A 53-year-old male presents to the emergency with severe abdominal - TopicsExpress

A 53-year-old male presents to the emergency with severe abdominal pain and hematemesis. The patient’s history is significant for osteoarthritis, for which he has been taking ibuprofen for several years. He states he has had epigastric abdominal pain during meals for several months, but has never experienced pain like this. Vital signs are T 38C, HR 130, BP 100/55, RR 22, O2 saturation 99%. Physical exam reveals marked abdominal pain with rebound tenderness and involuntary guarding. Upright chest radiograph reveals free air under the right diaphragm. Which of the following is the most appropriate next step? 1. Intravenous octreotide 2. Exploratory laparotomy 3. Intravenous antibiotics and pantoprazole 4. Esophagogastroduodenoscopy (EGD) 5. Angiographic embolization هاتو لشوف !!!!

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