Clinical scenario: 50-year-old female with nausea and vomiting

You are asked to respond to an office for a report of a sick person

"Engine 44, respond Code 2 to 623 Enterprise Lane Suite 300. This will be at International Shipping Logistics in the employee breakroom for a report of a 50-year-old female with nausea and vomiting."

As you arrive on scene of the call, you are met by a man who identifies himself as the office manager. "Margaret hasn’t been feeling well today," he advises and leads you to the breakroom.

You introduce yourself to Margaret and ask what is going on today.

"I finished eating lunch about an hour ago and while I was sitting at my desk I suddenly got a really bad stomach cramp and felt like I was going to throw up. I didn’t think I could make it all the way to the bathroom so I came in here and vomited in the trash can."

Margaret points to the right upper quarter of her abdomen when asked to point to the pain location and states that it feels like a very strong cramp that comes in waves and radiates to her back. She rates the pain as 9 on a 10 scale.

She appears to be in significant discomfort and struggles to find a comfortable position to sit in. When asked if she has experienced pain like this before she states that she has several times in the past "few months", but without any nausea or vomiting.

Her previous episodes of pain usually resolved in a couple of hours. You question Margaret about her medical history and she reports Crohn’s disease and high cholesterol. You note that she is somewhat overweight. She says that this pain does not feel like a flare up of her Crohn’s. Margaret reports normal urination and bowel movements and replies that she is pre-menopausal when asked about her last normal menstrual period.

Margaret’s vital signs are:

  • BP: 166/96
  • HR: 114
  • RR: 18
  • SpO2: 97% RA

Think about these questions as you consider what to do next:

  • What is a possible differential diagnosis for Margaret?
  • Should she be transported to the hospital? Why or why not?
  • What should her prehospital treatment be?

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

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