Primary Survey:
Short History
Pain (site, character, duration, severity), vomiting, distention, absolute constipation.
Look for features of strangulation obstruction
Physical Examination:
Check heart rate, blood pressure, temperature, respiratory rate, and hydration status. Per-rectal examination.
Resuscitation:
1- Keep the patient Nil by Mouth till further orders.
2- Maintain two I/V lines with 18 G branula.
3- Draw blood samples for Hb%, TLC, DLC, S/Electrolytes (Na+, K+), Blood Urea, S/Creatinine, Blood Sugar Fasting. (Serum Amylase in suspicion of Acute Pancreatitis.)
4- Start I/V fluids to correct dehydration: Inj. Ringer’s Lactate I/V 44 drops/min.
5- Pass N/G tube #16-18 in adults and maintain active suction intermittently I/V 8 hourly.
6- Pass Foley’s catheter #16 for adults
7- Record intake-output strictly on a chart.
8- Start I/V Antibiotics: Inj. ampicillin 500 mg I/V ATD 6 hourly, Inj. gentamycin 80 mg I/V 8 hourly, Inj. metronidazole 500 mg I/V 8 hourly.
9- Calculation of potassium deficit:
– For every 0.27mEq decreased in K+ replace 100 mEq of potassium
– Rate of infusion should not be more than 20 mEq/h.
– Maximum concentration for infusion should be < 40 mEq/l through peripheral vein.
– ECG monitoring for rapid replacement therapy
Secondary Survey:
- Detailed history and examination.
- X-Ray abdomen supine and erect.
- X-Ray Chest PA view and ECG if patient is > 40 years of age.
- Preparation for operation.
- Consent and arrange medicine for operation (For list of medicines, see appendix A).
- Inform anaesthetist and theater sister.
Rule out acute pancreatitis clinically as well as S/Amylase levels before decision for.
In cases of volvulus sigmoid colon try passing rectal tube in the absence of features of strangulation.
