Answer
1) Hypovolumic shock secondary to acute pancreatitis
2) Management
- Secure the airway, breathing and circulation.
- Give oxygen via facemask and monitor patient condition as she may require intubation
- Set 2 large bore IV line
- Fluid resuscitation + aggressive fluid rehydration
- Admit the patient to HDU/ICU
- Continue the analgesic
- Frequent monitoring of the hematological and biochemical profile (LFT, RFT, PT/apTT, Serum calcium, blood glucose)
- Invasive vital sign monitoring (CVP, urine output, blood gasses)
- Nasogastric drainage
- Antibiotic prophylaxis (imipenam, cefuroxime)
- Supportive therapy for organ failure if develop (inotropes, ventilator, hemofiltration)
- Keep patient nil by mouth (some author said that it is save to give nasogastric feeding)
- Treat the underlying cause. ERCP within 72 hours if severe gall stone pancreatitis or sign of cholangitis.
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