Main menu:

Google


RLQ pain in thin woman

Scroll to bottom for case answer and E-meducation 

History:

A 22-year-old female presents to the ED with RLQ pain that has been getting progressively worse for about 18 hours.  She has nausea, but denies any vomiting, diarrhea, vaginal discharge, fever or other symptoms.

Exam:

Vital signs are normal.  Physical exam is normal except for RLQ tenderness.  A pelvic exam is deferred until after further testing.

Initial Concerns:

  • Appendicitis
  • Ovarian cyst
  • Ectopic pregnancy

Testing:

  • Pregnancy test is normal
  • WBC count is elevated at 14
  • Bedside ultrasound: See image BELOW

 

Questions:

  1. What does the image show?
  2. What should you do next?

<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>

***************************************************************************

Tarascan Emergency Department Quick Reference GuideA to Z 3rd ed book cover

Get one of our publications, all designed specifically for Emergency Care Providers:

***************************************************************************

<<<<<<<<<<<<<<<<<<<<<<<<< END SPACER >>>>>>>>>>>>>>>>>>>>>>>>>

ANSWERS:

  1. What does the image show? The case image shows a non-compressible blind, finger-shaped structure in the RLQ just anterior to the iliac artery c/w acute appendicitis
  2. What should you do next?  Call a surgeon and see if he or she will take the patient to the OR without a CT scan.  More and more surgeons are willing to do this.

****

E-meducation page-shot for educational topic for this case from the Emergency Medicine 1-Minute Consult Pocketbook

CLICK HERE TO SEE OUR BOOKS

CASE CONCLUSION: The surgeon requested a CT scan which confirmed acute appendicitis.

:
Google
 
Web www.edinsight.com