Free air suggests GI perforation. The sources say most perforations need urgent explorative laparotomy, especially with signs of peritonitis or sepsis (this patient has HR 130), and such patients may go to surgery without more imaging. But the free air here is only questionable and peritonitis isn't clearly described, so a CT with oral and IV contrast to confirm perforation is also defensible. The sources don't address equivocal free air directly.