You are a trip leader for a 21 day winter ski trip. On day 13 one of your students, a 17 y/o male, approaches you before breakfast and tells you his belly hurts and he is not hungry. After questioning him further you find that he has generalized achy pain in his abdomen that prevented him from sleeping well the night before. He said he first noticed the pain yesterday after lunch and it slowly worsened through the day from a one to a four on the ten scale. An abdominal exam reveals mild tenderness in all quadrants. He has no relevant personal or family history. No one else in the group is feeling poorly. His pulse is 72 & regular, his respirations are 18 and easy, his skin is pink, and warm, & dry, his oral temperature is 99.4º F. A "heel drop" test is negative. You prudently decide to remain at the hut for the day to see if he gets better and to examine your evacuation options.
Three hours later he reports that he is nauseous and the pain is still getting worse and is now six on the ten pain scale. The pain has also localized to his lower right quadrant. Another abdominal exam reveals slight tenderness in his lower right quadrant. He reports a sharp pain when asked to stand on his toes and drop suddenly to his heels. His pulse is 80 & regular, his respirations are 20 and easy, his skin is pink, warm, & dry, and his oral temperature is 100.6º F.
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