Overly Traumatic: A Teenager Elbowed in the Stomach

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Overly Traumatic: A Teenager Elbowed in the Stomach

Case: 

A 17 yo healthy M presents with abdominal pain and a syncopal episode several hours after getting elbowed in the stomach at a soccer game.

PMH: Intermittent asthma

ROS: Sore throat, cough and fatigue x 1 week.

Physical Exam:

VS: T 98.3 °F | HR 90 | BP 129/60 | RR 16 | SpO2 100%

Pale but comfortable and alert. Abdomen diffusely tender, guarding in the upper quadrants. Exam otherwise unremarkable.

FAST exam: 

RUQ: Free fluid in Morrison’s pouch & at the tip of the liver

LUQ: Free fluid in splenorenal recess & bowel floating in free fluid

Transverse Bladder: Large amount of fluid & clotted blood anterior to the bladder

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