Download Abdominal Pain

Abdominal Pain
History
Signs and Symptoms
Differential
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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)
Pain (location / migration)
Tenderness
Nausea
Vomiting
Diarrhea
Dysuria
Constipation
Vaginal bleeding / discharge
Pregnancy
Associated symptoms:
(Helpful to localize source)
Fever, headache, weakness, malaise,
myalgias, cough, headache, mental
status changes, rash
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 (infectious)
Ovarian and Testicular Torsion
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Serious Signs / Symptoms
NO
I
Hypotension, poor perfusion,
shock
YES
IV Procedure
IV Procedure
Adult Pain Control Protocol
if indicated
I
IO Procedure
Normal Saline Bolus 500 mL
Repeat as needed
Titrate SBP ≥ 90
Maximum 2 L
Cardiac Monitor
Adult Pain Control Protocol
if indicated
Signs / Symptoms
Suggesting Cardiac
Etiology
Nausea and /
or Vomiting
NO
Appropriate
Cardiac Protocol
as indicated
YES
P
Odansetron 4 mg
IV / IO / IM / ODT
May repeat in 15 minutes
If no response
Promethazine
12.5 mg IV / IO / IM
May repeat x 1 as needed
Signs / Symptoms
Suggesting Cardiac
Etiology
YES
YES
Nausea and /
or Vomiting
Improving
NO
Exit to
Hypotension / Shock
Protocol
Notify Destination or
Contact Medical Control
Protocol 23
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
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Adult Medical Section Protocols
P
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Abdominal Pain
Adult Medical Section Protocols
Pearls
· Recommended Exam: Mental Status, Skin, HEENT, Neck, Heart, Lung, Abdomen, Back, Extremities, Neuro
· Document the mental status and vital signs prior to administration of anti-emetics
· Abdominal pain in women of childbearing age should be treated as pregnancy related until proven otherwise.
· Antacids should be avoided in patients with renal disease.
· The diagnosis of abdominal aneurysm should be considered with abdominal pain especially in patients over 50 and /
or patients with shock/ poor perfusion.
· Repeat vital signs after each fluid bolus.
· The use of metoclopramide (Reglan) may worsen diarrhea and should be avoided in patients with this symptom.
· Choose the lower dose of promethazine (Phenergan) for patients likely to experience sedative effects (e.g., Age ≥
60, debilitated, etc.) When giving promethazine IV dilute with 10 mL of normal saline and administer slowly.
· Consider cardiac etiology in patients > 50, diabetics and / or women especially with upper abdominal complaints.
Protocol 23
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS