• Scene – vitals, monitor
• En Route – IV, 50mcg fentanyl, 4mg Zofran
• Hospital – n/a
• Response to treatment – decrease in pain.
• Pt was discharged home. CT negative for appendicitis.
Authors:
• Eric Boyd, Paramedic Woodburn Ambulance
Editors:
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Abdominal Pain
• Peritoneal pain
• Appendicitis
• Mesenteric adenitis
• Irritable bowel syndrome
• Gastroenteritis
• Small bowel obstruction
• Trauma
• Patient states – Describes periumbilical pain that migrates to RLQ. Pain is sharp, rated at 6/10. Pain started 7 hours ago and has progressively gotten worse.
• Normal bowel movements and urination.
• No Hx of abdominal surgery or disorder.
• No recent trauma, back/flank pain, SOB, syncope.
• Two episodes of nausea/vomiting yesterday and this morning.
• Physical findings – RLQ tender to palpation with rebound tenderness.
• Tenderness in RLQ when palpating LLQ. Upper quadrants soft, non-tender. No other deficits noted on physical exam.
• GCS – 15
• EKG – NSR
• CBG – 97mg/dcl
The paramedic did a nice job demonstrating findings consistent with a peritoneal process such as appendicitis. When pressing on the LLQ induces radiated pain in the RLQ, this is called a positive “Rovsing’s” sign, and is associated with appendicitis. This patient’s pain seems to be maximal in the RLQ, which does suggest acute appendicitis, but one must consider other etiologies.
-Dr. David Spiro
• Gender: Male
• Age: 23 years
• Height: Not Available
• Weight: Not Available
• Temperature: 97.7 F/36.5 C
• Blood Pressure: 146/80
• Heart Rate: 86
• Respiratory Rate: 18
• Pulse Oximetry: 98% RA
Periumbilical pain migrated to RLQ
• PMH: Seizures
• Allergies: Bactrim
• Dispatch info: Sharp abdominal pain.
• Pt lives in temporary housing. Pt states no PCP or regular medical care. Pt denies drug or alcohol use.
• None
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