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Clinical scenario: A 27-year-old with abdominal pain

You are asked to respond to a private residence for a female patient

“Medic 2901, respond Priority Two to 417 North Park Ave., apartment 33 for a 27-year old-female complaining of abdominal pain. The patient reports vaginal bleeding as well.”

After locating the caller’s apartment, you are met by a man introducing himself as the patient’s husband. He leads you to a bedroom and introduces you to his wife, Julia, who is sitting upright in bed.

You initial impression of the patient is that she is experiencing some discomfort, is pale and slightly diaphoretic, and does not exhibit signs of shortness of breath or other respiratory compromise.

When asked to describe what caused her to call 911 Julia states that she experienced an abrupt onset of belly pain on the lower-left side this afternoon while sitting on the couch. Shortly after that, she noticed vaginal bleeding.

Julia says that she and her husband have been trying to get pregnant for a while and that she has a history of miscarriage “about a year ago.” She had a positive home-pregnancy test approximately a week ago and estimates that her last menstrual cycle completed seven or eight weeks ago.

Julia asked her husband to call 911 after her bleeding increased in volume and she became concerned that she was having another miscarriage. She also says that she feels some left shoulder pain when she lies flat.

Your partner reports that Julia’s blood pressure is 118/70, her pulse rate is 112 and her respiratory rate is 18. Her pulse oximetry reading is 96 percent.

  • What other questions would you like to ask Julia?
  • What is your suspected differential diagnosis?
  • What are some “must-not-miss” diagnoses?
  • What are your first steps for treatment?

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

An EMS practitioner for nearly 15 years, Patrick Lickiss is currently located in Grand Rapids, MI. He is interested in education and research and hopes to further the expansion of evidence-based practice in EMS. He is also an avid homebrewer and runner.