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em@3am

EM@3AM: Viscous Perforation

A 57-year-old male presents with progressively worsening epigastric pain.  Shortly after dinner he felt a sharp pain in his epigastric region. He is tachycardic and tachypneic and appears in distress with diaphoresis. Abdominal exam shows diffuse tenderness with guarding. What should you consider?