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Moaning & Vomiting

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 62-year-old female presents to the ED in the early afternoon for 3 days of abdominal bloating and occasional vomiting but then severe generalized abdominal pain starting 2 hours ago.  She had a BM this morning that was normal.  She denies any fever, diarrhea, bleeding or other complaints.

Vital Signs & Physical Exam:

Vital signs are normal except for BP in the 180s systolic.  Physical exam is otherwise normal except for diffused guarding without rebound and a patient who is moaning in pain.

Initial Differential Diagnosis: SBO, AAA, ACS

Initial Diagnostic Testing:

  • Labs: none ordered
  • Imaging: KUB is normal, US: see below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows dilated fluid filled loops of bowel
  2. What should you do next?  Order a CT.  Treat for SBO.  Consult surgery.
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Went to the OR

CASE LESSONS:

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