ITU Referral (Perforation)

Doctor Instruction:

Mrs Smith, 73-year-old lady with a background of COPD, presented with perforated vicus and has now gone into acute renal failure. Blood results showed: K 2.5 (3.5), and Creatinine 200 (65). Her ABG showed metabolic acidosis with a high lactate with a negative base excess. Hb also dropped by 2 units.

She was brought in by her daughter in the emergency department for being 'under the weather', unremarkable until she ate food and suddenly developed severe abdominal pain. Examination reveals peritonism. CXR revealed air under the diaphragm and ultrasound showed free fluids in the abdomen. Urgent laparotomy is required after discussing with the on-call general surgeon, Mr Dark. He is now on the way to the hospital to do the operation.

Mr Dark has asked you to ring the ITU registrar to ask for pre-operative advice and request for HDU/ITU bed.

Questions from ITU Registrar:

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