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Abdominal pain algorithm
This document provides a guide for evaluating and treating patients presenting with acute abdominal pain. It outlines a systematic approach including: 1. Performing a thorough history and physical exam, assessing ABCDEs and looking for signs of MI, DKA, or instability. 2. Ordering initial tests like EKG, ABG, US, DRE, glucometry, and guaiac to help localize or characterize the pain. 3. Considering various differential diagnoses depending on localized or diffuse pain patterns, examination findings, and initial test results. These include conditions like ruptured ectopic pregnancy, mesenteric ischemia, or pancreatitis. 4. Consulting specialists as needed and considering imaging tests or surgical consultation to establish
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Abdominal pain algorithm
- 1. Urin Acute abdominal Pain ConsiderMonitoring 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