A 45-year-old male presents to the emergency department with sudden onset of severe, diffuse abdominal pain that started 6 hours ago. The pain is non-radiating and the patient describes it as a constant, sharp ache. His abdomen is diffusely tender on palpation but there is no rebound tenderness. Vital signs show a heart rate of 110 bpm, blood pressure of 145/90 mmHg, and temperature of 38.2°C (100.8°F). Laboratory results reveal elevated white blood cells. There are no signs of external trauma. Which of the following should be the most immediate next step in the management of this patient?
Given the rapid onset of severe, diffuse abdominal pain, elevated white blood cells, and fever, this patient likely has an acute inflammatory or infectious process in the abdomen such since peritonitis or acute pancreatitis could present similarly. Obtaining an abdominal CT scan is critical as it helps in quick assessment of the abdominal organs and identification of potential causes such as acute appendicitis, pancreatitis, or any other intra-abdominal pathology. Though abdominal X-ray, IV fluid resuscitation, and administration of broad-spectrum antibiotics are useful in management, they do not provide immediate diagnostic insight as needed in this acute setting.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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