Situations where patient complains of moderate to severe abdominal discomfort from either medical or traumatic causes. The time spent at the scene should be minimized to ensure rapid evalution at the Emergency Department. Special consideration should be given to ectopic pregnancy in women of childbearing age, trauma, prior history of abd pain, and the elderly with history of cardiac disease. Signs and symptoms like rigid abdomen, rebound tenderness and absent bowel sounds indicate an acute abdomen in need of possible surgical evaluation/intervention. The causes of abdominal pain are many and varied and may ultimately have nothing to do with the abdomen (e.g., heart attack, pneumonia, etc.).  Patients who complain of sudden onset of abdominal pain, especially if it is described as tearing or radiating, should be transported without delay.

EMPHASIS ON PATIENT CARE

Airway management, adequate perfusion, and transport.  In general, the patient should receive nothing by mouth.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT

1. Initial Management -Assess airway, breathing and circulation and manage as indicated.

2. Initiate transport to appropriate medical facility.

3. Focused H&P -History, physical exam, vital signs:

• Ask the patient to describe the pain:
• What was the patient doing when the pain started?
• What makes it better or worse?
• What does it feel like?
• Where is the pain? 
• Does it go anywhere?
• How bad is it?
• Has the patient ever had this pain before?
• When did the patient last eat? 
• What was it?
• When was the last bowel movement? 
• Was there any blood or black material in it?
• Has the patient vomited?
• Was there blood or coffee ground material present?
• What other symptoms has the patient noted (fever, chest pain, nausea, trouble breathing)?
• Is there any history of trauma?
• If the patient is female:
  • Determine when the last menstrual period was.
  • Have menstrual periods been regular?
  • Has there been any vaginal bleeding?
  • Is there any other relevant past medical history?
  • Has the patient had any surgeries on the abdomen?
  • What medications has the patient been or is supposed to be taking?  Compliant?

4. Consider possible causes:

• Gastrointestinal disorders
• Blunt or penetrating trauma
• DKA
• Pancreatitis
• Ruptured aneurysms or aortic dissection
• Renal stones
• Pain associated with ACS
• Sexually transmitted disease

Note: Any female of childbearing age who presents with abdominal pain and signs &
symptoms of shock, is considered to have suffered ruptured ectopic pregnancy until proven otherwise

INTERMEDIATE LIFE SUPPORT

If vitals are abnormal or unstable, or the history suggests evidence of internal hemorrhage, initiate IV access of an isotonic solution for volume replacement. Titrate infusion rates to support patient vitals and condition. Multiple IV's may be indicated.

1. Request ALS Intercept if Shock is present, or suspected.

ADVANCED LIFE SUPPORT

1. Consider ECG monitoring if history or presentation suggests cardiac complications, involvement or if signs are abnormal.
2. Morphine or other analgesics will not be administered in the prehospital setting under this protocol. (Exception: For suspected kidney stones, refer to PAIN MANAGEMENT protocol).