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Likelihood Ratio (LR) in Emergency Medicine


Where is peritonitis?

Clinical Scenario

A 80 YO man with a history of hypertension presents to the ED complaining of abdominal pain. He felt well until 8 hours ago, when he developed diffuse abdominal pain. The patient is afebrile, tachicardic, BP is 180/100 his lungs are clear, ECG shows no changes suggestive of ischemia.  There is diffuse abdominal rigidity.

In another room there is a 22 yo girl with abdominal pain started two days before. She is febrile (38°C) and tachicardic, blood pressure is 120/80, her abdomen is soft. The cough test is positive, but rebound is negative.

In the 3rd room there is a 48 yo patient.  Come in -says the nurse- this abdomen is like a board.

Where is peritonitis?