Abdominal pain is one of the most common reasons people call EMS or come to the emergency department, with causes from mild gastritis to life-threatening bleeding. The first job is to find patients in shock or with a surgical or vascular emergency and move them quickly.
Key symptoms
- Location, onset, character and spread of the pain (OPQRST)
- Nausea, vomiting, diarrhea or blood in vomit or stool
- Fever, painful urination or flank pain
- Missed period or vaginal bleeding in people who can be pregnant
- Chest pain, shortness of breath or fainting
What you find on exam
- Vital signs and signs of shock: pale, sweaty skin, fast pulse, low blood pressure
- Inspect, listen and palpate all four quadrants; start away from the pain
- Guarding, rigidity or rebound tenderness (peritonitis)
- Pulsating mass or back pain in older patients (aortic aneurysm)
- Hernia sites, and testes in males
Tests
- Blood glucose and 12-lead ECG for upper abdominal pain
- Pregnancy test in people who can be pregnant
- Blood count, electrolytes, liver tests, lipase and urinalysis
- Ultrasound or CT based on the suspected cause
Treatment basics
- Position of comfort, oxygen only if saturation is low, nothing by mouth
- IV access and fluids for shock; permissive hypotension in suspected bleeding
- Ondansetron for nausea and fentanyl or morphine for pain
- Rapid transport to a surgical center for shock, aneurysm or ectopic pregnancy
- Treat the cause: surgery, antibiotics or endoscopy
Red flags
- Low blood pressure, fainting or fast heart rate
- Rigid abdomen, vomiting blood or black stool
- Sudden severe pain in an older adult or in early pregnancy
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.