Emerg Med J 30:259 doi:10.1136/emermed-2012-201589
  • Images in emergency medicine

Coffee-ground vomit and subdiaphragmatic air

  1. Jack Pottle
  1. Ealing Hospital, Southall, London, UK
  1. Correspondence to Dr Jack Pottle, Ealing Hospital, Southall, London UB1 3HW, UK; jackpottle{at}
  • Accepted 10 June 2012
  • Published Online First 4 July 2012


A 90-year-old nursing home resident was admitted with confusion and reported ‘coffee-ground’ vomit. A chest radiograph was performed.

Coffee-ground vomit and subdiaphragmatic air

A 90-year-old female nursing home resident was found minimally responsive by her carers with a reported history of ‘coffee-ground’ vomit. She had a past medical history of Alzheimer's dementia and recent humeral fracture. Her only regular medication was lansoprazole 30 mg OD.

On arrival to the emergency department she was in circulatory shock with a blood pressure of 73/54 and pulse rate of 143 beats per minute. Respiratory rate was 44 and she was feverish at 38.2°C. …

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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