Question

Sample Clinical Pathway about diarrhea

Answer 1

Patient presenting with persistent diarrhoea defined as Persistent alteration from the normal stoo passing 5-7 times Increassed frequency > weeks duration

Detailed clinical history and physical examination

Absence of red flag indicators-Intial screening investigations.

full blood count Thyroid function test CRP Coeliac serology Faecal calprotection

Presence of redflag indicators-Routine examination as appopriate.

AND onward referal using a suspected cancer pathway referel

Patient with Diarhhoea presents ED

If the patient is hemodynamically stable

• Complete history and physical examination,ask about recent antibiotic use.
• Determine approximate level of dehydration ,mild/moderate/severe.
• In mild and moderate case give weight based dose or ondaseteron,after 20-30 minutes begin oral;
• In severe dehydration place iv catheter and start 20mL/kg NS bolus
• Check rapid glucose level and give dextrose as nedded
• Order serum electrlytes and renal function testing
• Give IV ondaseteron.

If the patient tolerate oral cahllenge

• Discharge home once tolerating ORS well
• Recommend probiotic
• Give strict return precautions.

If the patient is not toelrating oral challenge

• Discuss Ng tube versus IV with family
• NG tube - Start ORS via NG tube,Give 50-100 ml/kg of ORS 3-4 hours.
• IV - place IV ,satrt 20mL/kg NS bolus ,repeat if needed.Test elctrolytes,After giving bolus ,consider dextrose containg fluids.
• Start second oral challenge
• If tolerating discharge from hospital,Recommend probiotic.
• Not tolerating give further hydration via NG tube or IV

When patient presenting to Ed the patient is not hemodynamically stable

• Rapidly obtain IV/IO access and push 20mL/kg NS as fast as possible.
• Check glucose level
• Give dextrose if nedded.
• Check ABG,elctrolytes anf CBC,RFT levels.
• Start antibiotic therapy.
• Consider vasopressor if no improvement in heart rate and blood preassure.
• Admit in ICU.