Examkin

Question

Difficulty: EasySurgical and Procedural Interventions

A 28-year-old woman arrives at the emergency department due to severe, progressive right lower quadrant abdominal pain over the past 12 hours, accompanied by nausea and vomiting. Vital signs show a temperature of 38.3°C (100.9°F), blood pressure of 112/72 mmHg, and pulse of 105/min. Physical examination demonstrates localized rigidity and rebound tenderness in the right lower quadrant. A complete blood count reveals a leukocyte count of 16,000/mm³. Cross-sectional imaging of the abdomen and pelvis confirms acute, uncomplicated appendicitis. The surgical team schedules an urgent laparoscopic appendectomy. Which of the following interventions are appropriate in the immediate preoperative management of this patient? (Select all that apply)

  1. Administration of isotonic intravenous fluidsAnswer
  2. Administration of broad-spectrum intravenous antibioticsAnswer
  3. C
    Delaying the operation to obtain magnetic resonance imaging of the abdomen
  4. D
    Administration of therapeutic-dose subcutaneous enoxaparin
  5. E
    Discharge to home with oral antibiotics and a scheduled outpatient follow-up in 48 hours

Answer

The appropriate interventions are the administration of isotonic intravenous fluids and the administration of broad-spectrum intravenous antibiotics.
The correct interventions are the administration of isotonic intravenous fluids and broad-spectrum intravenous antibiotics. In a patient presenting with acute appendicitis and clinical signs of volume depletion (vomiting, tachycardia, fever), immediate preoperative management must prioritize hemodynamic stabilization with intravenous fluids. Additionally, broad-spectrum antibiotics covering gastrointestinal flora (gram-negative rods and anaerobes) are the standard of care to prevent surgical site infections and control the underlying infection before the primary incision.

Step-by-Step Solution

1
Identify the diagnosis and clinical status.
The patient has confirmed acute appendicitis and exhibits signs of mild volume depletion (tachycardia, vomiting, and fever).
Establishing the clinical baseline guides the immediate preoperative requirements.
2
Determine required preoperative interventions.
The patient requires prompt volume resuscitation and infection control.
To optimize the patient for safe surgical and anesthetic management.
3
Evaluate potential contraindications and avoid unnecessary steps.
Avoid therapeutic anticoagulation, redundant imaging, and inappropriate discharge.
To prevent complications such as severe hemorrhage, disease progression, or delayed care.

Key Concept

Essential preoperative management for urgent abdominal surgery (e.g., acute appendicitis) includes prompt fluid resuscitation and administration of prophylactic broad-spectrum intravenous antibiotics.
Estimated Time:1m 0s
Rate this question

Topics

Surgical and Procedural Interventions

More questions from this topic