Notes – Abdominal Pain

Abdominal Pain

Patient Safety Considerations

None recommended

Notes/Educational Pearls

Key Considerations

  1. Assess for life-threatening causes of abdominal pain
  2. Provide appropriate treatment for pain, vomiting, and shock
  3. Consider transport to a trauma center if aortic aneurysm is suspected

Pertinent Assessment Findings

  1. Rebound tenderness
  2. Guarding
  3. Abdominal distension
  4. Abdominal tympany to percussion
  5. Tenderness focal to a specific abdominal quadrant
  6. Presence of “pulsatile” abdominal mass
  7. Absence of or significant inequality of femoral or distal arterial pulses in lower extremities
  8. Hyper or hypothermia
  9. Rectal bleeding, hematemesis (character), vaginal bleeding

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914109 – Medical-Abdominal Pain

Key Documentation Elements

  • Assessment of abdomen to include findings on palpation/percussion including presence or absence of masses and presence and nature of tenderness/pain
  • Treatment and response to treatment

Performance Measures

  • Assessment for life-threatening etiology
  • Mitigation of pain per the Pain Management guideline

References

  1. Attard AR, Corlett MJ, Kidner NJ, Leslie AP, Fraser IA. Safety of early pain relief for acute abdominal pain. BMJ. 1992;305(6853):554-6.
  2. Brewster GS, Herbert ME, Hoffman JR. Medical myth: analgesia should not be given to patients with acute abdominal pain because it obscures the diagnosis. West J Med. 2000;172(3):209-10.
  3. LoVecchio F, Oster N, Sturmann K, Nelson LS, Flashner S, Finger R. The use of analgesics in patients with acute abdominal pain. J Emerg Med 1997;15:775-9.
  4. Manterola C, Astudillo P, Losada H, Pineda V, Sanhueza A, Vial M. Analgesia in patients with acute abdominal pain. Cochrane Database of Syst Rev. 2011;1:CD005660.
  5. Pace S, Burke TF. Intravenous morphine for early pain relief in patients with acute abdominal pain. Acad Emerg Med. 1996;3:1086-92.
  6. Ranji SR, Goldman LE, Simel DL, Shojania KG. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA. 2006;296(14):1764-74.
  7. Vermuelen B, Morabia A, Unger PF, et al. Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate – a randomized trial. Radiology. 1999;210:639-43.