Two weeks after his emergency cardiac bypass surgery, R.B. was admitted to the hospital with acute pancreatitis, probably triggered by the trauma of the heart surgery. As a nurse, R.B. knew that the mild form of the disease was self-limiting, whereas severe pancreatitis has a mortality rate near 50%. He was terrified, having survived heart surgery, to now have to worry about multisystem organ failure. He had once cared for a patient who died of necrotizing hemorrhagic pancreatitis.
On admission, R.B. had severe stabbing midepigastric pain that radiated to his back, nausea, vomiting, abdominal distention and rigidity, and jaundice. He also manifested a low-grade fever, hypotension, tachycardia, and decreased breath sounds over all lung fields. His cardiac enzymes were normal, but he showed an increase in serum leukocytes, amylase, and lipase. CT scan of the abdomen showed pancreatic inflammation with edema. His chest radiograph showed bilateral pleural effusion and atelectasis.
R.B.'s treatments included NPO, an NG tube, medications to decrease his pain and gastric secretions, and supplemental oxygen. He was monitored for all physiologic parameters, with close attention paid to his fluid and electrolyte balance and intravascular volume, and recovered and was discharged after 6 days.
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