Clinical scenario: Office worker complaining of weakness

"Medic 7, respond with Engine 11 to 678 Front Boulevard at 419 Banking Services. This is for a report of a 44-year-old female who is feeling ill. The caller states that he is concerned the patient may pass out."

As you walk into the employee breakroom, you are introduced by the bank manager to Rebecca, a bank employee. Rebecca answers your questions appropriately, but is slow to respond. Her coworker reports that she came into the breakroom to lie down after mentioning that she was not feeling well. The coworker states that Rebecca has seemed ill for several days.

When asked, Rebecca tells you that she noticed worsening abdominal pain several days ago, but that it resolved “either yesterday or the day before”. She says that she has felt run down and feverish all day today and feels dizzy when she stands quickly. Rebecca reports a “pounding” headache and diffuse abdominal tenderness.

Rebecca denies pertinent medical history and reports taking birth control medication. She denies any allergies to medications.

Your physical exam reveals hot, damp skin and diffuse abdominal tenderness that becomes painful with palpation. You do not note any masses or other abnormal findings during the physical exam. Rebecca’s lips and mucous membranes are dry.

Rebecca’s vital signs are:

• BP: 118/68
• HR: 116
• RR: 22
• SpO2: 96% on room air

The ALS transport unit is approximately 10 minutes away. Given what you know about Rebecca’s presentation, think about these questions as you consider what to do next:

• What is your differential diagnosis?
• Would you consider a different diagnosis if Rebecca was 24 or 64 years old?
• What is the severity of Rebecca’s presentation?
• What are your treatment priorities?

Post your answers below in the comments and view the clinical solution for this patient.