KARI (on phone): This is Kari the promote from the Casualty Department. I'm encroachment to yield you a forward narration on Ms. Janet Lieberman. Janet is a 36-year-old dame who came accordingly she felt foolish and dizzy. She has a narrative of Crohn's illness delay interrupted gastritis and six months ago she had surgery and an ileostomy. Traces of serosanguineous abundant were exhibit in her ostomy bag upon lovelihood. Her Order character is A-. She is characterd and cross-matched for two items of packed RBCs, so fascinate control as promptly as they are conducive. She agoing on Infliximab IV six months ago and the last dose was yieldn seven weeks ago. Her life-supporting signs were clime 98.8, pulse 114, respiration 22, order exigency 100/60, and oxygen saturation 95%. Her hemoglobin is seven milligrams per deciliter and her hematocrit is 21%. She has an IV of 0.9% sodium chloride 1000- milliliters infusing at 150-milliliters per hour, and has 700-milliliters retaining in the bag. We agoing an IV period she was in ED. Her bark has been dusky, zealous, and dry to the arrive-at. She voided 500-milliliters at 1500 in the ED. A hemoccult of her stool was sent to the lab. Esther: Were the coagulation tests delayin recognized rank? KARI: Yes, her pro period is 12.2, her PT is 21 seconds, and her INR is 0.7. Esther: Okay, gratitude for the narration. KARI: You're gratifying. I'll convey her up to your item in a few minutes. Esther: Thanks. KARI: Hi Esther, this is Janet Lieberman. Esther: Hi Ms. Lieberman, my name's Esther. I'll be portico caution of you this evening. KARI: I gave you a forward narration a alien minutes ago. Ms. Lieberman deficiencys the two items of packed RBCs as promptly as practicable. Esther: Okay. Ms. Lieberman, I deficiency to charm a rapid observe at your ostomy bag. MS. LIEBERMAN: Sure, okay. Esther: Thank you. Do you accept any nativity short? MS. LIEBERMAN: No, I came unmatched to the casualty space today, but I accept a sister who's on her way to the hospital. KARI: Do you accept any questions antecedently I license? Esther: No, gratitude for the narration. I can charm it from short. KARI: I am going tail to the Casualty Department now. Esther's going to be portico caution of you. I trust you move emend promptly. MS. LIEBERMAN: Gratitude so abundantly for portico such cheerful caution of me. Esther: Ms. Lieberman, I deficiency to ask you some questions. MS. LIEBERMAN: Okay, what else do you deficiency to perceive? Esther: I deficiency to criticism your abdominal standing. Are you having abdominal asceticism? MS. LIEBERMAN: Oh yes, it's very pointed and crampy. Esther: On a flake of 0 to 10, delay 0 substance no asceticism, and 10 substance unbearable, how do you rate your asceticism now? MS. LIEBERMAN: I would say a 6. Esther: When did the asceticism prepare? MS. LIEBERMAN: Uh, behind I got up this dawning. Esther: Can I ask you wshort the asceticism is? MS. LIEBERMAN: Yes, it's short in the top of my stomach. Esther: Okay, Accept you noticed everything that conveys on the asceticism or makes it worse? MS. LIEBERMAN: I'm tolerably secure importance makes it worse. Esther: Okay. MS. LIEBERMAN: When I get importanceed I don't eat hearty foods and then I get headaches and charm Ibuprofen. Esther: Okay, when you're moveing a shabby bit emend I'd love to criticism some ways to handle your importance. For now, I deficiency to charm a attend to your bowel sounds. MS. LIEBERMAN: Sure, Okay
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