1. Essential EMS Training Program – Block 2 Lesson 9
ABDOMINAL PAIN
Essential EMS Training Program – Block 2 Lesson 9

2. Special Note:
Abdominal Trauma is covered in Chapter 26 of the MTI Textbook.
The following content is additional material requested by the Ministry of Health to give EMT’s a deeper understanding of Medical causes of Abdominal pain
Abdominal Pain is a common complaint that will be evaluated by EMT’s
Special Thanks to Stanford Emergency Medicine International, Stanford University School of Medicine 2014 for assistance in producing some of these slides

3. QUESTION?
You are transporting a 25-year-old female with lower abdominal pain. What is your main concern as an EMT?
1) Diagnosing the exact cause of pain
2) Providing anti-nausea medication 
3) Providing oral pain medication
4) Assessing for high risk features and treating unstable vitals

4. ANSWER!
You are transporting a 25-year-old female with lower abdominal pain. What is your main concern as an EMT?
1) Diagnosing the exact cause of pain
2) Providing anti-nausea medication 
3) Providing oral pain medication
4) Assessing for high risk features and treating unstable vitals

5. Abdominal Trauma A leading cause of preventable trauma death
Often goes unrecognized
Internal injury difficult to assess in the field
Massive blood loss can lead to shock and death
Transport to a surgery capable hospital is recommended

6. What is Abdominal Pain
Any pain in the area below the ribs (diaphragm) and above the Pelvis
Can be caused by Infection, Trauma, Indigestion, Nausea & Vomiting, cancers, and many other causes
May be accompanied by other signs and symptom such as swelling, tenderness, pain on palpation, bruising, rigidity, etc.

7. Anatomy and Physiology
Abdomen is the largest body Cavity in the body
Abdomen is separated from Chest Cavity by the diaphragm
Most of the Organs are enclosed in a membrane called the peritoneum
The Organs behind & outside the Peritoneum are the kidneys, pancreas, and Abdominal Aorta

8. Abdomen is divided into four Quadrants.

9. Types of Abdominal Pain
Superficial
Dermatomal
Referred
Radiated
Deep
Rebound
Sharp or Dull
Somatic
Visceral
But most patients will just tell you it hurts “badly”
Photo: Stanford University School of Medicine

10. Three main Types of Abdominal Pain
1) Visceral
2) Somatic
3) Referred

11. Visceral Pain Caused by stimulation of nerve fibers of Organs
Often described by patient as Crampy, Comes and Goes, (Colic) or Gassy
Tends to be all over and difficult to pinpoint
Commonly seen with other signs and symptoms
Nausea
Vomiting
Fast heart Rate

12. Somatic Abdominal Pain
A focal pain that occurs when a nerve is stimulated
Arises from the abdominal wall
Usually described by the patient as well localized, bright or sharp
Photo: Medguidence.com

13. Referred Abdominal Pain
A radiating pain felt away from the point of Origin
Pain from a kidney stone may be referred to pelvic or groin area
Heart Attack, Pneumonia, and Fractured bones can cause referred pain to the abdominal area

14. Causes of Abdominal Pain
Many Causes but Common causes may be:
Inflammation or stretching of an Organ
Blockage of a Duct
Swelling of a body Structure
Loss of Blood Supply to an Organ

15. Common Ailments Abdominal Aortic Aneurysm (AAA) Appendicitis
Bowel Obstruction
Cholecystitis
Cystitis
Diverticulitis
Ectopic Pregnancy
Esophagitis
Intestinal Parasites
Kidney stones
Stomach Ulcers
Urinary Tract Infections
Other infections

16. Assessment & Treatment
All patient assessments start with the Primary Survey
Airway
Breathing
Circulation
Is the patient in shock?
Level of consciousness
Skin
Pulse
Capillary Refill

17. Initial Assessment After ABC’s
Assess Vital Signs including Mental status, Skin signs, and pulse Ox
Consider Patients Chief Complaint and Nature of Illness
This should be enough information to begin immediate care
Begin Rapid Exam

18. QUESTION?
You are performing your exam, which finding is most concerning that your patient may have a life threatening cause of abdominal pain?
1) Pain is in the right upper quadrant
2) Pain is moderate
3) Patient feels nauseated
4) The patient is lightheaded and pale

