Abdominal Pain Management in Pre-Hospital Environment

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Questions and Answers

What is the primary reason for understanding the possible causes of abdominal pain in the pre-hospital environment?

To assist in the management of the patient (correct)

To identify the presence of hypotension

To diagnose the cause of abdominal pain

To determine the need for a 12-lead ECG

Which of the following is a sign or symptom that may indicate the need for immediate management in a patient with abdominal pain?

Presence of a surgical scar

Past medical history of abdominal pain

History of medication use

Nausea and vomiting (correct)

Which of the following patients should be treated as a possible ectopic pregnancy until proven otherwise?

Females of childbearing years (correct)

Any male 35 years or older

Any patient with a history of abdominal pain

Any female 45 years or older

What is the significance of a patient's past medical/surgical history in evaluating abdominal pain?

It is frequently helpful in determining the cause of the patient's current episode of abdominal pain Signup and view all the answers

What should be considered in a male patient 35 years or older with upper abdominal pain?

The need for a 12-lead ECG Signup and view all the answers

Which of the following is a vascular emergency that may cause abdominal pain?

Ruptured abdominal aortic aneurysm Signup and view all the answers

What should be considered in a patient with lower abdominal pain?

The possibility of an ectopic pregnancy in females of childbearing years Signup and view all the answers

What is the significance of determining current medication use in a patient with abdominal pain?

It can assist in understanding reasons for the patient's abdominal pain Signup and view all the answers

What is the significance of hypotension in a patient with abdominal pain?

It is an associated sign or symptom that may indicate the need for immediate management Signup and view all the answers

Where does the pain of renal colic typically start?

Posterior flank Signup and view all the answers

What is a characteristic of gallbladder pain?

It starts in the right upper quadrant and may move to the mid back Signup and view all the answers

What is a common cause of left upper quadrant pain?

Pancreatitis Signup and view all the answers

Why is it important to consider past medical/surgical history in patients with abdominal pain?

To identify potential complications from previous surgeries Signup and view all the answers

Where does classic appendicitis pain typically start?

Mid-upper abdomen or around the umbilicus Signup and view all the answers

What is a common complication in patients who have had gastric bypass surgery?

Complications that can occur shortly after surgery to many years following the surgical procedure Signup and view all the answers

What is a characteristic of right upper quadrant pain?

It may move around the upper abdomen into the mid back Signup and view all the answers

What is the significance of asking about the onset of abdominal pain?

To distinguish between acute and chronic pain Signup and view all the answers

What is the purpose of asking about associated symptoms in a patient with abdominal pain?

To identify potential causes of the pain Signup and view all the answers

Why is it important to ask about the timing of last menses in a patient with abdominal pain?

To assess the patient's risk of ectopic pregnancy Signup and view all the answers

What is the purpose of asking about the patient's response to pain medication in abdominal pain?

To assess the effectiveness of pain management Signup and view all the answers

Why is it important to ask about the pattern of pain in a patient with abdominal pain?

To identify potential causes of the pain Signup and view all the answers

What is the recommended initial treatment for a patient with hypotension?

Administer normal saline, 500 mL IV bolus Signup and view all the answers

What should be done for a patient who is vomiting blood or bleeding large amounts per rectum?

Start a saline lock and administer normal saline only if patient also has hypotension or tachycardia Signup and view all the answers

What is the recommended dose of ondansetron (Zofran) for a patient with nausea and vomiting?

8 mg PO Signup and view all the answers

When should normal saline be administered to a patient who is vomiting blood or bleeding large amounts per rectum?

Only if the patient also has hypotension or tachycardia Signup and view all the answers

What is the primary goal of administering normal saline to a patient with hypotension?

To increase blood pressure Signup and view all the answers

Study Notes

Abdominal Pain Causes and Management

Diagnosing the causes of abdominal pain in the pre-hospital environment is not usually indicated, but understanding the possible reasons can assist in patient management.
Associated signs and symptoms, such as hypotension, nausea, vomiting, bleeding, and traumatic damage, determine the management of patients with abdominal pain.

