Right lower quadrant abdominal pain


• 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.


Eric Boyd, Paramedic Woodburn Ambulance


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


• Abdominal Pain
• Peritoneal pain

Differential Diagnosis

• Appendicitis

• Mesenteric adenitis

• Irritable bowel syndrome

• Gastroenteritis

• Small bowel obstruction

• Trauma

Patient Workup History

• 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 Exam

• 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


• CBG – 97mg/dcl

Editor’s Notes

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

Suggested References

Abdominal pain


• 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

Signs and Symptoms

Periumbilical pain migrated to RLQ

History Medical

• 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

Related videos