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 |
| Fever |
| Rigors |
| Right iliac fossa pain radiating to central abdomen |
| Vomited |
| Nausea |
| Chronic blood per rectum |
| Reduced appetite |
| Constipated |
| Passing flatus |
| Chronic productive cough |
| Relevant co-morbidities and family history |
| Peripheral vascular disease |
| Diabetes mellitus |
| Ischaemic heart disease |
| Smoker |
| Current medications |
| Simvastatin |
| Metformin |
| Positive clinical signs |
| Bibasal crackles |
| Abdominal tenderness with percussion |
| Tender rectum |
| Pallor |
| Dehydrated |
| Fever |
| Tachycardia |
| Initial tests performed and results (if available) |
| Leucocytosis |
| 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 |