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Acute pancreatitis checklist

• Start oxygen therapy if hypoxic.
• Establish IV access with two large-bore cannulas.
  • Send laboratory studies.
  • Perform ABG.
• Commence goal-directed IV fluid resuscitation.
• Replete electrolytes as needed.
• Administer supportive therapy: analgesics (e.g., NSAIDs), antiemetics
• Obtain ultrasound abdomen for all patients and CT abdomen in cases of diagnostic uncertainty.
• Establish the diagnosis based on the diagnostic criteria for acute pancreatitis.
• Assess severity, e.g., revised Atlanta grades of severity, BISAP , APACHE II
• Urgent consults as needed, e.g.,
  • Gastroenterology consult for urgent therapeutic ERCP in patients with biliary pancreatitis and concomitant cholangitis
  • Early general surgery consult for suspected severe or necrotizing pancreatitis
• Admit to hospital; consider ICU admission if any of the following are present:
  • Organ dysfunction or failure
  • Ongoing SIRS
  • Significant fluid resuscitation requirements or electrolyte imbalances
  • Older age or high-risk comorbidity
• Monitor vitals, urine output, laboratory studies, and perform serial abdominal examinations (see “Fluid therapy goals for acute pancreatitis”).
• Initiate enteral nutrition (either PO or via nasogastric or nasojejunal tube) as early as tolerated.
• Identify and treat the underlying cause.