ER CASE

CONFERENCE
AUGUST 31, 2021

UY, NATASHA NICOLE

VALDECAÑAS, FRANCESCA ANNA
VALLO, JOLAINE ASHLEY
VASQUEZ, NETHANIA MAE
 RED GROUP
Aaron Heather Kristen Tash Q Shayne

Uy, Aaron Josef E. Uy, Heather Uy, Kristen Kylie T. Uy, Natasha Uy, Quolynn Uy, Wyll Ann
Allison O. Nicole G. Yvonnie Y. Shayne D.
BS Occupational Therapy BS Physical Therapy BS Medical Technology BS Medical Technology BS Nursing BS Pharmacy
09778300174 09175449624 09178541996 09177915888 09178870182 09175291905
aaronjosef.uy.med@ust.edu.ph heatherallison.uy.med@ust.edu.ph kristenkylie.uy.med@ust.edu.ph natashanicole.uy.med@ust.edu.ph quolynnyvonnie.uy.med@ust.edu.ph wyllann.uy.med@ust.edu.ph

Glee Aica Gie Jolaine Miguel Tanya

COLOR LEADER Valdecañas, Valeriano, Maria Vallo, Jolaine Vargas, Miguel Vasquez, Nethania
Uycoco, Glee Ann L.
Francesca Anna T. Gieniv C. Ashley T. Javier G. Mae A.
BS Medical Technology BS Biology BS Nursing BS Biology BS Medical Technology BS Medical Technology
09171490829 09175481117 09777783874 09605293195 09263044951 09178337968
gleeann.uycoco.med@ust.edu.ph francescaanna.valdecanas.med@ust.edu.ph mariagieniv.valeriano.med@ust.edu.ph jolaineashley.vallo.med@ust.edu.ph migueljavier.vargas.med@ust.edu.ph nethaniamae.vasquez.med@ust.edu.ph
INTENDED LEARNING OUTCOMES

MERCURY JUPITER
1 Mercury is the closest 3 Jupiter is the biggest
planet to the Sun planet of them all

VENUS MARS
2 Venus is the second 4 Despite being red, Mars
planet from the Sun is actually a cold place
 01
HISTORY
GENERAL DATA
● 45 year old
● Bulakeño
● Advertising executive

CHIEF COMPLAINT
“I’m passing black stool”
HISTORY OF PRESENT ILLNESS
3 years PTC
● Told of an ulcer
○ No specific evaluation or
treatment
● Hypertension
○ Maintained on Amlodipine
5 mg OD

2 years PTC
● Chronic epigastric burning
pain
○ Maalox tablets (self
prescribed)
HISTORY OF PRESENT ILLNESS
3 days PTC
● First episode of black, sticky,
malodorous stool passage
● Lightheadedness
● Fatigability
○ Hinders activities of daily living
● Worsening of chronic epigastric
burning pain
○ Maalox tablets double dose (self
prescribed), without significant
relief
● Normal bowel habit
● No prior abdominal surgery and
blood transfusion
● Denies bleeding tendencies
HISTORY OF PRESENT ILLNESS
Unknown onset
● Usually misses lunch and drinks a shot of
alcohol before dinner
● History of ibuprofen and aspirin intake

Transfer to other parts of the history

● Back pain
● Stable to increased weight
● Voracious appetite
● Denies any known cardiac history
● Started on one aspirin per day for cardiac
prophylaxis
● Does not smoke
REVIEW OF SYSTEMS
● Constitutional: (+) Stable to
increased weight, (+) voracious
appetite
● Musculoskeletal: (+) back pain

PAST MEDICAL HISTORY

● Adult illnesses:
○ Denies any known cardiac history
○ Takes aspirin as cardiac
prophylaxis
CURRENT HEALTH STATUS
● Medication data:
○ Aspirin OD for cardiac prophylaxis
○ Amlodipine 5 mg OD for
hypertension

ADDITIONAL CRITIQUE
Missing family history
●

Missing personal and social

history
●
 02
PHYSICAL
EXAM
GS & VS
● Alert, oriented, anxious and
somewhat restless

● Supine
○ BP 120/80 mmHg
○ HR 110 bpm
● Standing - Patient complains
of dizziness upon standing
○ BP 90/60 mmHg
○ HR Thready
● RR 22 cpm
● T 36.0℃
● Ht 5’7”
● Wt - patient cannot tolerate
standing
Skin & HEENT
● Pale, cool, moist skin

● No telangiectasia of the lips or

oral cavity
● Pale palpebral conjunctiva
● Anicteric sclera
● Pupils equally reactive to light

Neck
● No thyromegaly, bruit no
lymphadenopathy
● No neck vein engorgement
Thorax
● (+) Spider angioma, mild
gynecomastia

Chest
● Lungs are clear to auscultation
and percussion

Heart
● Adynamic precordium
● Apex beat not visible nor
palpable
● Regular rhythm with an S4
● No murmur is appreciated
Abdomen
● Globular abdomen
● Hyperactive bowel sounds
● Moderate tenderness in the
epigastrium
● Liver is percussed to 13cm MAL,
firm edge
● Traube’s space intact
* The exam was felt to be suboptimal
secondary to the patient’s obesity

Rectal Exam
● Black, tarry stool on tactating
finger
● No visible hemorrhoids
Peripheral Pulses
● Present but are rapid and weak

Urogenital
● Testicles normal by age

Extremities
● (+) Bipedal edema
● No clubbing
● Slight palmar erythema
● (-) Asterixis

Musculoskeletal
● No dupuytren’s contractions
 03
SALIENT
POINTS
 04
CLINICAL
IMPRESSION
 Acute gastrointestinal bleeding secondary to
peptic ulcer secondary to chronic NSAID and
aspirin use and alcohol intake(?), hypovolemic
with possible chronic liver disease, and,
hypertension, controlled
 05
DIFFERENTIAL
DIAGNOSIS
 06
ER ORDERS
ER ORDERS
● Hook the patient to a cardiac monitor and pulse oximeter
● Monitor BP, HR, RR, Temp, and O2 sat q15
● Establish IV access with 2 large bore needles (gauge 18)
● Volume replacement - Start IVF bolus - NSS
● Start PPI (Omeprazole) 80mg IV bolus followed by an infusion of
8mg/hr
● Start Octreotide 50mcg IV bolus followed by continuous infusion
of 25 mcg/hr
● Refer for Esophagogastroduodenoscopy (EGD)
● Labs: Blood typing and crossmatching, CBC, coagulation studies,
BUN, Creatinine, electrolyte, glucose, liver function test , ECG,
COVID RT-PCR
 07
TREATMENT
GOALS OF MANAGEMENT
 08
ADMITTING
ORDERS
THANK YOU!
ER Case Conference
August 31, 2021
IM Group 12 - RED Team
Uy, Natasha Nicole
Valdecañas, Francesca Anna
Vallo, Jolaine Ashley
Vasquez, Nethania Mae