Severe upper abdominal pain

48-year-old man with severe upper abdominal pain and repeated vomiting.

Pain started approximately 12 hours ago and has progressively worsened.

He is now clammy, tachycardic and hypotensive.

Pre-alert observations

HR 126
BP 88/54
RR 26
SpO₂ 95% RA
GCS 15
BM 7.8 mmol/L

ETA: 6 minutes.

Ambulance treatment: IV morphine, an antiemetic, one peripheral cannula. No significant improvement in pain.

The diagnosis is not on the pre-alert. The monitor stays dark until he is in the bay.