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Abdominal Pain


This protocol is ideal for patients with negative CT scans and some remaining clinical suspicion for disease



Transfer Criteria

  • Stable VS
  • Ancillary Signs/Sx - anorexia, N&V, fever, elevated WBC
  • Negative pregnancy test
  • Non-surgical abdomen
  • High likelihood (~70%) of discharge within 15 hours

Exclusion Criteria

  • Unstable VS (HR >110, SBP<100, RR > 22)
  • Immunocompromised patient (T-cells < 200, chemo, transplant)
  • Pregnant pt (any gestation)
  • Bowel obstruction (even partial) or ileus
  • Cholecystitis (sonographic Murphy, pericholecystic fluid, GB wall thickening>4mm, or dilated CBD)
  • Surgical abdomen - free air, rigidity, rebound tenderness
  • Hx of frequent ED visits for abdominal pain – suspected habitual patient / narcotic abuse

Potential Interventions

  • Analgesics
  • NPO, IV hydration, repeat CBC
  • Imaging studies as indicated (i.e. CT abd / pelvis, ultrasound)
  • Serial VS
  • Serial exams Q2-4 hours while awake and as indicated
  • Surgical consultation as needed

Discharge Criteria

Home

    • Pain and / or tenderness resolved or significantly improved
    • VS acceptable
    • No diagnosis requiring hospitalization

Admit

    • Persistent vomiting
    • Pain not resolving or worsening
    • Unstable VS
    • Clinical condition or positive testing that merits hospitalization
    • Consultant preference
    • Surgical abdomen




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