next step - usmle68

[ArchivalUser]

16 month baby, 1w diarrhea, came for colicky abdominal pain for 12 h and vomiting for 1day. PE: tender abdomen, lethagic child. T=101.3, WBC=18000. next step?
a. electrolytes replacement
b. abt
c. reduction of bowel
d. O2 morphine
e. bowel resection
f. endoscope

[ArchivalUser]

forgot to add "pass black bloody stool today".

[ArchivalUser]

c is ans

[ArchivalUser]

A.
Check his electrolytes.He might be dehydrated and hypokalemic. Rest follows

[ArchivalUser]

What if the Q asks the next most important step is ?

[ArchivalUser]

its intsusseption or PS ?

[ArchivalUser]

most improtant next step would be reduction.

[ArchivalUser]

This looks like intususseption....so 1st will be Air enema which is preferred than gastrograffin enema this can be therapeutic & diagnostic...

Now post enema recurrence rate is high so admit the patient in floor with mother and correct all possible electrolyte issues. Now admit & montitor for at least 24 hrs if doesnt recur in 24 hrs patient can be discharged with helathy diet advice and immunization counselling. Standard counselling like regular weight & height monitoring and looking for any further black stool.


If recurrs in 24hr immediate surgery ( Laparotomy) to reduce the intususseption. Prepare patient with NPO,coags, IV fluids. Bowel prep is not possible in emergency.

[ArchivalUser]

Hi, spritit, you are so good. you'll ace the exam!