This 79 year old lady presented to emergency with abdominal pain, nausea and vomiting. On examination, she appeared shocked, with cool mottled extremities and a weak thready pulse. The heart rate was 150 (in AF, but apparently that is long-standing) and the non-invasive blood pressure cuff generated improbable numbers (Pfft, 52/35mmHg? Really?).
A CT of the abdomen was ordered, which revealed the following findings:
- Free gas and fluid in the peritoneum;
- Loops of thickened bowel with intramural gas pockets;
- Bilateral small pleural effusions with overlying atelectasis.
Shortly after returning from CT, the surgical team were disappointed to find her breathless and semicomatose. A rapid sequence induction and intubation were carried out, and a post-intubation blood gas was collected.