Home

Acute Abdominal Pain Pathway - Emergency Management

Within 60 minutes of arrival:

Patient presenting with abdominal pain

Initial Assessment:

  • History
  • Examination of Abdomen
  • EWS
  • Pain Score
  • NBM
  • Consider IV Fluids

If Surgical Crisis Probable

Call Surgery Middle Grade (BLP 903)

Go to Acute Abdominal Pain Pathway - General Surgery

Administer Analgesia - Consider:

  • Allergy
  • Analgesia prior to arrival

Must Do Investigations:

  • FBC
  • U&E's
  • Biochem profile
  • Urine dipstick
  • Serum HCG (In all women of childbearing age - 14-50yrs)

Investigations To Consider:

  • Venous Gas
  • Venous Lactate
  • Amylase
  • Clotting
  • Erect Chest X-Ray (for suspected perforation)
  • Supine Abdominal X-Ray (for suspected obstruction)
  • Contrast CT (for more severely ill acute abdomen patients)

 

Within 3 hours of arrival:

Is patient HCG positive?

Ectopic Pregnancy Symptom?:

  • Not had booking scan confirming uterine pregnancy
  • One-sided abdominal pain
  • Vaginal bleeding
  • Shoulder tip pain
  • Fainting
  • Postural Hypotension

Yes

HR > 100 Systolic BP < 100? - Gynae Registrar to assess in A&E prior to transfer.

No

Stable Obs:

HR < 100
RR < 20
Systolic BP > 100
Pain Score - 0
Temp <38 >36

Observations stable and pain settled with simple analgesia?

Observations Stable : Yes

9am - 6:30pm M-F?

     If Yes

     Refer to EPAU on 3731

     If No

     Contact BLP 706 to arrange scan appt for next EPAU session

Observations Stable : No

Transfer to SAU for urgent US with Gynae 1st on call (BLP 855/706) involvement

 

Is AAA in the differential diagnosis?

OBVIOUS

  • Inform Senior ED doctor
  • Call Surgery Middle Grade (BLP 903)
  • If not attending within 30 mins escalate to Vascular Surgeon on Call

UNCLEAR

Fast scan U/S Abdomen by A&E staff. Confirm AAA?

CT Aorta

Aneurysm Confirmed?

9am till 5pm Mon - Friday: Contact Vascular Services BTH

Outside core hours: Contact Vascular Services RPH

 

Patient Jaundiced?

Refer to Medics if any of the following:

  • Jaundice
  • Past history of Chronic Pancreatitis (or known to
  • Gastro Services)

Has patient got HOPI?

  • Haemorrhage (significant lower GI bleed)
  • Obstruction
  • Perforation/Peritonism (Rebound, Guarding, Rigidity)
  • Ischaemia

Yes

Refer to General Surgery

Go to Acute Abdominal Pain Pathway

 

Is Pancreatitis a differential?

Yes

Patient amylase elevated?

Refer to General Surgery

Go to Acute Abdominal Pain Pathway - General Surgery

Go to Acute Abdominal Pain Pathway

 

Has patient past history of chronic Pancreatitis?

Yes

Refer to Medics if any of the following:

  • Jaundice
  • Past history of Chronic Pancreatitis (or known to
  • Gastro Services)

Acute Urinary Retention a differential?

Bladder Scan

Catheterise

Record residual volume drained (<15 mins)

>1000mls

Refer to General Surgery

Admit to SAU

< 1000mls

Refer to OTP Urology

Consider Dischargeif patient stable, if not admit to SAU.

Is Renal Colic in the differential diagnosis?

Is patient >60 yrs?

Yes

Urgent surgical review if no history of renal stones

U/S Aorta

No - Refer to Urology and go to Renal Colic/Loin Pain Pathway

 

AAA identified?

Yes - Refer to Vascular Services

No - Refer to Urology and go to Renal Colic/Loin Pain Pathway

 

Acute Abdominal Pain - No Diagnosis

If female patient consider referral to Gynae 1st on call (BLP 855/706)

Refer to General Surgery

Go to Acute Abdominal Pain Pathway - General Surgery

Until Patient is diagnosed