To scan or not to scan?Created by:
Suppose you encounter a patient, Mr Z, 37 year old male who consulted the emergency room due to abdominal pain of 15 hrs duration. On history, he narrates that it initially started in the epigastric region, then eventually migrated to the right lower quadrant of the abdomen. Pain score also gradually progressed from 2/10 to 6/10. On physical exam, vital signs were normal, except for his temperature at 38C. His current pain scale is 6/10. On physical exam, his abdomen was soft, with direct tenderness on the right lower quadrant. No rebound tenderness. He has leukocytosis of 15 with neutrophilic predominance. Upon chart review, the patient does not have a health insurance and works as a family driver. Your presumptive diagnosis is appendicitis. However, there are no signs of peritoneal irritation on your examination. Would you send this patient for CT scan? Why or why not? Were you put in a similar ethical scenario? Please feel free to relay your experiences.