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Author: Anuprita Harne / Editor: Nick Tilbury / Codes: SLO4, SLO5, SuP1, TP5 / Published: 29/01/2025

A 17-year-old female presents with her father to the Emergency Department (ED) with worsening abdominal pain that began after falling off a bicycle the previous day. She fell on her left side and was struck in the abdomen by the handlebar. She also injured her left wrist during the fall.

After the accident she sought care at a nearby urgent care centre, where an X-ray of her wrist revealed no bony injuries, and she was given a sling for support. However, upon returning home, she began experiencing left-sided abdominal pain, which has gradually worsened over the following 24 hours and is not relieved by paracetamol, prompting her to visit the ED.

On arrival, the patient is assessed by the triage nurse. Her observations are as follows:

  • Heart rate (HR) 126 bpm,
  • Blood pressure (BP) 136/76 mmHg,
  • Respiratory rate (RR) 22 breaths per minute,
  • Temperature 36.6°C
  • Oxygen saturation (SpO2) 96% on room air.
  • She rates her abdominal pain as 8/10 in severity.

Due to the concerning presentation and elevated pain, the patient is moved to the ED resuscitation area.

Image 1 – Courtesy of Paul Adamoli, Radiopaedia.org, rID: 19644