A 48-year-old man has abrupt epigastric pain radiating to the shoulder after heavy alcohol use. He is febrile, hypotensive, and rigid on abdominal

Question

A 48-year-old man has abrupt epigastric pain radiating to the shoulder after heavy alcohol use. He is febrile, hypotensive, and rigid on abdominal exam. Upright chest radiograph shows free subdiaphragmatic air and lactate is 4.8 mmol/L. What is the most appropriate next step?

Accepted Answer

Immediate surgical consultation with resuscitation and broad-spectrum antibiotics

Answer

Outpatient gastroscopy

Answer

Oral antacid therapy and discharge

Answer

Therapeutic anticoagulation

Answer

Observation until pain resolves

Perforated viscus — RCPSC EM MCQ

A 48-year-old man has abrupt epigastric pain radiating to the shoulder after heavy alcohol use. He is febrile, hypotensive, and rigid on abdominal exam. Upright chest radiograph shows free subdiaphragmatic air and lactate is 4.8 mmol/L. What is the most appropriate next step?