Approach to pneumoperitoneum and peritonitis (perforated viscus) Quiz: Ace Your Exams
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A 56-year-old man is brought by ambulance to the emergency department with altered mental status. The patient was found down by his wife this morning and was unable to be aroused. The wife reports that the patient had been complaining of upper abdominal pain for the past several days and also noted that his stool appeared darker. Past medical history is significant for alcohol use disorder, peptic ulcer disease, hypertension, diabetes type 2, and a 10-pack-year smoking history. Temperature is 37.8 ºC (100.0 ºF), pulse is 131/min, blood pressure is 101/77 mmHg and respirations are 22/min, and oxygen saturation is 78% on room air. On physical examination the patient is ill-appearing, with altered mental status, and cool and clammy extremities. He responds only to painful stimuli. The patient has abdominal distension, diffuse abdominal tenderness, rebound and guarding on abdominal exam. IV access has been obtained, supplemental oxygen has been provided, and intravenous fluids are being administered. Which of the following is the best next step in management?
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