Clinical scenario: Female with belly pain

You respond for a call for a 34-year-old that woke up with abdominal pain that is now worsening


“Medic 109, I show you responding Code 2 to 723 West Elm for a report of a 34-year-old female with abdominal pain.”

When you reach the front door you are met by a woman, Lori, who identifies herself as the 911 caller. As she points to her right lower quadrant, Lori explains that she has been experiencing abdominal pain that has been worsening throughout the day. She also says she feels slightly nauseous, but has not thrown up. She reports feeling weak and you assist her to a chair by the front door.

Patient assessment

While your partner takes vital signs, you begin to ask Lori more questions. She says she has never experienced pain like this before and that she awoke with the pain this morning. She estimates that the pain began as two out of 10 and has steadily increased to five out of 10.

When you palpate the area where the pain is most severe Lori gasps and you feel the muscles of her abdomen tense up. She once again denies vomiting and reports normal urination and bowel movements. Lori had a normal menstrual period last month and is due to begin again in “a few days.” She also denies any vaginal bleeding. Lori has a history of pre-hypertension and has been told to make dietary improvements by her physician, but is not on any medications. Lori’s vital signs are: BP 148/98, HR 126, RR 16, SpO2 97%.

  • What are several potential differential diagnoses?
  • What is a “must not miss” diagnosis?
  • What are your first steps for treatment?

Post your answers below in the comments.

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