A 42-year-old male presents to the ED with a two day history of epigastric pain, nausea and vomiting. He has a history of diabetes and is alcohol dependent.
On examination he appears ill, with clinical signs of dehydration and severe tenderness in the epigastric region.
His observations:
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Question 1 of 3
1. Question
What is your initial approach?
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Question 2 of 3
2. Question
On examination you find a large ecchymosis patch on the trunk and persistent bleeding from the IV site. What specific blood tests will you order at this juncture?
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Question 3 of 3
3. Question
The laboratory investigations reveal the following:
Patient values
Reference
Haemoglobin
110 g/L
120-160 g/L
WBC
22 x 109 L
4-11 x 109 L
Platelet count
28 x 109 L
150-400 x 109 L
Urea
20 mmol/L
2.5- 7.8 mmol/L
Creatinine
31 µmol/L
3- 21 µmol/L
Bilirubin
30 µmol/L
< 21 µmol/L
PT
39 secs
12.5-17.0 secs
aPTT
62 secs
25.5-38.5 secs
Lipase
424 IU/L
13-60 IU/L
D dimer
3.2 µg/mL
<0.5 µg/mL
The patient’s oxygen requirements have gone up and he is currently on NRBM @15L with an SpO2 of 90%.
What specific treatment will you initiate now?
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