Question

A patient came in emergency with severe abdominal pain pulse 112/ minute and systolic BP 80 mm/Hg with the chest Xray shown below. What will be the next appropriate step to be taken for the patient?

• A. Exploratory laprotomy
• B. Saline Wash of stomach
• C. Intercostal tube drainage
• D. None

Answer 1

The Correct Option is A

The patient's symptoms—severe abdominal pain, a high pulse rate of 112/minute, and low systolic blood pressure of 80 mm/Hg—indicate a possible critical internal condition that requires immediate attention. These symptoms suggest hypovolemic shock, likely due to internal bleeding or perforation, based on the context of the emergency. The chest X-ray, which would be crucial for diagnosis, typically aids in identifying any air under the diaphragm, indicating free air due to gastrointestinal perforation. In such an emergency, time is critical.

Given the options provided:

• Exploratory laprotomy: This surgical procedure is performed to examine the abdominal cavity. It is appropriate when there is suspicion of internal bleeding, perforation, or other acute abdominal conditions.
• Saline Wash of stomach: This is usually not indicated in emergency settings for abdominal pain with the symptoms presented.
• Intercostal tube drainage: Typically used for conditions like pneumothorax; not directly related to abdominal pain with current symptoms.
• None: Not appropriate as the patient's condition is critical and demands intervention.

Thus, the most appropriate step, considering the severity of the symptoms and likely diagnosis, is an Exploratory laprotomy. This allows for direct assessment and intervention in case of perforation or intra-abdominal bleeding, which corresponds with the low blood pressure and rapid pulse.