Perforated Viscus: Management

00:01 So what do we do for these patients? So we found out that our patient does have a perforated viscus and we wanna move on and think about what the next steps are.

00:09 So first and foremost in the Emergency Department, ABC’s.

00:13 So think about the airway and the breathing.

00:15 Think about fluid and volume resuscitation.

00:19 Your patient will likely need two large bore IV’s.

00:22 So that’s something larger than an 18 gauge IV.

00:25 Either an 18, a 16, or a 14 gauge IV.

00:29 You wanna think about transfusing blood product or the very least, getting blood products ready.

00:34 So does your patient need a red blood cell transfusion? Are they on anticoagulants and do they need FFP? So sending coagulation studies and a type and cross will put you in a good place.

00:46 You wanna give antibiotics.

00:48 You wanna cover the gut flora.

00:50 So you wanna cover anaerobes.

00:52 You wanna cover enteric pathogens.

00:54 And you want those to be broad spectrum.

00:56 Your patient is super sick.

00:58 You wanna make sure that you’re covering all the possible bacteria that could be floating around in their abdominal cavity.

01:06 And then you wanna involve surgery.

01:07 Right when you suspect this diagnosis, you wanna call your surgical consult.

01:12 You wanna get them on board, you wanna tell them what your concerns are.

01:16 It’s possible that interventional radiology could play a role here but for the most part, your patient may in fact need surgical intervention.

01:25 So the conclusions here.

01:28 Perforated viscus is a very serious condition.

01:30 It has a very high mortality.

01:32 Maintain a high suspicion for this diagnosis.

01:36 This is not something that you wanna miss.

01:38 The most common causes of perforated viscus are peptic ulcer disease and diverticulitis.

01:44 And you wanna be sure you’re asking your patient about if they’ve ever had any prior abdominal pain that would support a diagnosis of peptic ulcers or prior symptoms that would support that.

01:54 Same thing with supporting diagnosis of diverticulitis.

01:58 The classic history here is severe and sudden onset of pain.

02:01 Oftentimes, this will not be a subtle presentation but be wary of the elderly and immunocompromised because they may present in very unusual ways.

02:10 Early surgical consultation is a key management step.

02:14 So definitely be sure to get your surgeon onboard early if you’re worried about a perforated viscus.