[khanar]

A woman struck by car accident presented to the ER well oriented with normal BP and vitals. OE showed generalized tenderness and rigidity.
Kaplan said the next step is exploratory laparotomy!
How come, I say we still have time for CT scan.

What are you ideas!

 

[dr.Hatem]

A woman struck by car accident presented to the ER well oriented with normal BP and vitals. OE showed generalized tenderness and rigidity.
Kaplan said the next step is exploratory laporatomy!
How come, I say we still have time for CT scan.

What are you ideas!

pt is stable right now, so keep observing & do u/s or CT scan if available in your fasility, then if any need proceed to exLap

 

[khanar]

So should we trust Kaplan or not?

pt is stable right now, so keep observing & do u/s or CT scan if available in your fasility, then if any need proceed to exLap

Yeah, this is exactly what I thought. But in their explanation they mentioned that this is acute abdomen. Regardless of whether the patient is stable or not you have to do exLap and no need to waste time doing CTs or observing the patient!

 

[FSUSTC]

Patient present with abd tenderness , muscle rigidity which means there is some how intra abdominal hemorrhage .. tho vitals are normal now but may deteriorate if bleeding continues , so its better to do exploratory laparotomy and treating abdominal hemorrhage ...

 

[drnyinyithan]

According to Sample Live Lecture at Kaplan Medical Pasadena, yesterday, Dr Faroogi said, if you are sure you have a patient with acute abdomen, the next step is take him to OT, for example, patient with classic presentation of acute appendicitis, but every hospital will do a CT of abdomen as soon as the patient came in, but it is for the prevention of Malpractice Lawsuit.

 

[khanar]

According to Sample Live Lecture at Kaplan Medical Pasadena, yesterday, Dr Faroogi said, if you are sure you have a patient with acute abdomen, the next step is take him to OT, for example, patient with classic presentation of acute appendicitis, but every hospital will do a CT of abdomen as soon as the patient came in, but it is for the prevention of Malpractice Lawsuit.

This is absolutely right. Practically speaking, do CT scan. USMLE speaking, do laporatomy.

 

[matz]

peritoneitis

whenever u saw the term rigidity or rebound tenderness, it means the next step is laparotomy, since they are the signs of peritoneitis!!

p.s: there is only one exception, in primary peritoneitis u have to treat the patient medically with 3 weeks of antibiotics and not laparotomy.

 

[Sabio]

To Laparotomy or Not

Thank you guys for the good discussion

I wrote something about it here
http://www.usmle-forums.com/usmle-step-2-ck-classic-clues/2495-laparotomy-case-scenario.html