Case of the Month
Februrary 2007

32-year-old female, lower right quadrant pain

Dispatch
"Aid 57, 32-year-old female with abdominal pain”

En route your crew discusses the following considerations:

• Causes of abdominal pain
• Female specific abdominal illnesses

While en route the dispatcher advises that the patient has a feeling of fullness in her lower right quadrant. 

Scene Size-up
You arrive at the patient’s apartment and her boyfriend states she started having discomfort a few hours before, but it has gotten a lot worse over the past fifteen minutes. He leads you into the bedroom where the patient is lying supine on the bed. She appears pale and mildly diaphoretic. There are no reports of trauma.

Initial Assessment
The patient appears slightly pale and mildly diaphoretic. She has a radial pulse of 110 and a pressure of 96/P. She is breathing with ease at 20 and she is alert. She indicates that she has had a feeling of fullness in her lower right quadrant, but it has become sharp in nature and she is now scared. She has had a low-grade fever since yesterday and mild nausea. 

Initial Treatment
You decide that the patient is SICK based on nature of illness (lower abdominal pain with an associated potential for ectopic pregnancy) and skin signs. You instruct your partner to initiate high flow oxygen utilizing a non-rebreathing mask. A medic unit is requested and your other crewmember is sent down to the rig to bring up the stretcher.

Event and Recent History
Further questioning reveals the patient has been receiving treatment to improve fertility that included clomiphene (Clomid, Serophene). She had her regular menstrual period about three weeks ago. She started experiencing a mild fever a few days ago and started having a pressure feeling in her lower right quadrant two days ago. 

Further Evaluation and Treatment
Postural vital signs are evaluated and the patient has a blood pressure of 92/P when sitting and a heart rate of 110. Your crew takes the patient downstairs and meets the ALS unit in the street. They decide to start an IV line and transport because of the NOI, location of the pain and the potential for ectopic pregnancy.

In the ED the patient is found to have a growing ovarian cyst. It is remove surgically the next day and the patient experiences a full recovery.

Lower Abdominal Pain in Women
Lower abdominal pain in women can be caused by a number of different medical reasons: some are life threatening, some are not.  Ectopic pregnancy, ovarian cysts and cancer are three potentially life threatening causes of this type of pain in women. In the field, EMTs do not have the diagnostic equipment to determine the cause, so you must take each case seriously. The best treatment is to support ABCs, administer oxygen and provide rapid transport to a medical center that can properly assess and treat the patient.