Abdominal pain emergencies: how US rescuers intervene
Abdominal pain is the second most common emergency call that EMS providers respond to. Because the abdomen includes a wide range of organs and vessels belonging to the digestive, urinary, and muscular systems, it can be challenging to diagnose the cause of an abdominal pain, especially in a pre-hospital setting
For this reason, EMTs and paramedics require a solid understanding of abdominal pain and its causes.
Your ability to gather a thorough history and perform a detailed medical assessment is critical for effectively treating any abdominal pain emergency.
About the Abdomen
The abdomen (commonly called the stomach or belly) is the large body cavity between the thorax (chest) and the pelvis.
It is surrounded by abdominal muscles in the front and to the sides, and by the vertebral column at the back.
The lower ribs also enclose the ventral and lateral walls.
The abdominal cavity contains most of the digestive system and is where most of our food absorption and digestion occurs.
The digestive system includes the stomach, small intestine, and the colon with its attached appendix.
Other digestive organs, known as the accessory digestive organs, include the liver, gallbladder, and the pancreas.
Our abdominal cavities also protect our spleen and parts of our urinary system including our kidneys, adrenal glands, and many blood vessels, including the aorta and inferior vena cava.
The urinary bladder, uterus, fallopian tubes, and ovaries are also considered abdominal organs.
Finally, the abdomen contains an extensive membrane called the peritoneum.
What is Abdominal Pain?
Abdominal pain is pain felt anywhere between the chest and groin.
Almost everyone experiences some pain in their abdomens at some point in their lives.
Most of the time, it’s not serious.
Furthermore, the severity of abdominal pain does not always reflect the seriousness of the condition.
For example, gas or stomach cramps due to gastroenteritis can be extremely painful.
Meanwhile, fatal conditions, such as colon cancer or early appendicitis, may only cause mild pain.
Types of Abdominal Pain
Generalized abdominal pain: This is pain felt in more than half of the abdomen area. This pain is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be a blockage of the intestines.
Localized abdominal pain: This is when pain is felt in only one area of the abdomen. Localized abdominal pain is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.
Cramp-like abdominal pain: This type of pain is not serious most of the time. It is likely due to gas and bloating, and is often followed by diarrhea. More worrisome signs include pain that occurs more frequently, lasts more than 24 hours, or occurs with a fever.
Colicky pain: This type of pain comes in waves. It usually starts and ends suddenly, and is often severe. Kidney stones and gallstones are common causes of this type of abdomen pain.
Abdominal Pain Symptoms
Abdominal pain can be associated with a variety of symptoms, including nausea, vomiting, fever, diarrhea, dark stools (melana), and urinary symptoms.
To effectively diagnose these symptoms, medical first responders will typically require a clear understanding of their patients’ medical histories, as well as their previous experiences of stomach pain or injury.
They must also consider the location of the abdominal pain, its onset (sudden or gradual), intensity, quality (dull, sharp, or cramping), progression, and character (intermittent or constant).
You should also check if there are any factors that could lessen or worsen the pain, based on previous episodes of similar pain.
Finally, current medications and social history can be extremely helpful when responding to an abdominal pain emergency.
When to Call Emergency Number for Abdominal Pain
If you or someone you know is experiencing abdominal pain, you should seek immediate medical help if the pain is accompanied by other worrisome signs and symptoms, including:
- Bloody stools
- Difficulty breathing
- Persistent nausea and vomiting
- Severe tenderness when you touch your abdomen
- Skin that appears yellow
- Swelling of the abdomen
- Weight loss
Causes of Abdominal Pain
Many different conditions can cause abdominal pain.
The key is knowing when immediate medical attention is required, based on your symptoms.
In most cases, medical attention is only required if these symptoms persist.
Less serious causes of abdominal pain include:
- Irritable bowel syndrome
- Food allergies or intolerance (such as lactose intolerance)
- Food poisoning
- Stomach flu
Other possible causes include:
- Abdominal aortic aneurysm (bulging and weakening of the major artery in the body)
- Bowel blockage or obstruction
- Cancer of the stomach, colon (large bowel), and other organs
- Cholecystitis (inflammation of the gallbladder) with or without gallstones
- Decreased blood supply to the intestines (ischemic bowel)
- Diverticulitis (inflammation and infection of the colon)
- Heartburn, indigestion, or gastroesophageal reflux (GERD)
- Inflammatory bowel disease (Crohn disease or ulcerative colitis)
- Kidney stones
- Pancreatitis (swelling or infection of the pancreas)
How to Treat Abdominal Pain
There are some steps you can take to ease mild abdominal pain at home.
These include the following remedies:
- Sip water or other clear fluids.
- Avoid solid food for the first few hours.
- If you have been vomiting, wait 6 hours, and then eat small amounts of mild foods such as rice, applesauce, or crackers. Avoid dairy products.
- If the pain is high up in your abdomen and occurs after meals, antacids may help, especially if you feel heartburn or indigestion. Avoid citrus, high-fat foods, fried or greasy foods, tomato products, caffeine, alcohol, and carbonated beverages.
People with diabetes should check their blood sugar and adjust their medication as needed.
Do not take any medicine without talking to your healthcare provider.
How to Prevent Abdominal Pain
The following steps may help prevent some types of abdominal pain:
- Drink plenty of water each day
- Eat smaller meals, but more frequently
- Exercise regularly
- Limit foods that produce gas
- Make sure your meals are well-balanced and high in fiber
- Eat plenty of fruits and vegetables
USA, How Do EMTs & Paramedics Treat Abdominal Pain
In the event of abdominal pain emergency, an EMT or paramedic will likely be the first healthcare provider to assess and treat your condition.
EMTs have a clear set of protocols and procedures for most of the emergency number emergencies they encounter, and abdominal pains and injuries are no different.
For all clinical emergencies related to abdominal injuries, the first step is a rapid and systematic assessment of the patient.
For this assessment, most EMS providers will use the ABCDE approach.
ABCDE stands for Airway, Breathing, Circulation, Disability, and Exposure.
The ABCDE approach is applicable in all clinical emergencies for immediate assessment and treatment.
It can be used in the street with or without any equipment.
It can also be used in a more advanced form where emergency medical services are available, including emergency rooms, hospitals or intensive care units.
Treatment Guidelines & Resources for Medical First Responders
Treatment guidelines for abdominal pain can be found on page 46 of the National Model EMS Clinical Guidelines by the National Association of State EMT Officials (NASEMSO).
These guidelines are maintained by NASEMSO to facilitate the creation of state and local EMS system clinical guidelines, protocols, and operating procedures.
These guidelines are either evidence-based or consensus-based and have been formatted for use by EMS professionals.
The guidelines include a rapid assessment of the patient for life-threatening causes of abdominal pain, which may include:
- Ischemic, necrotic, or perforated bowel
- Dissecting or ruptured abdominal aortic aneurysm (AAA)
- Ruptured ectopic pregnancy
- Acute Cholecystitis
- Other causes, including kidney stone
Pre-hospital treatments and interventions might include:
- Providing analgesia
- Administering antiemetics
- Provide transport to an appropriate medical facility
- Reassess vital signs and response to therapeutic interventions throughout transport
EMS providers should reference the CDC Field Triage Guidelines for decisions regarding transport destination for injured patients.