A 45-year-old man arrives at the emergency department with sudden, severe abdominal pain that began 6 hours ago. Examination reveals a rigid, guarding abdomen. Vital signs are blood pressure 100/60 mm Hg, heart rate 120 beats/min, respiratory rate 22 breaths/min, and temperature 38.2 °C. What is the BEST immediate next step in this patient's management?
Administer broad-spectrum antibiotics immediately.
Initiate aggressive IV fluid resuscitation and consult a surgeon.
Order abdominal radiographs and comprehensive laboratory studies.
Apply a heating pad to the abdomen for symptomatic relief.
The findings strongly suggest an intra-abdominal catastrophe such as perforation with peritonitis. Initial management priorities follow the ABCs: establish large-bore IV access, begin aggressive crystalloid resuscitation to support blood pressure, and obtain an emergent surgical consultation. Laboratory tests, imaging, and broad-spectrum antibiotics are all important, but they must not delay hemodynamic stabilization and early operative evaluation in an unstable patient.
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BCEN CEN
Gastrointestinal, Genitourinary, Gynecology, and Obstetrical
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