The Rational Clinical Examination
David L. Simel, Drummond Rennie
Opiates and Abdominal Pain
David L. Simel
Make the Diagnosis: Opiates and Abdominal Pain
Topics Discussed:
abdominal pain, diagnosis, make the diagnosis, measures of outcome, medical errors, narcotics, opiates, pain, physical examination
Excerpt:
"The initial diagnosis of the patient with abdominal pain is rarely
certain, and the first examining physician is often not the surgeon
responsible for making an operative decision. Thus, the examining
physician must decide whether to prescribe analgesics (usually opiates)
while awaiting results from additional tests, surgical consultation,
or both. Unlike most Rational Clinical Examination questions that
focus on the likelihood ratio for symptoms and signs, the decision
to use opiates must address the question of whether these analgesics
alter the findings. By altering the findings, opiates could affect
the differential diagnosis and, consequently, the decision to operate or
pursue other diagnostic tests or therapies. For the changes in physical
findings to be important, the changes must create management errors
such as delayed or unnecessary surgery...."
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