Two hours nausea, vomiting and abdominal pain


• Scene – vitals, exam

• En route – IV 18g ~75ml fluid TKO, 8mg Zofran IV – did not seem to improve nausea.

• Hospital – not known


• Patient initially refused transport but later agreed to evaluation.

• Patient was taken to hospital


• Elliot Williams, Paramedic Woodburn Ambulance
• Matthew Hansen, MD Associate Professor of Emergency Medicine Oregon Health & Science University


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Craig Warden, MD Oregon Health & Science University
• Toni Grimes, EMT-P Woodburn Ambulance

• Emesis – Etiology unclear

Differential Diagnosis

• Myocardial ischemia
• Mesenteric ischemia
• Cholecystitis
• Gastroenteritis
• Dehydration
• Diabetic ketoacidosis (new-onset DM unusual in 85 y/o female)
• Anxiety
• Arrhythmia

Patient Workup

• History
• Physical exam – abdominal exam was soft and non-tender.
• Emesis was brown in color, no blood noted.

Suggested Approach

• This patient presents with abdominal pain which reportedly started after taking senna, a medication which can cause abdominal pain. However, providers should take caution in anchoring on this as the cause of her pain. Elderly patients are more likely to minimize their symptoms when talking to medical providers; and the symptoms and location of pain may not correlate as well to the underlying cause.
• Compared to younger patients, abdominal pain in the elderly is more likely to be caused by a serious disorder such as MI, aortic aneurysm, bowel obstruction, cancer, and gall bladder disease among others. Generally these patients should be highly encouraged to be transported to the hospital, even though they may initially wish to stay at home. Prehospital care in this case should include taking a brief but thorough history as demonstrated in the video, performing a focused exam, diligent monitoring of vital signs, administration of anti-emetics, glucose testing, and obtaining a 12 lead electrocardiogram.
Suggested references
Abdominal Pain


• Gender: Female
• Age: 85 years
• Height: Not Available
• Temperature: 97.4 F/36.3 C
• Blood Pressure: 111/61
• Heart Rate: 72
• Respiratory Rate: 18
• Pulse Oximetry: 96% RA
Signs and Symptoms
Nausea; vomiting; abdominal pain; periodic rapid breathing.
• Pacemaker, hypertension (HTN), diverticulitis.
• Patient states she took Senna for constipation earlier today, just before symptoms started.
• Patient was atraumatic, transported ~3 months ago for similar episode.
• Allergies: NKDA
• Dispatch info: unknown medical, 3rd party caller.
• Patient described family-related stress earlier in the day.
• Coumadin, Lovastatin, isosorbide dinitrate, levothyroxine, metoprolol, lisinopril, paroxetine, Protonix, felodipine

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