Page 103 - 2022 Ranger Medic Handbook

Abdominal Pain
(Includes Surgical Abdomen, GERD, Dyspepsia)
DEFINITION: Common causes in young healthy adults include appendicitis, cholecystitis, pancreatitis, perforated ulcer,
and diverticulitis. Consider constipation/fecal impaction as a potential cause of abdominal pain.
S/Sx: Epigastric burning pain, present bowel sounds, nausea and/or vomiting, absence of rebound tenderness, if diar-
rhea is present, treat per Gastroenteritis Protocol.
MANAGEMENT:
1. Famotidine 20mg PO bid OR rabeprazole 20mg PO qd OR proton pump inhibitor of choice.
2. Increase PO hydration.
3. Avoid triggers (acidic/spicy foods/tobacco); wait 3 hours between eating and lying down.
4. Antacid of choice (antacids will mask other S/Sx). Treat per Nausea/Vomiting Protocol as required.
Note: Determine pregnancy status of females with abdominal pain to evaluate for ectopic pregnancy. Follow SECTION 3
appro priate protocol only after ruling out ectopic pregnancy.
DISPOSITION: Observation and reevaluation; Priority evacuation if symptoms not controlled by this management within
12 hours.

Acute Surgical Abdomen
S/Sx Suggesting Urgent Evacuation: Severe, persistent, or worsening abdominal pain is the key sign; rigid abdomen,
rebound abdominal tenderness, fever, absence of bowel sounds, focal percussive tenderness, uncontrollable vomiting,
presence of bloody vomitus or stools, presence of black tarry stools, presence of coffee ground vomitus, positive find-
ings of Murphy’s, McBurney’s, or Grey-Turner sign.
MANAGEMENT:
1. Start IV with crystalloid, 1L bolus, followed by crystalloid 150mL/hr.
2. Keep NPO except for medications or PO hydration.
3. Ertapenem 1g IV qd OR ceftriaxone 1g IV qd, PLUS metronidazole 500mg PO q8hr.
4. Treat per Pain Protocol.
5. Treat per Nausea and Vomiting Protocol
DISPOSITION: Urgent evacuation to a surgical facility.

Allergic Rhinitis / Hay Fever
DEFINITION: Inflammation of the nasal passages due to environmental allergy.
S/Sx: Clear nasal drainage; pale, boggy or inflamed nasal mucosa; with or without complaints of nasal congestion;
watery or red eyes; sneezing; normal temperature; history of environmental allergy.
MANAGEMENT:
1. Fluticasone 1 spray each nare bid +/– loratadine 10mg PO qd OR fexofenadrine 180mg PO qd OR cetirizine 5–10mg
PO qd AND/OR if no previous available, then diphenhydramine 25–50mg PO q6hr if tactically feasible (drowsiness
is a side-effect).
2. Increase oral fluid intake.
3. If prolonged management, consider fluticasone 2 sprays in each nostril daily. Nasal saline spray may be very helpful
in clearing upper airway secretions.
DISPOSITION: Evacuation usually not required

2022 RANGER MEDIC HANDBOOK 89