Abdominal pain, edema at surgical site


• Scene – vitals, EKG, assess
• En route – IV, O2, BG, 12 lead, TT, Zofran PO and IV, fentanyl 50mcg x2, vitals
• Hospital – unknown


• Response to treatment – both meds seemed to help some, she was not significantly distressed with pain, but did not like any palpation to ABD
• Disposition – unknown


Mark Shelton Paramedic Woodburn Ambulance


• Abdominal pain
• Surgical site pain

Differential Diagnosis

• Hernia recurrence
• Small bowel obstruction
• Constipation
• Gastroenteritis
• Post-surgical infection (MRSA abscess vs. other)

Patient Workup History

• Patient states – abdominal pain has been going for about a week, but today is really bad. I have been vomiting all day off and on. The pain in my abdomen is from where it gets infected.
• Patient states – I went up to the hospital last week when my abdomen had some leakage with green and yellow puss. They did not do anything for me and sent me home. There was no draining of the infected area, no bandaging.

Physical Exam

• Physical findings – tachycardia, hyperglycemic, ABD pn, nausea
• GCS – 15
• EKG – SR • CBG – 209

Editor’s Notes

This patient has multiple medical problems. Does she seem to have altered mental status in this video clip? Important to understand if her interaction with providers is normal/baseline. Patients with diabetes have increased risk of infection. MRSA infections can be serious and cause long term complications once the patient is colonized. This highlights the importance of universal precautions.

-Dr. David Spiro


• Gender: Female
• Age: 53 years
• Height: Not Available
• Weight: Not Available


• Temperature: 97.8 F/36.6 C
• Blood Pressure: 125/93
• Heart Rate: 108
• Respiratory Rate: 18
• Pulse Oximetry: 93% RA

Signs and Symptoms

1week worsening abdominal pain, swelling and redness; vomiting

History Medical

• PMH: Hx of 7 abdominal hernia repairs. Recent MRSA at site of hernia surgery.
• Other PMH: asthma, COPD, emphysema, vocal cord dysfunction, stridor.
• Allergies: amoxicillin, ASA, mold, NSAIDS.
• Dispatch info: abdominal pain


• Lives at a retirement facility, normally is the “bell of the ball,” a fun person to be around.


• NovoLog, Lantus, lisinopril, ranitidine, diazepam, gabapentin, famotidine, Piriva, trazadone, Phenergan, cephalexin, simvastatin, albuterol, oxycodone, ProAir, docusate.

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