A 35 years old previously healthy gentleman presented to the Emergency Department with a sudden-onset severe and diffuse abdominal pain which started an hour ago. Chest X-ray was ordered; what do you see?
Abdominal pain is one of the commonest ED presentations. Like acute MI, AAA rupture, or DKA, viscus perforation should be in our worst-case scenario list. The image shows free air under the diaphragm.
The expected hints for this type of patient are a history of peptic/duodenal ulcer disease, severe abdominal pain that patients do not want to move, and a rigid and very tender abdomen, which any palpation gives much pain to the patient.
We need to remember that this situation is a surgical emergency. There are some steps that we need to do immediately for this patient.
- Proper history and examination
- Attaching to monitor and following vital signs and intervene if necessary to normalize them
- Opening 2 large-bore IV lines and fluid resuscitation as needed
- IV pain medication
- IV antibiotics
- Stopping oral ingestion and placing NG tube
- Contact surgery
- Sending basic biochemistry lab, coagulation profile, blood type and cross, CBC, which will be asked by surgery soon.
- Arranging transfer to the OR
Abdominal pain is one of the commonest ED presentations. Like acute MI, AAA rupture, or DKA, viscus perforation should be in our worst-case scenario list. The image shows free air under the diaphragm.
The expected hints for this type of patient are a history of peptic/duodenal ulcer disease, severe abdominal pain that patients do not want to move, and a rigid and very tender abdomen, which any palpation gives much pain to the patient.
We need to remember that this situation is a surgical emergency. There are some steps that we need to do immediately for this patient.
- Proper history and examination
- Attaching to monitor and following vital signs and intervene if necessary to normalize them
- Opening 2 large-bore IV lines and fluid resuscitation as needed
- IV pain medication
- IV antibiotics
- Stopping oral ingestion and placing NG tube
- Contact surgery
- Sending basic biochemistry lab, coagulation profile, blood type and cross, CBC, which will be asked by surgery soon.
- Arranging transfer to the OR
Additional reading
Perforated Viscus
Abdominal Pain
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