Course in the intensive cover unit: The tolerant of was admitted at the ICU under the impression of septic dishonor probably utility(prenominal) to intraabdominal infection; t/c abdominal compartment syndrome. The proposal was to go ventilatory support, start empiric antibiotics, and possible surgery. At this time, the patients alliance pressure dropped further to 94/50 even with fluids. Heart rate was at cxl crush per minute, respiratory rate at 30 breaths per minute, and a spotO2 of 80%. The patient still presented with icteric sclera, bibasal crackles, a dist nullifyed stomach with inactive bowel sounds. The patient too presented with oliguria. Positive air-pressure was provided for the patient. small-arm on NPO, the patient was given over Tramadol for the pain and sedated with midazolam drip. A CT scan of the upper abdomen was do revealing: (1) livery ectasia with a gallstone at the distal end of the common bile duct (2) knowing pancreatitis with possible ab scess organization (3) a possible obstruction in the right urinary collecting system. Laboratory results already showed: overhead railway levels of serum amylase and lipase which was at par with the radiograph results. The patient underwent an ERCP unconscious process with stenting, sphincterotomy and gallstone extraction.
Post-operative care was continued at the ICU. A twin chest roentgenogram added the finding of a bilateral pneumonia to the earlier radiographic impression. Piperacillin-Tazobactam was given for the pneumonia and Fluconazole for the nosocomial infection cultured from the endotracheal subway system aspirate. Since the patient was also in acute respiratory failure , blood gases were serially monitored. Fluid! s and electrolytes were correct as necessary to assist the patient in providing for sufficient urine output and be physiologically balanced. Laboratory parameters were apply to guide the clinical management of the pancreatitis, which opinionated on the quaternate hospital day. Anemia was corrected with blood...
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