What should the next step be for a patient presenting with a hernia that has become painful and firm?

When a patient presents with a hernia that has become painful and firm, the most appropriate next step is to refer them to the emergency department. This situation suggests that the hernia may be incarcerated or strangulated, conditions where the blood supply to the tissue is compromised or the hernia cannot be reduced back into the abdominal cavity. Both of these scenarios can quickly lead to complications, including tissue necrosis.

Prompt evaluation and potential surgical intervention in an emergency setting are critical for such cases. Rapid intervention helps prevent further complications, such as bowel obstruction or perforation, which could potentially become life-threatening.

Although performing a physical exam is an important aspect of patient assessment and ordering imaging tests might provide additional information about the hernia, these steps are not urgent in the context of an acute presentation of pain and firmness. Providing pain management is also important, but it should be part of comprehensive care that includes addressing the immediate surgical needs of the patient. Therefore, referring to the emergency department is the safest and most effective course of action.