Associated Signs and Symptoms

Hypotension is associated with: • Vascular emergencies (e.g., ruptured abdominal aortic aneurysms) • Ruptured ectopic pregnancies • Bowel obstructions • Traumatic damage to solid organs (e.g., spleen, kidney, liver) • Gastrointestinal bleeding
Nausea and/or vomiting are important signs to consider.
Bleeding from the mouth or rectum is a significant symptom.

Evaluating Patients with Abdominal Pain

Upper Abdominal Pain

In patients with upper abdominal pain (above the umbilicus): • Males 35 years or older require a 12-lead ECG. • Females 45 years or older require a 12-lead ECG.

Lower Abdominal Pain

In patients with lower abdominal pain (below the umbilicus): • Females of childbearing years should be treated as a possible ectopic pregnancy until proven otherwise.

Patient History and Medication

The patient's past medical/surgical history is frequently helpful in determining the cause of their abdominal pain.
Determining current medication use can assist in understanding the reasons for the patient's abdominal pain.

Abdominal Pain Diagnosis

Location of pain is the most helpful information for determining cause of pain

Renal Colic (Kidney Stones)

Pain starts in posterior flank and radiates to lower abdomen on same side
Pain never crosses midline

Right Upper Quadrant Pain

Gallbladder pain starts in right upper quadrant and may move to upper abdomen and mid back

Right Lower Quadrant Pain

Possible causes: kidney stones, ectopic pregnancy, classic appendicitis
Classic appendicitis pain starts in mid-upper abdomen or around umbilicus and later moves to right lower quadrant

Left Upper Quadrant Pain

Possible cause: pancreatitis
Pancreatitis often associated with history of pancreatitis, alcohol abuse, or gallbladder stones

Left Lower Quadrant Pain

Possible causes: diverticulitis, ectopic pregnancy, kidney stones

Abdominal Pain Complications

May be associated with nausea and/or vomiting, diarrhea or constipation, urinary symptoms, difficulty breathing, cough, fever
Patients with history of gastric bypass surgery at increased risk for complications
Complications can occur shortly after surgery or many years later
Patients with abdominal pain after gastric bypass surgery should be transported to hospital for further evaluation

Pain Assessment Questions

Onset of pain can be either sudden or gradual
Pain can be constant or intermittent since its onset
Pain may or may not have changed location since it started
It is essential to determine if the patient has experienced similar pain before
Identifying factors that exacerbate or relieve the pain is crucial
Associated symptoms and clinical findings to be explored include: • Nausea • Vomiting • Diarrhea • Urinary symptoms • Shortness of breath
Pain severity should be assessed on a scale of 1-10, with 10 being the worst
Patient's self-medication attempts and their effectiveness should be noted
In relevant cases, the timing of the last menses should be recorded

Initial Patient Assessment and Care

Universal initial adult patient assessment and care is the first step in treatment

Hypotension Management

Administer 500 mL IV bolus of normal saline to treat hypotension
Repeat the normal saline IV bolus once if needed
Inform the receiving hospital of the patient's status

Nausea and Vomiting Management

Administer ondansetron (Zofran) ODT, 8 mg PO, to treat nausea and vomiting
Alternatively, administer ondansetron (Zofran), 4 mg IVP/IO/IM, if available
Treating abdominal pain often relieves associated nausea

Pain Management

Consider pain management as part of the treatment plan

Vomiting Blood or Bleeding Management

Start a saline lock in cases of vomiting blood or bleeding per rectum
Administer normal saline only if the patient is also hypotensive or tachycardic

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Description

Diagnosing abdominal pain causes is not a priority in pre-hospital settings, but understanding possible reasons helps manage patients. Associated signs and symptoms like hypotension guide management decisions.