Abdominal Pain

 

History:

 

  • Age
  • Past medical/surgical history
  • Medications
  • Onset
  • Palliation/Provocation
  • Quality (crampy/constant/ sharp/dull/etc.)
  • Region/Radiation/Referred
  • Severity (1-10)
  • Time (duration/repetition)
  • Fever
  • Last meal eaten
  • Last bowel movement/emesis
  • Menstrual history (pregnancy)

 

Significant Findings:

 

  • Pain (location/migration)
  • Tenderness
  • Nausea
  • Vomiting
  • Diarrhea
  • Dysuria
  • Constipation
  • Vaginal bleeding/discharge

 

Pregnancy associated symptoms (Helpful to localize source)

 

  • Fever
  • Myalgias
  • Headache
  • Cough
  • Weakness
  • Headache
  • Malaise
  • Rash
  • Mental status changes

 

Differential:

 

  • Pneumonia or pulmonary embolus
  • Liver (hepatitis/CHF)
  • Peptic ulcer disease/gastritis
  • Gallbladder
  • Myocardial infarction
  • Pancreatitis
  • Kidney stone
  • Abdominal aneurysm
  • Appendicitis
  • Bladder/prostate disorder
  • Pelvic (PID/ectopic pregnancy/ ovarian cyst)
  • Spleen enlargement
  • Diverticulitis
  • Bowel obstruction

 

Treatment:

 

 

 

 

 

 

    • Initiate IV

 

 

Hypotensive with signs of poor perfusion ?

 

  • Yes

 

 

 

    • > 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.

 

  • No

 

Nausea and/or vomiting ?

 

  • Yes

 

 

  • No

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • 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

 

NREMR

National Registry Emergency Medical Responder

NRAEMT

National Registry Advance Emergency Technician

NRAEMT

National Registry Advance Emergency Technician