FOAMed

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EM@3AM: Perforated Viscus

A 70-year-old female presents with left lower quadrant abdominal pain for 2 days, gradually worsening until it was no longer controlled with over-the-counter meds. She also mentions that she has not had a bowel movement for two weeks but has been passing flatus. She has not taken her temperature but has felt feverish and chilly; she also vomited twice today (non-bilious and non-bloody). She has no appetite and has only managed sips of water in the past few days. On exam, she appears ill and visibly uncomfortable. She has tachycardia and mild tachypnea. Abdominal exam reveals diffuse tenderness, with maximal tenderness in the left lower quadrant as well as rebound and involuntary guarding. What is the diagnosis?

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EM@3AM: Pediatric Trafficking

A 15-year-old female with no reported past medical history presents with lower abdominal pain and possible STI symptoms. She reports living with a “friend” but cannot provide an address, does not attend school regularly, and is accompanied by an adult male who claims he’s “just a family friend” but refuses to leave her side and answers all questions for her. She is alert and oriented but appears fatigued, with mildly matted hair. She avoids eye contact with the clinician and nurse, and her story has changed multiple times since arrival. What are you concerned about outside of the abdominal pain?

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