• Scene – vitals, assessment, O2 2L/min
• En route – IV, 50mcg fentanyl, 4mg Zofran
• Hospital – chest X-ray, labs
• Response to treatment – no change
• Disposition – transported to hospital without change
• Per ED, chest X-ray and labs unremarkable
• Eric Boyd, Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Abdominal pain
• Urinary tract infection
• Pneumonia
• Myocardial infarction
• Aortic aneurysm
• Pulmonary embolus
• Pneumothorax
• Small bowel obstruction (e.g., volvulus)
• Pyelonephritis
• Colitis
• Malignancy
• Pancreatitis
• Patient states – complains of nondescript, left-sided abdominal pain increased with palpation
• Caregiver states – patient started antibiotics two days ago for a urinary tract infection. She has complained of abdominal pain off and on for the last two days.
• Patient is normally on home O2 at night, but was having some difficulty breathing yesterday, so she had her O2 on for a while during the day.
• Physical findings – left sided abdominal pain increased with palpation. Abdomen was soft, nondistended; skin was pink, hot, dry.
• GCS – 15
• EKG – normal sinus
• CBG – 121
This patient’s history of dementia makes it difficult to be sure if she is in pain. She doesn’t seem to have peritoneal findings, based upon the exam. Abdominal pain in the elderly can have a large differential diagnosis, from myocardial infarction and abdominal aortic aneurysm to small bowel obstruction. Paying attention to vital signs at presentation and during transport, to look for trends, is another important aspect of care. The DDx below is just a partial list.
-Dr. David Spiro
• Gender: Female
• Age: 86 years
• Height: Not Available
• Weight: Not Available
• Temperature: 99.4 F/ 37.4 C
• Blood Pressure: 136/52
• Heart Rate: 82
• Respiratory Rate: 14
• Pulse Oximetry: 96% RA
Left-sided abdominal pain, pain with palpation.
• PMH: Arthritis, hypertension, asthma, neuropathy, Hx of left lower lobe pneumonia
• Allergies: sulfa, penicillin
• Dispatch info: altered mental status
• Lives at home with her husband, attends regular PCP appointments
• oxycodone, metoprolol, ProAir, amlodipine, nexium, furosemide, albuterol, trazodone, buspirone, oxybutynin, gabapentin
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