You are working in the department when you get a pre-arrival for
"abdominal pain". You follow EMS into the room and are confronted with a
middle-aged to elderly female who appears very pale and quite sick. As
she is placed on the monitor, you speak with her and she endorses some
diffuse abdominal pain and nausea for the last two days. Her initial
blood pressure is 80/60 with a heart rate of 112, and you start working
her up for all the badness that causes hypotension and abdominal pain in
the elderly. Everyone gets cracking on some IV access, and you head
for the ultrasound to help you better evaluate the cause of this
patient's hypotension. You start with the cardiac views of your RUSH exam, and see this:
Given these findings, you order an EKG:
What is your differential? What do you do next? Please leave your comments. Click here to read the case conclusion.
Thank you to Dr. Chris Holthaus for the echo video.