طراحی الگوریتم برای پراکتیس با استفاده از منابع معتبر طب اورژانس

1. Urin
Acute abdominal Pain
Consider Monitoring
Pain Management (IV MS)-NG tube
Hydration
History and Physical Examination
A.B.C.D.E
MI, DKA
StableUnstable
EKG, ABG, US, DRE, BS Glucometry, Guaiac
Extraabdominopelvic
Treatment
Surgery Consult. OR
1. Ruptured
ectopic
Pregnancy
2. Ruptured
or leaking
Abdominal
Aneurysm
3.Mesenteric
Ischemia
4. Intestinal
Obstruction
5. Perforated
viscous
6. Acute
pancreatitis
7. DKA Internist Consult
Localize PainDiffuse Pain
EKG, ABG, CBC,BUN/Cr, BS, S/E, Amylase,Lypase, CPK,B-HCG,U/A, LFT, D-dimer
Proportion to examination?
Cardiac Disease?
Mesenteric Ischemia
RUQ
Females of childbearing age?
Abdominal x ray
Chest X Ray
Intestinal obstruction
Abdominal distention ?
Hyperactive bowel sounds?
Diffuse tenderness?
Radiation from epigastrium
to midback?
ABG, CPK, Amylase, WBC
Pancreatitis Lipase
Ectopic pregnancy B-hCG , US
US
DM ? Alterd mental status,
polyuria
ABG, BS, KetonemiaDKA
RLQ LLQ LUQ
Colic
Urinary Symptom
pulmonary Symptom
Hepatobiliary-Nephrolithias
US-LFT
U/A-US
UTI - Nephrolithiasis
PTE, Pneumonia
CT.CXR
Tenderness, Rebound, Migratory Pain,Guarding
Appendicitis
Tuboovarian abscess
Ovarian torsion
Ectopicpregnancy
US, WBC
Cholelithiasis
Cholecystitis
Gallbladderobstruction
Cholangitis
Suspected intraabdominal infection? Sepsis Ceftriaxon+_ Metronidazole
Start antibiotic
CTDiverticulitis
Fever, Diverticular disease
Genitourinary CT,US
Pain Refer to Back & Shulder
Splenic pathology
Gastritis
GERD
Pancreatitis
MI, Pneumonia, Pericatditis
Pleural effusion, Myocarditis
Testicular torsion,
Infections disease ,PTE
US.CT
EKG. CXR.Troponin.US ,D dimer
Urologic Consult
Internist Consult
Design by Alireza Majidi Faculty Member of Emergency Medicine, SBMU
Emergency
Medicine
Approach
Non Specific Abdominal Pain %40
Observe 6 – 8 h