A 47-year-old woman presented to the ED on November 6 with abdominal pain. The patient had undergone a Roux-en-Y gastric bypass surgery on October 20. She had developed worsening abdominal pain, and went to see a nurse practitioner at an outpatient clinic. She was given Rocephin and Phenergan, and then referred to the ED.
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On arrival to the ED, the patient was seen by a physician. The T-sheet is shown below. The copies entered in the trial for this case are of particularly poor quality, therefore a summary of the information is shown below. The chief complaint is left abdominal wall abscess/drainage. Onset was today. Context: bypass on 10/20, now with incisional infection and drainage at L upper abdomen. A set of vitals revealed a temperature of 100.3 F, BP 141/74, HR 114, respirations 28/min, 100% O2 sat. The patient was noted to be in moderate distress. She had ecchymosis on her right side with a drain, the incision had purulent material and there was surrounding cellulitis. A CT with contrast was ordered to rule out abscess. An IV was started, she was given 1L NS bolus, several doses of morphine and Zofran.
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Chemistry:
Glucose | 98 mg/dL |
BUN | 7 mg/dL |
Creatinine | 0.6 mg/dL |
Sodium | 134 mmol/L (L) |
Potassium | 3.2 mmol/L (L) |
Chloride | 96 mmol/L (L) |
CO2 | 22 mmol/L |
Calcium | 9.1 mg/dL |
Anion Gap | 19 mmol/L (H) |
GFR estimated | 114 mL/min |
CBC:
WBC | 15.9 K/uL(H) |
RBC | 4.16 mil/dL (L) |
HGB | 11.7 g/dL (L) |
HCT | 35.1% (L) |
MCV | 84.4 fl |
MCH | 28.2 pg |
MCHC | 33.4 g/dL |
Platelets | 494 K/uL (H) |
Differential | |
NEUT | 70.9% (H) |
LYMP | 20.6% (L) |
MONO | 6.1% |
EOS | 0.7% |
BASO | 1.7% |
ABS NEUT | 11.3% (H) |
ABS LYMPH | 3.3% |
ABS MONO | 1.0% (H) |
ABS EOS | 0.1% |
ABS BASO | 0.1% (H) |
A CT scan was ordered. The results are below.
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Given this information, what would be the appropriate next steps? Can this patient be discharged?