Mesenteric Ischemia

Shannon Toohey

doi:10.5070/m511031676

Abstract

Audience: This simulation session is appropriate for emergency medicine residents at any level or medical students. Introduction: Mesenteric ischemia is a rare, but serious cause of abdominal pain. Practitioners must recognize the diagnosis quickly. The clinical course rapidly advances from bowel ischemia to infarction, sepsis, and frequently death. Mesenteric ischemia accounts for approximately 1% of all ED cases of abdominal pain in the elderly, but the mortality is as high as 93%. Objectives: At the end of this simulation session, the learner will: 1) Recognize signs and symptoms of mesenteric ischemia; 2) order appropriate imaging and labs in the workup of an elderly patient with abdominal pain; 3) manage a patient with mesenteric ischemia, a rare, but serious cause of abdominal pain in the elderly; 4) discuss anchoring bias, specifically related to patients referred to the ED with an established diagnosis by outside specialists. Methods: This educational session is a high-fidelity simulation.Topics: Mesenteric ischemia, simulation, abdominal pain in the elderly, SIRS, lactic acidosis, anchoring bias.

Highlights

Background and brief informationThe patient’s daughter transports the patient to the ED in after being referred from oncology clinic for gastroenteritis due to his chemotherapy
Linked objectives and methods: Mesenteric ischemia is a relatively rare diagnosis that some learners may not encounter during their training
The patient should initially present as well appearing, in order to demonstrate the importance of reassessment in an elderly patient with abdominal pain

Summary

Introduction

The patient’s daughter transports the patient to the ED in after being referred from oncology clinic for gastroenteritis due to his chemotherapy. The oncologist called the ED physician before the patient arrived advising that he seems to have gastroenteritis due to his 5-FU chemotherapy and recommends labs and admission to medicine for intravenous (IV) hydration. Initial presentation: That patient is placed in a bed after being triaged. He complains of significant abdominal pain, vitals are within normal limits, except for tachycardia. How the scenario unfolds: Participants should take an initial history and complete a physical exam. They should consider the differential for the patient’s abdominal pain, order appropriate labs and pain medications, anti-emetics, and IV fluids.

Objectives

Methods

Results