Question

Your patient sees you at a preplanned postoperative visit 4 weeks after being hospitalized for acute alcohol withdrawal. Upon questioning, she states that her husband is abusive, so she drinks to 'drown out his yelling.' The patient also complains of depression and severe pain in the epigastric region that radiates to her back and has been constant since yesterday. She has vomited twice in the past 12 hours. What is your first priority?

1) Refer her immediately for treatment of depression.
2) Call social services and report spousal abuse.
3) Assess her for pancreatitis.
4) Administer a test or scale that assesses alcohol withdrawal.

Answer 1

The first priority should be to assess the patient for pancreatitis, a serious condition that correlates with her symptoms and alcohol history. Immediate medical stabilization is critical before addressing other issues such as depression, abuse, or alcohol withdrawal.

Step-by-step explanation:

The first priority in addressing the concerns of a patient presenting with severe pain in the epigastric region that radiates to her back, along with a history of vomiting, is to assess her for pancreatitis. This condition can be a serious complication often associated with heavy alcohol use and can present with the symptoms described. Pain in the epigastric area, especially if radiating to the back and accompanied by vomiting, is a classic presentation of pancreatitis. Due to the acute nature of the symptoms and the potential for rapid deterioration, it is important to prioritize medical assessment and stabilization before addressing other significant issues such as depression, spousal abuse, or alcohol withdrawal.

Reporting spousal abuse is vital, but immediate medical needs must take precedence to ensure the patient's safety. Once the patient is stable, the necessary steps to address the abuse and other psychosocial issues can be taken, including a referral for depression treatment and engagement with social services. Assessing and treating the physical ailment urgently need to be prioritized to prevent further complications or even life-threatening situations.