Page 183 - ATP-P 11th Ed

ABDOMINAL PAIN PROTOCOL

SPECIAL CONSIDERATIONS
1. Common causes in young healthy adults include appendicitis, cholecystitis, pan-
creatitis, perforated ulcer, and diverticulitis.
2. Consider constipation/fecal impaction as a potential cause of abdominal pain.
3. Consider bowel perforation if abdominal pain begins within 72 hours of a blast
injury.
SECTION 2
Signs and Symptoms Suggestive for Urgent Evacuation
1. Severe, persistent, or worsening abdominal pain is the key sign.
2. Rigid abdomen
3. Rebound abdominal tenderness
4. Fever
5. Absence of bowel sounds
6. Focal percussive tenderness
7. Uncontrollable vomiting
8. Presence of bloody vomitus or stools
9. Presence of black tarry stools
10. Presence of coffee ground vomitus
Management
1. Start IV with normal saline (NS), 1L bolus, followed by NS 150mL/hr. Keep NPO
except for medications or PO hydration.
2. Ertapenem (Invanz ) 1g IV daily
®
3. OR ceftriaxone (Rocephin ) 1g IV daily, plus metronidazole (Flagyl ) 500mg PO
®
®
q8hr
4. Treat per Pain Management Protocol (DO NOT USE NSAIDs).
5. Treat per Nausea and Vomiting Protocol.
Disposition
Urgent evacuation to a surgical facility

172 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 173