Protocol Status: PUBLISHED
Protocol:
Version: 2026.01
Effective Date:
Last Reviewed:
Medical Director Approval:
Clinical Note: This content reflects current GCEMS clinical guidelines as of the dates listed above. If content appears inconsistent with current policy, use the most recent approved guideline and notify leadership for correction.

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
  • Gastroenteritis (infections)

 

Treatment:

 

    • Initiate IV

 

 

Hypotension 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