Abdominal pain, hypotension with h/o colon cancer part 2


• Scene – vitals, IV, CBG,
• En route – zofran, O2, fluids, blankets, TT, Trendelenburg
• Hospital – unk


• Response to treatment – pt was not as pale upon arriving at the hospital but still did not look normal.
• BP did not come up over 70’s systolic.


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Abdominal pain
• Hypotension

Differential Diagnosis

• GI bleed (upper vs. lower)
• GI tumor with bleed
• Aortic aneurysm
• Pancreatitis
• Dehydration
• Cirrhosis with GI bleed (coagulopathy)
• Arrhythmia

Patient Workup History

• Patient states – Spanish speaking only; interpreter on scene says pt was at the hospital and recently released.
• Had an endoscopy and found some bleeding.
• Pale today and not as talkative as normal.
• Wife confirmed history.

Physical Exam

• Physical findings – hypotension, abdominal pain, nausea
• GCS -15
• CBG – 253

Editor’s Notes

This case highlights potential issues around language barriers. Not obtaining an accurate history from the patient, including past medical history and current meds, can be problematic. Fortunately, in this case, the patient’s caregiver spoke English and was able to provide the team a reasonable medical history and consent for this video. The differential Dx of abdominal pain and hypotension is broad. Gastrointestinal bleeding, even if occult, must be considered due to history of rectal bleeding, as well as an aortic aneurysm. See Differential Dx for a more complete list.

-Dr. David Spiro

Suggested References

Abdominal pain
Abdominal Pain in the Elderly


• Gender: Male
• Age: 72 years
• Height: Not Available
• Weight: Not Available


• Temperature: 97.1 F/36.2 C
• Blood Pressure: 74/46
• Heart Rate: 97
• Respiratory Rate: 16
• Pulse Oximetry: 95% RA

Signs and Symptoms

Abdominal pain, syncope, rectal bleeding, jaundice.

History Medical

• PMH: Cirrhosis, colon cancer
• Allergies: None
• Dispatch info: GLF and semi-alert


• Lives at home with wife. Well kept home. Patient is normally very active.


• Protonix

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