Sudden in Surgery — 45yo Man | General Surgery | SMLE Q#17765
SMLE Question #17765
Surgery
General Surgery
Objective: OBJ-TRACH-EMERG-01
Last updated: February 2026
A 45-year-old man presents to the emergency department with sudden, severe generalized abdominal pain for 6 hours. He has peptic ulcer disease and takes ibuprofen daily. He lies still and appears toxic. The abdomen is rigid with diffuse guarding and rebound tenderness. Upright chest radiograph shows free subdiaphragmatic air. Two large-bore IV cannulas are in place. What is the next best step in management?
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