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Small bowel obstruction

  • Common ddx

    • adhesions, hernia
  • Serious ddx

    • malignancy, Crohn's, volvulus, intussusception
  • Admission orders

    • Admit: Floor
    • Diagnosis: SBO
    • Condition: Guarded
    • Vital Signs: VS q 2 hours x 4, then q 4 hours. Orthostatics on admission
    • Allergies:
    • Nursing:
      • NG tube to low intermittent suction
      • Foley catheter, accurate I/Os, including NG output
    • Diet: NPO
    • Activity: Bedrest
    • Labs:
      • Chem q 8 hours
      • Calcium, magnesium, Phos
      • serum lactate
      • Abdominal flat plate
      • CXR
    • IV: NS 250 mL/h for 4 Hours, then 150 mL/h
    • Special: surgical consult
    • Medications:
      • Prochlorperazine 12.5-25 mg IV q 8 hours prn nausea
      • Ondansetron 4-8 mg IV q 8 hours prn nausea not relieved by prochlorperazine
      • Morphine sulfate PCA per protocol
      • Heparin 5000 units SQ q 8 hours
    • Call HO: increasing pain, temperature > 38.5 C, and HR > 110, UO < 30 mL/h
  • Discharge

    • criteria: pain and nausea resolved, tolerating PO
    • education: return if nausea, pain or fever

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