Page 27 - 2023 SMOG Digital

Medical

ABDOMINAL

PAIN

Signs and Symptoms:
• Pain (RUQ, RLQ, LUQ, LLQ) (Location /
Migration / Radiation)
• Tenderness
• Nausea / Vomiting
• Diarrhea (Bloody?)
• Dysuria
• Constipation
• Vaginal Bleeding / Discharge
• Distention
• Guarding / Rigidity
Associated symptoms:
• Fever, Headache, Weakness, Malaise /
Fatigue, Myalgia, Cough, Mental Status
Changes, Rash
Universal Patient Care Guideline Consider use of BLOOD PRODUCT for:
Continued from: O2 (if Hypoxemic) • Persistent or Worsening Signs of Hypovolemic Shock
(Tachycardia, Hypotension, ↓Pulse Pressure)
Tactical Evacuation Guideline IV/IO Guideline • Rigid Distended Abdomen and/or Known: AAA, GI
Cardiac Monitor
12 Lead ECG (>40yo) Bleed, or Ruptured Ectopic / Abruption
500mL IVF Bolus
(Repeat as Needed) YES Tachycardia / Hypotension / Orthostatic BP? Pain Management Guideline
IV/IO Guideline
NO Consider
Significant or Disabling Pain? YES Chest Pain Guideline
NO
Nausea and/or Vomiting? YES 500mL IVF Bolus
NO Promethazine 12.5-25mg IV
OR
When appropriate, return to:
Tactical Evacuation Guideline Reassess every 5 minutes Ondansetron 4-8mg IV
Pearls:
• Maintain a high index of suspicion for ectopic pregnancy as a cause of abdominal pain in females of
childbearing age.
• Antacids should be avoided in patients with renal disease.
• Patients older than 50 are at increased risk for life-threatening diagnoses (e.g., AAA).
• Appendicitis presents with vague, periumbilical pain that migrates to the RLQ. This classic
presentation may not be present in some patients.
• Repeat VS after each intervention. In non-traumatized patients, may repeat fluid bolus prn depending
on patient condition and VS. In trauma patients, fluid boluses should be used in accordance with
hypotensive resuscitation guidelines (see Multiple Trauma Guideline).
• Choose the lower promethazine dosage for patients likely to experience sedative effects (e.g., elderly).

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