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A 78-Year-Old Man Is Brought to the Emergency Department After

question 339

Multiple Choice

A 78-year-old man is brought to the emergency department after he was found obtunded and moaning in bed at his nursing care facility. For 2 days prior, he refused to eat most of his food. Medical history is significant for early Alzheimer disease, hypertension, hyperlipidemia, bilateral knee replacement, and right hemicolectomy for stage I colon cancer. The patient has a 50-pack-year smoking history but no longer smokes or drinks alcohol. Temperature is 38.7 C (101.7 F) , blood pressure is 102/54 mm Hg, pulse is 114/min, and respirations are 22/min. The patient is holding his abdomen and groaning. He opens his eyes to a loud voice but does not follow commands. The abdomen is distended, tympanitic to percussion, and rigid to palpation. Stool guaiac test is negative. The patient cannot tolerate sitting upright. Lateral decubitus x-ray of the abdomen is shown below. Which of the following is the best next step in management of this patient?

Definitions:

Limbic System

A complex system of nerves and networks in the brain, involved with instinct and mood. It controls the basic emotions (fear, pleasure, anger) and drives (hunger, sex, dominance, care of offspring).

Frontal Lobes

The part of the brain located at the front of each cerebral hemisphere, responsible for higher cognitive functions, such as reasoning, planning, parts of speech, movement, emotions, and problem solving.

Intimacy

The sense of closeness and attachment resulting from a deep understanding and mutual affection between individuals, often developed through sharing personal thoughts, feelings, and experiences.

Emotionally Close Relationships

Bonds between individuals characterized by deep affection, trust, mutual support, and strong emotional connections.