Podcast
Questions and Answers
Morphine 0.1mg/kg IV, most start with ______
Morphine 0.1mg/kg IV, most start with ______
4-6mg
Give Zofran 8mg IV to counteract ______
Give Zofran 8mg IV to counteract ______
nausea/vomiting
Demerol is a poor choice of opiate to use due to its side effects and causes lots of ______
Demerol is a poor choice of opiate to use due to its side effects and causes lots of ______
euphoria
Special attention to surgical history, previous ______
Special attention to surgical history, previous ______
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Benadryl 25mg IV PRN for ______
Benadryl 25mg IV PRN for ______
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Morphine, fentanyl and ______ are all excellent painkillers
Morphine, fentanyl and ______ are all excellent painkillers
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Don’t dive for the abdomen- do an ______ exam, heart/lung exam
Don’t dive for the abdomen- do an ______ exam, heart/lung exam
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Uncover the abdomen and ask patient to point where it ______
Uncover the abdomen and ask patient to point where it ______
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Check ______ sounds first
Check ______ sounds first
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Peritoneal signs- usually indicate ______ or other surgical pathology
Peritoneal signs- usually indicate ______ or other surgical pathology
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Psoas sign- roll onto left side, extend ______ back
Psoas sign- roll onto left side, extend ______ back
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Murphy’s sign- patient takes a deep breath, push in ______, positive if patient stops inhaling due to pain
Murphy’s sign- patient takes a deep breath, push in ______, positive if patient stops inhaling due to pain
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Do a ______ exam in all males- don’t miss a torsion!
Do a ______ exam in all males- don’t miss a torsion!
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The ______ for females involves UA/HCG (no culture unless you admit or treat for UTI)
The ______ for females involves UA/HCG (no culture unless you admit or treat for UTI)
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CBC is important as up to ______% of appys have normal WBC.
CBC is important as up to ______% of appys have normal WBC.
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Hypokalemia can cause an ______.
Hypokalemia can cause an ______.
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Before talking to the patient, it's crucial to look at them as they sit on the ______.
Before talking to the patient, it's crucial to look at them as they sit on the ______.
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Associated signs and symptoms include nausea, vomiting, diarrhea, back pain, and ______ symptoms.
Associated signs and symptoms include nausea, vomiting, diarrhea, back pain, and ______ symptoms.
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Pain control is critical, so clinicians should not ______ it.
Pain control is critical, so clinicians should not ______ it.
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For older patients, a VBG with lactate can indicate if a high lactate equals ______ disease.
For older patients, a VBG with lactate can indicate if a high lactate equals ______ disease.
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Appendicitis patients usually want to remain very ______.
Appendicitis patients usually want to remain very ______.
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Imaging the abdomen effectively by quadrants is important for evaluating ______ pain.
Imaging the abdomen effectively by quadrants is important for evaluating ______ pain.
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LUQ abdominal pain rarely requires imaging unless there is a suspect of a bowel ______.
LUQ abdominal pain rarely requires imaging unless there is a suspect of a bowel ______.
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To diagnose an AAA, use ______ to check for size and presentation.
To diagnose an AAA, use ______ to check for size and presentation.
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RUQ pain is best assessed using a ______ ultrasound for cholecystitis.
RUQ pain is best assessed using a ______ ultrasound for cholecystitis.
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CT A/P is indicated for ______ to evaluate appendicitis.
CT A/P is indicated for ______ to evaluate appendicitis.
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LLQ pain may require a CT A/P for ______
LLQ pain may require a CT A/P for ______
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Flank pain may require a CT A/P without ______ for kidney stones
Flank pain may require a CT A/P without ______ for kidney stones
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A suprapubic pain in isolation is usually a ______
A suprapubic pain in isolation is usually a ______
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Patients with stones may have ______ hematuria on UA
Patients with stones may have ______ hematuria on UA
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It is better to document as 'abdominal pain' rather than using ______ or gastroenteritis
It is better to document as 'abdominal pain' rather than using ______ or gastroenteritis
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For gastroenteritis, one must have both vomiting and ______
For gastroenteritis, one must have both vomiting and ______
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If you have increased pain or new pain in the right lower ______, return to the ER
If you have increased pain or new pain in the right lower ______, return to the ER
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I think you have a GI bug. These usually get better on their ______
I think you have a GI bug. These usually get better on their ______
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Study Notes
Abdominal Pain Assessment and Management
- Not all cases require labs; surgical abdominal pain warrants testing.
- History-taking should include UA/HCG for females, but no culture unless treating a UTI.
- Review triage notes and vitals—evaluate the patient’s presentation carefully.
- Criteria for lab tests include:
- CBC: normal WBC counts in up to 30% of appendicitis cases.
- Chem 10: checks for conditions like hypokalemia and acidosis.
- Coags: important before surgery, liver disease can elevate coags.
- LFTs: relevant for cholecystitis; not always needed for appendicitis.
- Lipase: preferred for pancreatitis diagnosis, amylase is less useful.
- VBG with lactate for older patients; high lactate indicates severe disease.
Pain Management
- Administer pain control without hesitation—Morphine recommended at 0.1 mg/kg IV.
- Consider Zofran 8mg IV for nausea and vomiting; prolonging antiemetic administration can help.
- Beware: Demerol is discouraged due to side effects and its potential for euphoria.
- Opt for morphine, fentanyl, or dilaudid as effective painkillers.
Physical Examination
- Perform HEENT and heart/lung exams before assessing the abdomen.
- Determine precise pain location; initiate with light palpation, increasing pressure gradually.
- Monitor for signs of peritoneal irritation, indicating potential surgical issues.
- Assess for tenderness, psoas and obturator signs, and utilize Rovsing’s and Murphy’s signs for diagnosis.
Differential Diagnosis
- Common conditions causing abdominal pain include:
- Appendicitis: most prevalent surgical emergency.
- Cholecystitis: gallbladder inflammation, diagnosed via RUQ ultrasound.
- Pancreatitis: characterized by epigastric pain.
- Diverticulitis: typically presents with LLQ pain.
- Kidney stones: associated with flank pain, may or may not show hematuria.
- Bowel perforation: emergency requiring swift intervention.
- Gastroenteritis: must present with both vomiting and diarrhea.
Imaging Strategies
- Imaging choice depends on pain location:
- LUQ: imaging rarely needed unless signs of obstruction or rigidity present.
- Epigastric: minimal imaging unless pancreatitis is suspected.
- RUQ: ultrasound is preferred for cholecystitis detection.
- RLQ: CT A/P for suspected appendicitis, can often be performed without contrast.
- LLQ: CT A/P for diverticulitis.
- Flank pain: CT A/P without contrast useful for kidney stones.
Discharge Instructions
- Conduct repeat abdominal exams before discharging patients.
- Communicate clearly with patients about their conditions and possible complications.
- Advise patients to return if symptoms worsen or if new pain develops, particularly in the RLQ.
Important Pearls
- Avoid using "gastritis" or "gastroenteritis" as diagnoses—opt for broader terms like "abdominal pain."
- For gastroenteritis diagnosis, both vomiting and diarrhea are necessary.
- A surgical consult may be warranted even with negative imaging if the clinical picture remains concerning.
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Description
This quiz focuses on the evaluation of abdominal pain in emergency medicine. It includes considerations for laboratory tests and surgical indications. Gain insights into effective management strategies for abdominal pain cases.
