The EM Educator Series: The Critically Ill Pancreatitis Patient

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 44-year-old male with known alcohol dependence presents to the ED for severe abdominal that radiates to the back pain for three days. He has had nausea with multiple episodes of non-bloody, non-bilious emesis. On examination his heart rate 110 bpm, but the rest of his vital signs are normal. His abdomen is diffusely tender but with no signs of peritonitis.

Case 2:

A 36-year-old female with known cholelithiasis presents with upper abdominal pain. Her vital signs include HR 115 bpm, temperature 100.5F, RR 22, BP 109/62 mm Hg, and saturation 98% on room air.

Considerations:

• What are the etiologies of pancreatitis?
• How can patients with pancreatitis present?
• What are other mimics of sepsis?
• What is the ED evaluation for suspected pancreatitis?
• How do you determine who is critically ill with pancreatitis, and what risk stratification tools are available?
• What is the management of pancreatitis?
  • How much IV fluid resuscitation is necessary?
  • Which patients should receive antibiotics?
  • When should patients be allowed to eat?
• Do all patients require inpatient admission?
• What are the complications of pancreatitis?

Suggested Resources:

• Articles
  • emDOCs – Pancreatitis Pearls and Pitfalls
  • emDOCs – Severe Pancreatitis
  • emDOCs – Pancreatitis Disposition
  • EP Monthly – Sepsis Mimics
  • PulmCrit – Pancreatitis
  • REBEL EM – Acute Pancreatitis

• Journal Articles
  • JEM – Acute Pancreatitis
  • AGA Guideline – Acute Pancreatitis