Table 5

 Case assessment and “must-not-miss” diagnoses

Patient characteristics
    69 years old, male, white, Irish
Clinical presentation
    Registering complaint(s): abdominal pain
    Triage category: 3
    Vital signs at triage: temp 38.8, BP 108/65 mm Hg,
    heart rate 120/min, respiratory rate 20 bpm, saturations
    96% in room air, GCS 15/15
Presenting clinical symptoms
    Right iliac fossa pain radiating to central abdomen
    Chronic blood per rectum
    Reduced appetite
    Passing flatus
    Chronic productive cough
Relevant co-morbidities and family history
    Peripheral vascular disease
    Diabetes mellitus
    Ischaemic heart disease
Current medications
Positive clinical signs
    Bibasal crackles
    Abdominal tenderness with percussion
    Tender rectum
Initial tests performed and results (if available)
    High serum bilirubin
    Elevated CRP
    Sinus tachycardia on ECG
    Thickened right colon, suspected mass on ultrasound scan abdomen
Panel assessment – “must not miss” diagnoses to consider
    Acute appendicitis
    Carcinoma colon
    Ischaemic bowel