19. ANSWER!
You are performing your exam, which finding is most concerning that your patient may have a life threatening cause of abdominal pain?
1) Pain is in the right upper quadrant
2) Pain is moderate
3) Patient feels nauseated
4) The patient is lightheaded and pale

20. Goal of Our Assessment
Many Causes but we DO NOT need to know exactly which one
Your goal is to decide if a patient is SICK or Not SICK
You should begin to provide supportive care
You DO NOT have to diagnose the cause

21. Assessment Goal You should try to determine three (3) things
1) Quality of Pain
2) Location of Pain
3) Any abnormalities
Swelling
Distension
Lumps
Photo: Stanford University School of Medicine

22. Physical Exam ABC’s First (and repeat often)
Always immediately address Life Threats
Assess Patients attitude & posture
Check skin
Assess quality and location of Pain
Look for Guarding, fetal position
Look for Abnormalities, swelling, lumps

23. Important Exam Note
Always be alert to signs of Hypotension or shock. Shock can be caused by Blood loss or Infection.
Restlessness is the first sign of shock
Rapid Pulse
Slow Capillary Refill time (CRT > 2 sec)
Fast Breathing
Decreasing or low Blood Pressure

24. Patient Examination Ask Patient location of Pain Place Patient Supine
Check Quadrants not
affected first
Palpate Painful
area last
Be gentle,
Note Guarding
Photo: Stanford University School of Medicine

25. Identifying High Risk Patients
Ridged Abdomen
Distention/swelling
Vomiting
Abdominal Pain with symptoms of:
Dizziness/Giddiness
Pallor
Sweating (diaphoresis)
Confusion

26. Identifying High Risk Patients
Vital signs
HR>90
SBP<90 OR
Suggests severe cause

27. Non Life Threatening Causes of Abdominal pain
Many Causes of Abdominal Pain are not life threatening.
Some Non Life threatening causes are:
Menstrual Cramps
Indigestion
Gastritis
Hepatitis “A”
Cholecystitis
Kidney Infections (Mild)
PID

28. QUESTION?
You are taking a history from your 25-year-old female patient. What information is essential to obtain?
1) Recent dietary changes
2) Any recent travel
3) Pain medications tried at home
4) Dates of last menstrual period

29. ANSWER!
You are taking a history from your 25-year-old female patient. What information is essential to obtain?
1) Recent dietary changes
2) Any recent travel
3) Pain medications tried at home
4) Dates of last menstrual period

30. Additional High Risk Patients
Pregnancy
Assess for trauma
if pregnant
Consider Other
Complications
(In OB lectures)
Obtain History
news.thousanddays.org/maternal-child-health/future-nutrition

31. Additional High Risk Signs
Blood in Vomitus
Blood in Stool (can be dark & tarry or bright red)

32. QUESTION?
You are transporting a 25-year-old female with abdominal pain. She has a blood pressure of 85/60 and a HR of 120, what are the next actions you should take?
1) Place an IV and bolus IV fluid
2) Sit upright
3) Repeat abdominal exam
4) Provide pain control medications

33. QUESTION?
You are transporting a 25-year-old female with abdominal pain. She has a blood pressure of 85/60 and a HR of 120, what are the next actions you should take?
1) Place an IV and bolus IV fluid
2) Sit upright
3) Repeat abdominal exam
4) Provide pain control medications

34. Pain Control
Note: Most Abdominal Pain can be transported to Hospital without Pain Control Medications Opiate abuse of prescribed medication for other pain can cause abdominal pain by paralyzing the normal intestinal peristalsis

35. Additional Treatment Treatment of high risk patients
Place large bore IV
Bolus 500cc NS
Reassessment (often)
Recheck vitals
If SBP < 90 or HR>100 repeat fluid bolus

36. Summary for Abdominal Pain
There are many causes of abdominal pain
The job of the EMT is to:
Be Professional, treat with Compassion
Gather basic history
Assess for serious signs and symptoms
Recognize unstable vitals
Treat Life threats immediately
Transport to hospital

37. Title - 36
Detail - 24