An elderly female presents to the emergency department with vomiting and abdominal pain. She has a history of a cholecystectomy about 5 years ago. On exam, she is significantly uncomfortable and nauseated. Lung and cardiovascular exam is normal. Abdominal exam shows diffuse tenderness, some distention with tympany, and an empty rectal vault. Vital signs are:
HR 102 BP 145/86 RR 24 SpO2 96% RA Temp 99.9F
You order an acute abdominal series, which is read by the radiologist as "nonspecific bowel gas pattern, no perforation." What is your management plan?
A. IV fluids, pain medication, consult vascular surgery for serial exams
B. IV fluids, pain medication, CT abdomen
C. IV fluids, pain medication, consult vascular surgery
D. IV fluids, pain medication, discharge if improved
A 45 year old female patient presents to the emergency department in the care of her husband with a complaint of agitation and anxiety. Her husband states that she has been acting "strangely" for the past several days. She's been hyperactive, "agitated", and sometimes delusional. She is previously healthy but has allergies to penicillins, iodine, and morphine. On exam, the patient is clearly anxious and frustrated with the visit. She's diaphoretic and on cardiovascular exam a harsh systolic murmur is heard as well as an irregularly irregular rhythm. Vital signs show a temperature of 101.5, HR 123, BP 175/98, RR 27, and SpO2 98% on RA. An EKG shows rapid atrial fibrillation. What is the definitive treatment for her condition?
A. Diltiazem, benzodiazepines, IV fluids
B. Aspirin, benzodiazepines, fluids
C. Lithium, propranolol, acetaminophen
D. Acetaminophen, haloperidol, atenolol