1. ACUTE ABDOMINAL PAIN Dr Ha Thi Hanh A&E

2. CASE REPORT Mr GRAS PAUL EUGENE 59 YO Mr GRAS PAUL EUGENE 59 YO VISIT DATE 15-DEC-2009 23:10 VISIT DATE 15-DEC-2009 23:10 CHIEF COMPLAIN: pain at waits and hypogastric. CHIEF COMPLAIN: pain at waits and hypogastric. Past history: coronary stenting 2008, dislipidemia Past history: coronary stenting 2008, dislipidemia Treatment: plavix, Imdur, Tahor Treatment: plavix, Imdur, Tahor

3. Medical history: after bringing 2 heavy suitcases, patient has had lumbar pain that radiated to hypogastric areas from 3 h ago, that was a sharp, continue pain, he denied vomiting, diarrhea, fever. The pain was more and more serious he could not suffer the pain then admitted in FVH. Medical history: after bringing 2 heavy suitcases, patient has had lumbar pain that radiated to hypogastric areas from 3 h ago, that was a sharp, continue pain, he denied vomiting, diarrhea, fever. The pain was more and more serious he could not suffer the pain then admitted in FVH.

4. Physical examination and exploration: P:99, BP:136/70, T:37, RR:20, SpO2:98, P:99, BP:136/70, T:37, RR:20, SpO2:98, Pain score:08/10, Glasgow:15, W:70 Pain score:08/10, Glasgow:15, W:70 General state: alert, pale, very excitement. General state: alert, pale, very excitement. Heart sound : normal, Lung: clear, no rales, no dyspnea Heart sound : normal, Lung: clear, no rales, no dyspnea Abdomen: supple, pain at right flank and RLQ on palpation, blumberg (+/-), MacBurney(+), Murphy(-) Abdomen: supple, pain at right flank and RLQ on palpation, blumberg (+/-), MacBurney(+), Murphy(-) Neuro. System: nucha rigidity(-), neuro deficit(-) Neuro. System: nucha rigidity(-), neuro deficit(-)

5. Diagnosis: Diagnosis: - Acute lumbago with radiculopathy - Acute lumbago with radiculopathy - Right renal colic ? - Right renal colic ? - Mesenteric artery embolism ? - Mesenteric artery embolism ? - Dissecting of AAA ? - Dissecting of AAA ? Exploration: ECG, blood test,Abdo- pelvis CT Exploration: ECG, blood test,Abdo- pelvis CT Treatment : NaCl PIV, Morphin, Treatment : NaCl PIV, Morphin, Evolution ??? Evolution ???

6. Evolution: patient was still severe abdominal pain and always moving on the bed, after injection morphine 2.3 min, put the IV line, he screamed then SOB, more pale, no pulse, BP:76/53>> perfusion, O2, put the 2 nd IV line>> propose to do Abdominal US at A&E room because patient was very unstable. At that times abdominal palpation showed there was a mass at right abdomen. Evolution: patient was still severe abdominal pain and always moving on the bed, after injection morphine 2.3 min, put the IV line, he screamed then SOB, more pale, no pulse, BP:76/53>> perfusion, O2, put the 2 nd IV line>> propose to do Abdominal US at A&E room because patient was very unstable. At that times abdominal palpation showed there was a mass at right abdomen. 00:00 BP:83/50> go to CT 00:00 BP:83/50> go to CT

7. Abdo-pelvis CT:… Abdo-pelvis CT:… Disposition: call for ICU of FVH, call for Tam Duc hospital, call for Cho Ray hospital, Disposition: call for ICU of FVH, call for Tam Duc hospital, call for Cho Ray hospital, Transfer to Cho Ray hospital Transfer to Cho Ray hospital