Acute Mesenteric Ischemia
Rabind Antony Charles, Singapore
A 75-year-old woman presents to your Emergency Department (ED) with diffuse abdominal pain for the past day, associated with diarrhea and vomiting. She says the pain is increasingly worse and has failed to respond to paracetamol and charcoal tablets. She has a history of hypertension, hyperlipidemia, and atrial fibrillation. She has no history of laparotomy. She is alert and oriented. However, she is in distress because of her abdominal pain. The pain score is 9 out of 10. Blood pressure: 96 over 56 mmHg, pulse rate: 125 (irregularly, irregular), respiratory rate 20, pulse oximetry: 98% on room air, tympanic temperature: 37.5 degrees Celsius. Heart sounds: (irregular) S1S2 positive. Lungs sounds are bilateral equal and clear. Abdominal exam reveals diffuse tenderness; it is worse in periumbilical region, no guarding, bowel sounds are sluggish. No scars or hernias noted. Per rectal exam: brown stool. ECG is given on the side.