A Significant Injury with Just a Speck of Pain

​BY ARJUN BHARADWAJ & KHALID MALIK, MDA 58-year-old man who lived at a nursing facility came to the emergency department complaining of abdominal pain for three days. His pain was localized to the epigastrium and periumbilical regions. The nursing home staff indicated that he was hypotensive and possibly hypoxic.The patient said he never had similar pain before, which he said pain was mild and constant in severity and did not radiate to the chest, back, pelvis, or shoulders. He also reported nausea but no trauma, falls, vomiting, fever, chills, dizziness, chest pain, shortness of breath, trouble walking, or change in bowel movements or urination.He had a history of schizoaffective disorder, type 2 diabetes mellitus, hypertension, and hyperlipidemia. He said he did not use illicit drugs and that he had quit smoking more than three years before. He used to consume ethanol daily, but had stopped when he was admitted to the nursing home two years earlier. His vital signs were a heart rate of 116 bpm, a blood pressure of 70/42 mm Hg, a temperature of 97.1°F, a respiration rate of 29 bpm, an oxygen saturation of 97% on two L nasal cannula, and pain severity of 2/10.His neck and pharynx were normal, and he had no tenderness to chest or chest wall palpation. His breathing was not labored, but he had decreased bilateral breath sounds. A cardiac exam showed a regular rate and rhythm, he had no peripheral edema, and his peripheral pulses were equal bilaterally. His abdomen was so...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research