97%
    Keep Npo for OGDS
    Cont IvI pantoprazole
    Cont IVD 2.5L/day N/s
    Keep BP > 90mmHg
    Call surgical MO oncall , enquire on admission for pt
    Suggested for admission for OGDS from wad for better care
    surgeon on call come to review pt
    Admit to male surgical wad
    For OGDS today
    Keep NPO with IVD 2.5 L/hours n/s & Alt D5%
    C-xray
    Pneumoperitonium ( gas under diaphragm)
    ECG
    Tu jer TQ

    Anda mungkin juga menyukai