question: Q:A 50-year-old male presents to the emergency with abdominal pain. He reports he has had abdominal pain associated with meals for several months and has been taking over the counter antacids as needed, but experienced significant worsening pain one hour ago in the epigastric region. The patient reports the pain radiating to his shoulders. Vital signs are T 38, HR 120, BP 100/60, RR 18, SpO2 98%. Physical exam reveals diffuse abdominal rigidity with rebound tenderness. Auscultation reveals hypoactive bowel sounds. Which of the following is the next best step in management?? 
  {'A': 'Abdominal ultrasound', 'B': 'Chest radiograph', 'C': 'Abdominal CT scan', 'D': '12 lead electrocardiogram', 'E': 'Admission and observation'},