Page 86 - PJ MED OPS Handbook 8th Ed

Abdominal Pain

SPECIAL CONSIDERATIONS:
1. Common causes in young healthy adults include appendicitis, cholecystitis, pancreatitis,
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.

Signs and Symptoms for Urgent Evacuation:
1. Severe, persistent or worsening abdominal pain is the key sign
2. Rigid abdomen
3. Rebound abdominal tenderness
4. Focal tenderness
5. Distension
6. Fever >101°F
7. Uncontrollable vomiting
8. Presence of bloody vomitus or stools
9. Presence of black tarry stools
10. Presence of coffee ground vomitus

NOTES: If 7, 8, 9, 10 only, and vital signs are stable, use judgment for Priority Evacuation.
Progressive absence of passing gas and bowel movements can be danger signs.

Management:
1. Start IV with normal saline (NS), 1 liter bolus, followed by NS 150mL/hr.
2. Keep NPO except for medications. If no IV is attainable, provide intermittent small bolus PO
hydration.
3. NG tube for extended care
4. Ertapenem (Invanz) 1g IV daily
5. Fentanyl for pain (DO NOT USE NSAIDs)
6. Zofran for nausea and vomiting
7. Tylenol with sips of water for fever

DISPOSITION:
1. Urgent evacuation to a surgical facility.

Signs and Symptoms Suggestive for Continued Observation:
1. Epigastric burning pain
2. General cramping
3. Passing gas or having BMs
4. Nausea and/or vomiting
5. Soft abdomen, absence of rebound tenderness
6. If diarrhea is present, treat per Gastroenteritis Protocol

84 n Pararescue Medical Operations Handbook / 8th Edition