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Abdominal Pa...

Abdominal Pain After Fall Off Bike

Clinical Scenario
A 45 year old male complains of abdominal pain after falling off his bike. He was wearing a helmet and did not loose consciousness. He was ambulatory at the scene and is alert and oriented upon arrival to the emergency department. He now complaints of pain which is located in the epigastric region and is mildly tender to palpation on exam, however there is no external signs of trauma (such as bruising) and no rebound or guarding on exam. The patient's vitals are: HR 98, BP 110/78, Oxygen saturation 98% on room air. The remainder of the patient's exam is normal. His laboratory work is normal, CXR and AP pelvis XR are normal. A bedside ultrasound FAST exam is normal.
Question
What is the next best step?
  • Abdominal X-ray
  • Observe and serial abdominal exams
  • CT scan of the abdomen and pelvis
  • Exploratory Laparotomy for intraabdominal trauma
  • Perform a diagnostic peritoneal lavage
  • Question
    What is the next best step?
  • Abdominal X-ray
  • Observe and serial abdominal exams
  • CT scan of the abdomen and pelvis
  • Exploratory Laparotomy for intraabdominal trauma
  • Perform a diagnostic peritoneal lavage
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