In the most recent issue of EPMonthly, our good friend, Dr. Teresa Wu, and Brady Pregerson right up a case they had of a patient with abdominal pain. In their wisest and most sarcastic way, they present this case with a great teaching point (ok, there are many teaching points as you will find on the last page of the case – but one in particular that deserves special mention). Read on and see if you can get what that point may be…
“56-year-old otherwise healthy female who presented to the ED with a chief complaint of “severe abdominal pain” after she finished lifting boxes of heavy books at her job the day before. She states her pain is worse with movement and is better when she lies still. She has never had pain like this before, and today, it is 10 out of 10 in severity. The pain is described as sharp and tearing, but it does not radiate to her chest or back. She has no other associated symptoms, and she has tried Ibuprofen without any relief.
Her vital signs are all completely within normal limits and her physical exam is only remarkable for tenderness to palpation over her left rectus muscles, and a seemingly pulsatile aorta palpable through her thin abdominal wall. She has no rebound or guarding on abdominal exam, and she has no other abnormal findings. Given her symptoms and her palpable aorta, your senior resident decides it would be prudent to do a quick scan of her aorta to make sure nothing catastrophic is imminent.” The following image was obtained:”
The Aorta seems ok. Hmmmm…..Still wonder what happened to the case and what it was? Read the issue in depth and you’ll then get to know and love Teresa Wu as much as I do.
Hint – look at the entire screen when evaluating any organ by bedside ultrasound…..