Dx: Small bowel obstruction
*Pt has a hx of multiple abdominal surgeries. SBO likely 2/2 to adhesions.
Time & date of last BM:
Patient passing flatus? :
Time & date of last meal:
Admit to Med/Surg
Frequent reassessments of the patient (to ensure that there are no developing complications.)
NPO except for meds. If pain, n/v, and distension increases and patient has NGT suction going on frequently, consult pharmacy and convert all must-have meds to parenteral or rectal.
NGT for decompression prn
IV Fluids with D5NS
Consider Gastrografin UGI with small bowel follow-through after 24-26 hrs for further evaluation if ongoing abdominal pain. This is often diagnostic and therapeutic at the same time.
*Consult surgery if pt’s condition worsens / now
Zofran for nausea
Morphine for pain
Protonix for stomach protection
Continuous pulse ox (2/2 to placement on narcotics)
*You only place NGT if the pt is either actively vomiting, has a distented abdomen, or is in a lot of pain.
*You only need to consult surgery if pt is in significant pain and or vomiting a lot that you are afraid of complications and want to get them on board in case surgery is needed. Err on the side of consulting them earlier than later.
*If pt is vomiting too much and has NGT suction going on frequently, we’ve done NPO even for meds and consulted pharmacy to convert must-have meds to parenteral or rectal.
** You don’t diagnose SBO by CT (or imaging alone) especially when oral contrast wasn’t used. It’s a clinical diagnosis and consult surgery to manage it.
Dr. Paz gives gastrografin a 100g of gastrografin (large dose) to patients with PARTIAL SBO at midnight and gets a KUB at 6:00am. Most patients will be having BMs and discharged the same day. However, don’t do this without consulting surgery as it could be difficult to distinguish between partial and complete SBO and this large dose of grastrografin shouldn’t be given to patients with complete SBO as it wouldn’t pass and will be painful.
Uptodate.com “suggests a period of observation prior to surgery for patients with partial small bowel obstruction, provided that complications have been ruled out to the extent possible.”
**Patients with clinical or radiologic signs of complicated bowel obstruction (ischemia, necrosis, perforation) require prompt surgical exploration.