Doorway information:

35 year-old female complaining of abdominal pain
Blood pressure =146/88 Pulse = 92 Respirations = 20 Temperature = 99.1

site of abdominal pain decides further questioning in thinking.

Ectopic pregnancy or torsion of the ovary or an ovarian cyst must be kept in mind. Pregnancy test must be done even if other diagnoses are likely. Many clinicians forget to think of this life-threatening emergency particularly when the pain is in the right lower quadrant and appendicitis is suspected. Even if the patient has used contraception, pregnancy must be kept in mind.

If pregnancy test is positive, an ultrasound of the pelvis should be requested stat. The doctor who sleeps on ectopic pregnancy will allow his career to go to sleep.

Immediately request a gynecologist to see the patient. Get blood cross matched unless the patient is a Jehovah's Witness. Get IV access - 2 large bore cannulae securely placed.

One important sign which is also presents in splenic rupture is pain in the left shoulder when the patient is within the head down position due to irritation of the diaphragm from free floating blood in the peritoneum.

This young patient also has a slight fever. This can be present due to any of the above and not only infections.