Refer tо the bоxplоt from the previous question. Which city is there more spreаd in pollution levels?
A 55-yeаr-оld mаn is brоught tо the emergency depаrtment by ambulance for evaluation of abdominal pain. He developed pain this morning that radiates into his back with nausea and several episodes of vomiting. He has been unable to tolerate any oral intake. He has a medical history of alcohol use disorder and is not currently taking any medications. His temperature is 97.5°F (36.4°C), blood pressure is 100/67 mmHg, pulse is 98/min, respirations are 15/min, and oxygen saturation is 97% on room air. On physical exam, the patient is in acute distress due to pain. The abdomen is soft and non-distended. There is notable epigastric tenderness to palpation. The remainder of the physical exam is unremarkable. Serum lipase level is 800 U/L [Normal 0-160 U/L]. Which of the following is the most appropriate next step in management?
A 42-yeаr-оld wоmаn is brоught to the emergency room by her fiаncé for severe abdominal pain for the past 5 hours. She was watching TV after dinner when she felt a sudden, sharp, 10/10 pain at the epigastric region that did not go away. Ibuprofen also did not help. She reports recurrent abdominal pain that would self-resolve in the past but states that “this one is way worse.” Her past medical history is significant for diabetes. The patient endorses nausea and 1 episode of emesis, but denies fevers, chills, chest pain, shortness of breath, diarrhea, constipation, urinary symptoms, paresthesia, or weakness. She used to smoke marijuana in college and drinks about 2 beers a week. A physical examination demonstrates an overweight woman in acute distress with diffuse abdominal tenderness. Her vitals are within normal limits. Laboratory values are shown below:Hemoglobin: 12 g/dLHematocrit: 34%Leukocyte count: 4,900/mm^3 with normal differentialPlatelet count: 160,000/mm^3Serum:Na+: 138 mEq/LCl-: 98 mEq/LK+: 4.8 mEq/LHCO3-: 25 mEq/L Glucose: 123 mg/dLCa2+: 6.9 mg/dLAST: 387 U/LALT: 297 U/LALP: 168 U/LLipase: 650 U/L (Normal 0 – 160 U/L) What is the most likely cause of her condition?