[checkbox name="Q1" value="Abdominal Pain|Agitation|Alcohol Intoxication|Blood Pressure (Normal-Elevated)|Colorectal Cancer Screening (Discussion)|Constipation (Functional)|Cirrhosis|Fluids|Headaches|Migraine(s)"] [conditional field="Q1" condition="(Q1).is('Abdominal Pain')"] # ABDOMINAL PAIN —— ECG —— Chest X-Ray —— CBC # ABDOMINAL PAIN —— Abdominal X-Ray: Rule out intestinal obstruction, strangulation, adhesions, tumors, or regional enteritis. —— Abdominal Ultrasound: Rule out bowel infarction, aortic aneurysm. # ABDOMINAL PAIN —— Abdominal CT: Rule out appendicitis, diverticulitis —— Barium enema # ABDOMINAL PAIN —— Consider Meckel's diverticulitis —— Consider Acute Intermittent porphyria —— Consider Lead Intoxication [/conditional] [conditional field="Q1" condition="(Q1).is('Agitation')"] # AGITATION —— Oxygen via Nasal Cannula or Non-Rebreather Mask —— 2 Large Bore Peripheral IV Lines —— 1 Liter D5 Normal Saline —— Urinalaysis —— Urine Toxicology Panel —— Alcohol Level —— Basic Metabolic Panel —— Complete Blood Count —— Liver Function Tests —— PT —— PTT —— Monitor Vitals —— Finger Stick Glucose —— Reassess # AGITATION —— CT of Head Without Contrast —— Thiamine —— Folate —— D5 Normal Saline —— Reassess [/conditional] [conditional field="Q1" condition="(Q1).is('Alcohol Intoxication')"] # ALCOHOL INTOXICATION —- CT of Head Without Contrast —— Anion Gap —— Osmolar Gap —— Laceration Repair [/conditional] [conditional field="Q1" condition="(Q1).is('Blood Pressure (Normal-Elevated)')"] # BLOOD PRESSURE —— Follow-up is recommended with PCP in several weeks for re-evaluation. —— Reassess [/conditional] [conditional field="Q1" condition="(Q1).is('Colorectal Cancer Screening (Discussion)')"] # COLORECTAL CANCER SCREENING (DISCUSSION) —— Patient was advised that a baseline colonoscopy is recommended to screen for colorectal cancer. —— It was explained to the patient that recommendation for a subsequent colonoscopy are based on the endoscopic and pathological results of this exam and will be discussed when these are available. [/conditional] [conditional field="Q1" condition="(Q1).is('Constipation (Functional)')"] # CONSTIPATION (FUNCTIONAL) —— Increase oral hydration (without caffeine or alcohol) —— Increase physical activity BULKING AGENT —— Methylcellulose powder 19 g per day by mouth daily - onset in 12-72 hours —— Polycarbophil tablets 1250 mg by mouth 1 to 4 times per day - onset in in 12-72 hour —— Psyllium powder 1 teaspoon or 1 packet by mouth 1 to 3 times per day + onset in 12-24 hours OSMOTIC LAXATIVE —— Lactulose 15 to 30 mL by mouth once per day - onset in 24-48 hours —— Magnesium Citrate 150 to 300 mL by mouth as a single dose - onset in 30 minutes to 6 hours —— Magnesium Hydroxide 30 to 60 mL by mouth once per day onset in 30 minutes to 6 hours —— Polyethylene glycol powder 17 g by mouth once per day - onset in 24-48 hours STOOL SOFTENER —— Docusate sodium 100 mg by mouth twice per day - onset in 24-48 hours STIMULANT LAXATIVE —— Bisacodyl 5 to 15 mg by mouth per day - onset in 6-10 hours —— Senna 15 mg by mouth per day - onset in 6-10 hours [/conditional] [conditional field="Q1" condition="(Q1).is('Cirrhosis')"] # CIRRHOSIS —— Schedule a right upper quadrant ultrasound for Hepatocellular carcinoma monitoring for every 6-12 months —— Schedule an Esophagogastroduodenoscopy (EGD) —— Check Hepatitis C genotype to guide potential therapy —— Check Hepatitis C viral load to guide potential therapy —— Administer Hepatitis A vaccination series —— Administer Hepatitis B vaccination series —— Counsel on Alcohol cessation [/conditional] [conditional field="Q1" condition="(Q1).is('Fluids')"] # FLUIDS —— If the patient is DEHYDRATED: administer NORMAL SALINE at an infusion rate of 4 cc/h/kg for the FIRST 10 KILOGRAMS of the patient's weight and another 1 cc/h/kg of NORMAL SALINE for EVERY KILOGRAM OVER 10 KILOGRAMS. —— If the patient requires MAINTENANCE FLUIDS: administer NORMAL SALINE at an infusion rate of 1-2 cc/h/kg for EVERY KILOGRAM that the patient weights. —— (!) Hypotonic IV solutions should not be given with exception being hyperosmolar states. [/conditional] [conditional field="Q1" condition="(Q1).is('Headaches')"] # HEADACHES —— We discussed the possibility of nerve block injection; however, at this is not desired by the patient. —— We will titrate Zonisamide (Zonegran) to 200 mg q.h.s. to maximize this medication's pharmaceutical efficacy. —— We will then consider other anticonvulsants such as Gabapentin (Neurontin) or Pregabalin (Lyrica) if the Zonisamide (Zonegran) regimen is not effective. [/conditional] [conditional field="Q1" condition="(Q1).is('Migraine(s)')"] # MIGRAINE(S) —— The patient already had MRI of the brain and the cervical spine. —— MRI of the brain reported negative and therefore revealed no explanation for the temporal headache. —— Patient has already had received 50 mg today. —— The patient will be given a trial of prednisone and will taper off in 6 days. —— Valproic acid (Depakote) as a part of migraine prophylaxis —— Acetaminophen / Butalbital / Caffeine (Fioricet) on an as needed basis. —— Vasculitis workup. —— Plan and followup discussed with the patient in detail [/conditional]
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