Hypotension + Abdominal Pain = Ultrasound

Get to the Chopper!

You are working an busy overnight shift at your rural community ER when a nurse comes to notify you of a new patient in the lobby - there are no open beds currently, but she thinks he looks ill.

You go out to evaluate the patient quickly - He is complaining of severe generalized abdominal pain that started a few hours ago and is worsening. He looks pale and slightly diaphoretic, has severe abdominal tenderness with peritonitis. Concerned, you wheel him back to your trauma bay...

Initial vitals: HR 122, BP 92/63, Spo2 96%RA, T 97.8F

You obtain a quick abdominal series, EKG which is unremarkable, place IV's and start fluids and antibiotics, and order a CT of the abdomen. Labs are pending. A chart review reveals a history of HTN, DM, CAD, COPD, and a long smoking history. 

When you reassess the patient, he appears slightly more confused and drowsy. A repeat blood pressure is 71/45. He's definitely not stable enough to make the trip to the CT scanner (in the basement). You worry he needs to be flown out, but some dark clouds are starting to roll in... 

You need a diagnosis, and soon...

Check out the jump for a refresher on point-of-care aortic ultrasound