Approach to Management of Intraabdominal Abscesses Including Indications for Consideration of Percutaneous Versus Operative Drainage - Flowchart
Approach to Management of Intraabdominal Abscesses Including Indications for Consideration of Percutaneous Versus Operative Drainage - Flowchart Abdominal Abscess Abdominal Abscess
«Flowchart»

Tricyclic overdose?

Tricyclic overdose?

Tricyclic overdose?

Consider activated charcoal decontamination only if airway is protected or patient has no contraindications

Consider activated charcoal decontamination only if airway is protected or patient has no contraindications

Consider activated charcoal decontamination only if airway is protected or patient has no contraindications


Sodium bicarbonate 1-2 mEq/kg bolus
Continuous ECG monitoring
May repeat bolus every 3-5 minutes until QRS narrows and hypotension improves


Sodium bicarbonate 1-2 mEq/kg bolus
Continuous ECG monitoring
May repeat bolus every 3-5 minutes until QRS narrows and hypotension improves


Sodium bicarbonate 1-2 mEq/kg bolus
Continuous ECG monitoring
May repeat bolus every 3-5 minutes until QRS narrows and hypotension improves


Sodium bicarbonate 1-2 mEq/kg bolus
Continuous ECG monitoring
May repeat bolus every 3-5 minutes until QRS narrows and hypotension improves

CNS depression and/or hemodynamic instability should prompt early intubation

CNS depression and/or hemodynamic instability should prompt early intubation

CNS depression and/or hemodynamic instability should prompt early intubation


After sodium bicarbonate bolus; if narrowed, continuous infusion at 1.5× maintenance of 150 mEq sodium bicarbonate (approx. 3 ampules) in D5W
Titrate to target pH of 7.5-7.55
Continue for 12-24 hours


After sodium bicarbonate bolus; if narrowed, continuous infusion at 1.5× maintenance of 150 mEq sodium bicarbonate (approx. 3 ampules) in D5W
Titrate to target pH of 7.5-7.55
Continue for 12-24 hours


After sodium bicarbonate bolus; if narrowed, continuous infusion at 1.5× maintenance of 150 mEq sodium bicarbonate (approx. 3 ampules) in D5W
Titrate to target pH of 7.5-7.55
Continue for 12-24 hours


After sodium bicarbonate bolus; if narrowed, continuous infusion at 1.5× maintenance of 150 mEq sodium bicarbonate (approx. 3 ampules) in D5W 5
Titrate to target pH of 7.5-7.55
Continue for 12-24 hours


Treat dysrhythmias with lidocaine
If hypotension does not respond to sodium bicarbonate, give norepinephrine
ECMO and cardiopulmonary bypass if QRS interval still refractory


Treat dysrhythmias with lidocaine
If hypotension does not respond to sodium bicarbonate, give norepinephrine
ECMO and cardiopulmonary bypass if QRS interval still refractory


Treat dysrhythmias with lidocaine
If hypotension does not respond to sodium bicarbonate, give norepinephrine
ECMO and cardiopulmonary bypass if QRS interval still refractory


Treat dysrhythmias with lidocaine
If hypotension does not respond to sodium bicarbonate, give norepinephrine
ECMO and cardiopulmonary bypass if QRS interval still refractory

Any patient with QRS widening should be admitted to an ICU.
Symptomatic patients should be monitored for at least 24 hours after stopping treatment.
All others need monitoring for minimum of 6 hours.

Any patient with QRS widening should be admitted to an ICU.
Symptomatic patients should be monitored for at least 24 hours after stopping treatment.
All others need monitoring for minimum of 6 hours.

Any patient with QRS widening should be admitted to an ICU.
Symptomatic patients should be monitored for at least 24 hours after stopping treatment.
All others need monitoring for minimum of 6 hours.



Patients who are asymptomatic at 6 hours may undergo psychiatric evaluation

Patients who are asymptomatic at 6 hours may undergo psychiatric evaluation

Patients who are asymptomatic at 6 hours may undergo psychiatric evaluation

End

End

End


    Benzodiazepine for seizures
    If benzodiazepines do not stop seizures, use barbiturates or propofol

    Benzodiazepine for seizures
    If benzodiazepines do not stop seizures, use barbiturates or propofol

    Benzodiazepine for seizures
    If benzodiazepines do not stop seizures, use barbiturates or propofol

Benzodiazepine for seizures
If benzodiazepines do not stop seizures, use barbiturates or propofol

IV, oxygen, monitor, ECG, chemistry panel, fingerstick serum glucose measurement

IV, oxygen, monitor, ECG, chemistry panel, fingerstick serum glucose measurement

IV, oxygen, monitor, ECG, chemistry panel, fingerstick serum glucose measurement

Gastric lavage for life-threatening ingestion and presentation <1 hour after ingestion

Gastric lavage for life-threatening ingestion and presentation <1 hour after ingestion

Gastric lavage

ECG with QRS >100-120 msec?
Hypotension?

ECG with QRS >100-120 msec?
Hypotension?


ECG with QRS

Seizures or altered mental status?

Seizures or altered mental status?

Seizures