اوردر ها:

1️⃣ Admit to:
2️⃣ Impression: Acute Pancreatitis
3️⃣ Condition:
4️⃣ Vital Signs: q1-4h. Call physician if BP systolic >160, <90; diastolic. >90, <60; P >120, <50; R>25, <10; T>38.5°C ; urine output < 25 cc/hr for more than 4 hours.
5️⃣ Activity: CBR
6️⃣ Nursing: I/O, fingerstick glucose qid, stool sample for OB (occult blood). Foley to closed drainage.
7️⃣ Diet: NPO
8️⃣ IV Fluids: 1-4 L NS over 1-3h, then D5 ½ NS with 20 mEq KCL/L at 125 cc/hr. NG tube at low constant suction (if obstruction).

9️⃣ داروها : Ranitidine (Zantac) 6.25 mg/h (150 mg in 250 mL D5W at 11 mL/h) IV or 50 mg IV q6-8h OR Famotidine (Pepcid) 20 mg IV q12h.
Ticarcillin/clavulanate (Timentin) 3.1 gm IV, or ampicillin/sulbactam (Unasyn) 3.0 gm IV q6h or imipenem (Primaxin) 0.5-1.0 gm IV q6h.
Antibiotics are indicated for infected pancreatic pseudocysts or for abscess. Uncomplicated pancreatitis does not require antibiotics.
Heparin 5000 U SQ q12h.
Total parenteral nutrition should be provided until the amylase and lipase are normal and symptoms have resolved.

سایر داروها در صورت لزوم : Meperidine 50-100 mg IM/IV q3-4h prn pain.

11. سایر اقدامات پاراکلینیک : Upright abdomen, portable CXR, ECG, ultrasound, CT with contrast. Surgery and GI consults.

12. آزمایشات :CBC, platelets, SMA-7 (BUN/Cr, Electrolytes (Na, K, Cl, HCO3, ...), BS)&12, calcium, triglycerides, amylase, lipase, LDH, AST, ALT; blood C&S x 2, hepatitis B surface antigen, INR/PTT, type and hold 4-6 U P