Question

Case 31: 45M brought to the ED with sudden onset of severe burning epigastric pain, nausea, vomiting, malaise. He has a long hx of intermittent epigastric discomfort and is taking ibuprofen for tension headaches. Febrile, VS otherwise normal.

1. Emergency orders
2. Physical Exam
3. Diagnostic tests
4. Therapy
5. Location
6. Final order

Answer 1

The patient's symptoms suggest a possible case of gastritis or peptic ulcer disease. A step-by-step approach to the case includes emergency orders, physical exam, diagnostic tests, therapy, location, and final order. Treatment options may involve lifestyle modifications and medications to reduce gastric acid production.

Step-by-step explanation:

The patient's symptoms, including severe burning epigastric pain, nausea, vomiting, and malaise, suggest a possible case of gastritis or peptic ulcer disease. Given the long history of intermittent epigastric discomfort and the use of ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), it is important to consider the possibility of NSAID-induced gastric ulcers. Here is a step-by-step approach to the case:

1. Emergency orders: The patient should be assessed for stability. If vital signs are normal and there are no signs of acute complications, supportive care can be initiated, which includes pain relief and antiemetic medications.
2. Physical Exam: Perform a comprehensive physical examination to assess for any signs of complications such as gastrointestinal bleeding, perforation, or obstruction. Pay attention to the patient's abdominal tenderness and the presence of any masses or pulsatile abdominal aorta.
3. Diagnostic tests: Perform laboratory tests to assess the patient's complete blood count, liver function, renal function, and coagulation profile. It is also important to order imaging studies such as abdominal ultrasound or upper endoscopy to evaluate the integrity of the gastrointestinal tract and identify any potential pathology.
4. Therapy: Once the diagnosis of gastritis or peptic ulcer disease is confirmed, treatment options may include lifestyle modifications, such as avoiding NSAIDs and consuming smaller, more frequent meals. In addition, medications like proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) may be prescribed to reduce gastric acid production and promote healing.
5. Location: The patient should be admitted to a medical/surgical unit for further observation and management.
6. Final order: Develop a follow-up plan for the patient, which may include a referral to a gastroenterologist for further evaluation and long-term management.