In the ED, their vitals/exam are as above. Concern for intra-abdominal hypertension necessitating immediate or intervention. Hence, will proceed as below including checking for signs of endorgan dysfunction.
– Labs/Tests: VBG plus, Lactate, CBC, CMP, Lipase, PT/INR, Type & Screen, BCx, UA, UCx, COVID-19 RT-PCR, bedside bladder pressure (Foley attached to arterial line set up, with pressure >/ 20 mmhg consistent with intra-abdominal hypertension)
– Imaging: Bedside ultrasound looking for free fluid/free air/distended loops of bowel, bedside chest x-ray/KUB looking for free air +/- CTAP
– Treatments: NG tube for decompression, Zosyn vs. cefepime 2g IV q8h + metronidazole 500mg IV q8h, consider fluconazole 400-800mg IV q24h if evidence of esophageal perforation/immunosuppression/prolonged antacid therapy/prolonged antibiotic therapy/prolonged hospitalization/evidence of GI leak, IVF’/pain control/antiemetics as needed
– Consults: General surgery
– Dispo: Likely OR with subsequent admission to general surgery