acute abdominal pain dr ha thi hanh a e n.
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ACUTE ABDOMINAL PAIN Dr Ha Thi Hanh A&E

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ACUTE ABDOMINAL PAIN Dr Ha Thi Hanh A&E. CASE REPORT. Mr GRAS PAUL EUGENE 59 YO VISIT DATE 15-DEC-2009 23:10 CHIEF COMPLAIN: pain at waits and hypogastric. Past history: coronary stenting 2008, dislipidemia Treatment: plavix, Imdur, Tahor.

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case report
CASE REPORT
  • Mr GRAS PAUL EUGENE 59 YO
  • VISIT DATE 15-DEC-2009 23:10
  • CHIEF COMPLAIN: pain at waits and hypogastric.
  • Past history: coronary stenting 2008, dislipidemia
  • Treatment: plavix, Imdur, Tahor
slide3
Medical history: after bringing 2 heavy suitcases, patient has had lumbar pain that radiated to hypogastric areas from 3 h ago, that was a sharp, continue pain, he denied vomiting, diarrhea, fever. The pain was more and more serious he could not suffer the pain then admitted in FVH.
physical examination and exploration
Physical examination and exploration:
  • P:99, BP:136/70, T:37, RR:20, SpO2:98,
  • Pain score:08/10, Glasgow:15, W:70
  • General state: alert, pale, very excitement.
  • Heart sound : normal, Lung: clear, no rales, no dyspnea
  • Abdomen: supple, pain at right flank and RLQ on palpation, blumberg (+/-), MacBurney(+), Murphy(-)
  • Neuro. System: nucha rigidity(-), neuro deficit(-)
slide5
Diagnosis:

- Acute lumbago with radiculopathy

- Right renal colic ?

- Mesenteric artery embolism ?

- Dissecting of AAA ?

  • Exploration: ECG, blood test ,Abdo-pelvis CT
  • Treatment : NaCl PIV, Morphin,
  • Evolution ???
slide6
Evolution: patient was still severe abdominal pain and always moving on the bed, after injection morphine 2.3 min , put the IV line, he screamed then SOB, more pale, no pulse, BP:76/53>> perfusion, O2, put the 2nd IV line>> propose to do Abdominal US at A&E room because patient was very unstable. At that times abdominal palpation showed there was a mass at right abdomen.
  • 00:00 BP:83/50> go to CT
slide7
Abdo-pelvis CT:…
  • Disposition: call for ICU of FVH , call for Tam Duc hospital , call for Cho Ray hospital,
  • Transfer to Cho Ray hospital