A 43-year-old woman presents with sudden severe epigastric pain and shoulder-tip pain. BP is 98/62, HR 118, and abdomen is rigid. Upright chest X-ray

Question

A 43-year-old woman presents with sudden severe epigastric pain and shoulder-tip pain. BP is 98/62, HR 118, and abdomen is rigid. Upright chest X-ray shows free subdiaphragmatic air. What is the most appropriate initial management?

Accepted Answer

Give IV fluids, broad antibiotics, analgesia, keep NPO, and call surgery urgently

Answer

Give oral proton pump inhibitor and discharge

Answer

Perform colonoscopy in the ED

Answer

Start loperamide and oral fluids

Answer

Arrange outpatient endoscopy

Perforated peptic ulcer — RCPSC EM MCQ

A 43-year-old woman presents with sudden severe epigastric pain and shoulder-tip pain. BP is 98/62, HR 118, and abdomen is rigid. Upright chest X-ray shows free subdiaphragmatic air. What is the most appropriate initial management?