- Past medical/surgical history
- Quality (crampy/constant/ sharp/dull/etc.)
- Severity (1-10)
- Time (duration/repetition)
- Last meal eaten
- Last bowel movement/emesis
- Menstrual history (pregnancy)
- Pain (location/migration)
- Vaginal bleeding/discharge
Pregnancy associated symptoms (Helpful to localize source)
- Mental status changes
- Pneumonia or pulmonary embolus
- Liver (hepatitis/CHF)
- Peptic ulcer disease/gastritis
- Myocardial infarction
- Kidney stone
- Abdominal aneurysm
- Bladder/prostate disorder
- Pelvic (PID/ectopic pregnancy/ ovarian cyst)
- Spleen enlargement
- Bowel obstruction
Hypotensive with signs of poor perfusion ?
> 12 years old or > 55 kg;
- Normal Saline up to 1,000 mL IV
- to reduce signs of hypotension
1 day to 11 years old or < 55 kg;
- Normal Saline 20 mL/kg IV;
- max 60 mL or 1,000 mL.
Nausea and/or vomiting ?
- Notify receiving facility or contact Medical Control
- A 12-Lead will be performed on all patients over the age of 50 with a complaint of pain or discomfort above the navel, non-traumatic back pain, shortness of breath, and/or syncope.
- Abdominal pain in women of childbearing age should be treated as an ectopic pregnancy until proven otherwise.
- Antacids should be avoided in patients with renal disease.
- The diagnosis of abdominal aneurysm should be considered with abdominal pain in patients over 50.
- Repeat vital signs after each bolus.
- Appendicitis may present with vague, periumbilical pain, which migrates to the RLQ over time.
- Appendicitis may present with rebound tenderness and abdominal guarding.
Age based hypotension:
- less than 1 year: less than 70 mm/hg
- 1-10 years: less than 70 + (2 x age)
- greater than 11: less than 90