A 45-year-old male patient presents to the emergency department with sudden-onset, severe abdominal pain that started 6 hours ago. He has a rigid abdomen and is guarding. His vital signs are blood pressure 100/60 mmHg, heart rate 120 bpm, respiratory rate 22 breaths/min, and temperature 38.2°C. What is the BEST immediate next step in the management of this patient?
Apply a heating pad to the abdomen to provide symptomatic relief.
Order abdominal x-rays and laboratory studies.
Administer broad-spectrum antibiotics immediately.
Initiate aggressive fluid resuscitation and consult a surgeon.
A rigid and guarding abdomen, in conjunction with tachycardia, hypotension, fever, and sudden-onset severe pain, suggests an intra-abdominal catastrophe, such as perforation or severe peritonitis, which is a surgical emergency. Immediate fluid resuscitation to support blood pressure and consultation with a surgeon are critical steps. While laboratory studies and imaging are important components of the work-up, they should not delay resuscitation and surgical consultation in a hemodynamically unstable patient. Antibiotic administration is necessary in cases of suspected perforation or peritonitis, but again, should not precede volume resuscitation and surgical consultation.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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