Acute intestinal obstruction

Primary Survey:

Short History

Pain (site, character, duration, severity), vomiting, distention, absolute constipation.

Look for features of strangulation obstruction

Physical Examination:

Check heart rate, blood pressure, temperature, respiratory rate, and hydration status.  Per-rectal examination.

Resuscitation:

1-   Keep the patient Nil by Mouth till further orders.

2-   Maintain two I/V lines with 18 G branula.

3-    Draw blood samples for Hb%, TLC, DLC, S/Electrolytes (Na+, K+), Blood Urea, S/Creatinine, Blood Sugar Fasting.  (Serum Amylase in suspicion of Acute Pancreatitis.)

4-    Start I/V fluids to correct dehydration:  Inj. Ringer’s Lactate I/V 44 drops/min.

5-   Pass N/G tube #16-18 in adults and maintain active suction intermittently I/V 8 hourly.

6-   Pass Foley’s catheter #16 for adults

7-   Record intake-output strictly on a chart.

8-   Start I/V Antibiotics:        Inj. ampicillin 500 mg I/V ATD 6 hourly, Inj. gentamycin 80 mg I/V 8 hourly, Inj. metronidazole 500 mg I/V 8 hourly.

9- Calculation of  potassium  deficit:

–     For every 0.27mEq decreased in K+ replace 100 mEq of  potassium

–    Rate of infusion should not be more than 20 mEq/h.

–    Maximum concentration for infusion should be < 40 mEq/l through peripheral vein.

–    ECG monitoring for rapid replacement therapy

Secondary Survey:

  1. Detailed history and examination.
  2. X-Ray abdomen supine and erect.
  3. X-Ray Chest PA view and ECG if patient is > 40 years of age.
  4. Preparation for operation.
  5. Consent and arrange medicine for operation (For list of medicines, see appendix A).
  6. Inform anaesthetist and theater sister.

 

Rule out acute pancreatitis clinically as well as S/Amylase levels before decision for.

In cases of volvulus sigmoid colon try passing rectal tube in the absence of features of strangulation.

 

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