Perforation

Clinical Features:

• 1)chills.
• 2)fever.
• 3)nausea.
• 4)vomiting.
• 5)Abdominal pain

O/E:

• 1) Abdomen Board like rigidity 
• 2) abdominal tenderness 

Investigations: 

• 1) CBC
• 2)X-ray abdomen 
• 3)Usg W/A 
• 5)serum electrolyte 
• 6)serum creatinine 
• 7)LFT 

Rx:

• Bed rest
• Diet: NPO TFO
• NG Suction - 2 hourly
• Continuous Catheterization

1. Inf Hartsol ([post id="506" title="Hartmann"]) (2L)+5% DNS (1L)

• I/V@30 d/min

2. Inj. Ceftron([post id="398" title="Ceftriaxone"]) (1gm)

• 1 vial ...I/V..... BD

3. Inj. Filmet([post id="406" title="Metronidazole"]) (500mg/100ml)

• 1 bag/bottle... I/V .......TDS

4. Inj. Maxpro([post id="392" title="Esomeprazole"]) (40mg)

• 1 vial ........I/V ..........BD

5.Inj. Torax ([post id="450" title="Ketorolac"])(30mg)

• 1amp 1/M   ........stat& sos

if Severe pain

Inj.Nalbun-2([post id="457" title="Nalbuphine"])

1 ample .I/M .......stat

+(plus)

Inj. Vergon([post id="505" title="Prochlorperazine"] (12.5mg)

•  1 amp I/M- stat & sos

If Vomiting

Inj.Emistat([post id="509" title="ondansetron"])

• 1 ample I/V stat  & sos

6. Monitor vitals sign

7.Follow-up 

Pre-Operative Order:

1.Diet: NPO ,TFO

2. Inf. Hartman solution ([post id="506" title="Hartmann"])(1000ml)

• ……10-20 drop/min

3.Inj.Ceftron([post id="398" title="Ceftriaxone"]) (1gm)

• … 1 vial I/V ….stat

4. Inj.Sergel ([post id="392" title="Esomeprazole"])(40mg)

• …1 vial I/V stat

5.Inj.Rolac([post id="450" title="Ketorolac"]) (30mg)

• ….1 ample I/M OR I/V stat & SOS

6.Clean the operative area .

7.send the patient OT table 30 min before operation .

8. Counsel the patient party & written consent must be taken.

Post Operative Order:
1.Diet: NPO, TFO(Till further order)
2.Inf.Hartman ([post id="506" title="Hartmann"])(1L) +
Inf.5%DNS([post id="510" title="DNS"])(1L) +
Inf.5%DA ([post id="511" title="Dextrose "])(1L)

• ….I/V 30 drop/min.

3. Inj.Ceftron([post id="398" title="Ceftriaxone"])  (1gm)

• … 1 vial I/V ….BD 

4. Inj.Sergel ([post id="392" title="Esomeprazole"])((40mg)

• …1 vial I/V ….BD

5.Inj.Filmet([post id="406" title="Metronidazole"])(500mg/100ml)

• …1 bottle I/V….stat.& TDS

6.Inj.Rolac([post id="450" title="Ketorolac"]) (30mg)

• ….1 ample I/M OR I/V stat & TDS 

OR 
Inj.Anadol([post id="453" title="Tramadol"]) (100mg/2ml)

• ….1 ample I/M OR I/V stat & TDS

7.Nalbun-2( Nalbuphine)

• …1 ample I/M stat 

OR 
Inj.G-Pethidine([post id="456" title="Pethidine"](100mg/2ml)

• …..1 ample I/M stat

With 
Inj.Vergon(vergon) (12.5mg/ml)

• …1 ample …I/M stat 

8.Voltaline ([post id="448" title="Diclofenac"])suppository (50mg)

• ….1 stick Per rectal –SOS

9.Monitor all Vitals…any abnormality then call doctor

 Discharge Treatment:

1.Cap.Denver([post id="399" title="Cefixime"]) (200mg)

• 1+0+1……...7 days

2. Tab.Fimet ([post id="406" title="Metronidazole"]) (400mg)

• 1+1+1………..5 days

3.Cap.sergel ([post id="392" title="Esomeprazole"]) (20mg)

• 1+0+1………..14 days

4.Tab.Rolac([post id="450" title="Ketorolac"])  (10mg)

• 1+0+1(after meal) ….5 days

5.Tab.Rivotril([post id="474" title="Clonazepam"]) (0.5mg)

• 0+0+1……..15 days

6.Tab.CEEVIT([post id="466" title="Ascorbic"] Acid)(250mg)

• 1+0+1……...10 days

7.Tab.Xinc-OT([post id="470" title="Zinc"])

• 1+0+1…………1 month

উপদেশঃ

• ১ মাস বিশ্রামেে থাকবেন। 
• ১ মাস কোন ভারী কাজ করবেন না। 

❣️❣️নিরবতা এক ধরনের অলস্কার যা মহিলাদের জন্য অত্যন্ত শোভনীয়-হেনরীডেজন।❣️❣️