Abdominal Pain

Patient Care Goals

Identify life-threatening causes of abdominal pain and improve patient comfort.

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ DKA often presents with abdominal pain, nausea, and vomiting. 
□ Intussusception (episodic pain episodes)
□ Appendicitis
□ Consider necrotizing enterocolitis or volvulus in an infant
□ Bilious vomiting in babies is bad		□ Pain  
□ Nausea  
□ Vomiting  
□ Diarrhea  
□ Dysuria  
□ Constipation  
□ Vaginal bleeding / discharge  
□ Pregnancy  
□ Fever  
□ Abdominal distension		□ Pneumonia or P.E.  
□ Hepatitis or Pancreatitis  
□ Gastroenteritis  
□ Peptic Ulcer Disease  
□ Myocardial Infarction or CHF  
□ Kidney Stone  
□ Aortic Aneurysms  
□ Appendicitis  
□ Bladder/Prostate Disorder  
□ Pelvic – Pregnancy, Ectopic, STI, PID, Ovarian Cyst  
□ Diverticulitis  
□ Bowel Obstruction  
□ Testicular torsion

Clinical Management Options

EMT-B
• Place in position of comfort
• Keep the patient NPO
• Oxygen target SpO2 92% – 96%  
• Have the patients sniff alcohol swabs as needed for nausea
Paramedic
• IV / IO access as appropriate for patient condition  
• IV fluid with Isotonic Crystalloid as needed for dehydration.  
• Pain Management as needed (Pain Management)
• Antiemetics as needed (Nausea and Vomiting)
• Consider 12 lead ECG acquisition and 4 lead ECG placement
Consult Online Medical Control as Needed

Consult Online Medical Control as Needed

Pearls

  • Using a stethoscope to listen to the abdomen in all quadrants with gentle pressure may allow you to examine the abdomen in patients who are anxious about the exam.
  • Consider cardiac causes of epigastric abdominal pain in patients older than 40 years old.
  • Abdominal pain in women of childbearing age should be treated as an ectopic pregnancy until proven otherwise.  
  • Consider testicular pathology in males as testicular injury can present as abdominal pain.
  • The diagnosis of abdominal aneurysm should be considered with abdominal pain in patients over 50 Y/O.  
  • Orthostatic vital signs do not need to be assessed on obviously hypotensive patients.  
  • Mesenteric ischemia presents with severe pain with limited exam findings. Risk factors include age > 60, atrial fibrillation, CHF, and atherosclerosis.  
  • For all female patients ask about last menstrual period.  
  • Consider ovarian/testicular torsion in patients with sudden onset of unilateral low abdominal pain
  • Intermittent abdominal pain/cramping in young children is classic for intussusception.

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