From episode 152 on the ECC stream. With Dr Claire Sharp.
I find them to be some of the most frustrating cases: you’ve fixed whatever it was that upset the gut in the first place, but now your patient’s GI tract has decided to go on strike: zero peristalsis, stomach like a half-empty (half full?!) goon sack. You know your patient will feel better once that gut starts moving. So you reach for the metoclopramide, right?
But hold on a minute… in this fantastic discussion on prokinetics, Dr. Claire Sharp listed some ilius-aggrevators that should be addressed BEFORE you try to beat a dead horse/ floppy gut.
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Pain
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Opioids (I know right - it’s a conundrum! Dr Clair discusses, in detail, how to balance these two in the episode.)
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Hypothermia
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Hypovolaemia
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Fluid overload
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Electrolyte abnormalities: hypokalaemia, hypocalcaemia OR hypercalcaemia, and potentially hypomagnesaemia.
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Persistent hyperglycaemia. (Over 10mmol/l)
And then one often-overlooked thing, other than drugs, that will stimulate peristalsis really well: FOOD!
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