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Old 09-03-2014
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Default Gastric Perforation

If the pt has a gastric/viscus perforation. CXR shows free air under the diaphragm. What is the next step in management?

Uworld says that it is a surgery emergency therefore surgical emergency is next.

Mtb: Has it as a 4-step treatment. Starts with NPO, NG tube, IVF, then surgery.

Am I missing something? Thanks
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Old 09-06-2014
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Most probably by the time the patient got the CXR you've already worked yourself up through the IVF, NGT and NPO.
Management of patients goes through the ABCs first along with adjuncts. your ABCs are IVF, NGT and NPO and your adjunct is a CXR which showed perforation. SO IF YOU ARE EVER TO GET SUCH A QUESTION (which i don't think would happen ) your patient is to go the OR.
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Old 01-22-2015
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Cool same q

same question here!
MTB2 says one thing and uworld says another...

I guess we should pay attention to uworld!
gastric perforation NEXT STEP: O.R STAT.
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Old 01-22-2015
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I think it depends on how the question is phrased.

If the question points to a glaringly acute abdomen, with guarding, and sepsis, with severe anemia or hypotension... then the question is already telling you to answer Laparotomy stat.

But if the question uses "vague" or "unqualifying" terms... and diagnosis is still in question, then you do still do NPO, NGT, IVF and other diagnostics...

In short, much is to be derived as to how the question is being phrased.
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