Question of the Week # 463

463) A 48 year old woman presents to the emergency room with significant pain in the epi-gastrium and right upper quadrant. The pain has been persistent for the past 8 hours. She rates her pain at 8/10 in intensity. She reports some nausea but has not vomited. She has no jaundice. She denies any cough or burning urination or hematuria. On examination, she is obese, temperature is 99.9 F, blood pressure is at 120/80. She does not have any pallor or icterus. She lies still on the examination table since any movement aggravates her pain. She demands pain medication before you can examine her. An ultrasound of the abdomen is pending. What is the most appropriate next step?

A) Tell her that physical exam is done before analgesics since analgesia may obscure the diagnosis.
B) Give her morphine sulfate
C) Give her Meperidine
D) Obtain Urine drug screen
E) Tell her that you will not treat her pain without doing physical exam first

11 Responses

  1. Give her morphine, I believe.

  2. A

  3. “A” makes the most sense to me!

  4. a

  5. C , Meperidine seems the treatment of choice since morphine may cause smotmuscle contraction and thereby not helping for her pain. As far as urin drug screen, the patient should be trusted since she has all the signs that she is suffering from gallstones pain.

  6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1070812/

    It was previously believed that giving analgesia would obscure physical findings. But giving pain relief is considered more humane and if at all some findings are missed, we now have advanced imaging techniques to appropriately diagnose the conditions. refer article above. 🙂

    • “pain is the fifth vital sign” – as quoted by Dr. Red.
      I do not know if there is anything more to this question though!!!!!

  7. A

  8. patient should be given morphine as she exhibits sign of peritonism, she could have acute pancreatitis secondary to gallstones, diagnosis will be confirmed by ultrasound and blood tests, no history of narcotic abuse in history.

  9. Why morphine and not meperidine ?

  10. Meperdine is the drug of coice since morphine exacerbates the pain

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