Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

Wilderness and Rescue Medicine 208

Chapter 26 Review: Abdominal Pain

• Abdominal pain can be caused by a wide variety of problems. The mechanism may be trauma, obstruction, infection, or ischemia to infarction. • A specific diagnosis in the field is rarely possible. The generic diagnosis of serious or not serious is sufficient to initiate treatment and evacuation if necessary. • The red flags indicating serious abdominal pain include: localized and constant pain, pain aggravated by movement, persistent fever, persistent tachycardia, and blood or pus in stool or vomit. • For field purposes, we can consider the abdomen to consist of four types of organs: hollow organs, solid organs, the peritoneal lining, and the muscular abdominal wall. • A problem within a hollow organ generally results in cramp like pain as the organ is distended and is stimulated to contract. Problems that remain within the hollow organ are generally not serious. • A problem within the abdominal cavity will irritate the peritoneum, causing localized, constant pain aggravated by movement. Problems that involve the peritoneum should be considered serious. • A problem originating within the gut or another hollow or solid organ may progress to involve the peritoneum. Pain often evolves from generalized and cramp like to localized and constant. • Serious abdominal pain requires emergency evacuation to a hospital. Field treatment includes maintaining hydration, calories, and normal body core temperature. Preferred analgesics include acetaminophen and opioids. NSAIDs should be avoided.