Lower Abdo Pain Scenario

You quickly get to work and complete your basic observations. 123 HR, 26 RR, 86/53 BP, 98% Sp02, 36.2 Temp, 5.1 BM. 

What is this patients NEWS score? 

While completing these observations, you gain a little more history. The patient has a past medical history of hypertension, myocardial infarction (6 years ago), and high cholesterol. The patient has a high BMI and is a smoker. The patient explains he is aware he has a generally poor lifestyle.  

As the pain started it was difficult to pinpoint to an area and got more intense. As this happened the sweating, nausea and vomiting developed. 

When describing abdominal pain, how would you categorise this pain? 

Visceral abdominal pain is the pain you feel from your internal organs, such as your stomach, bladder, uterus, or rectum. It can be caused by infections, injuries, diseases, or growths that affect the organs. Parietal abdominal pain is a different type which is often sharper and more easily pinpointed. What is the pathophysiology behind parietal pain?

You are immediately concerned and try to do an abdominal assessment. What completes an abdominal assessment?

You note the abdomen is distended. The pain today is now more generalised. There are no bowel sounds. The lower quadrants are rigid and ‘board-like’ accompanied with generalised tenderness and guarding. It is quite difficult to do the assessment accurately due to the severe pain. You repeat a set of observations, and they are: 128 HR, 28 RR, 78/51 BP, 98% Sp02, 36.0 Temp.

What is your primary differential? 

You are concerned that the patient has an intra-abdominal bleed, can you use TXA in this scenario?

The HALT-IT trial in 2020 looked at the effectiveness of TXA in the acute management of GI bleeds. What were their recommendations after this study?

If the diagnosis of intra-abdominal bleeding was correct, what would you expect to hear on your percussion assessment of the abdomen?

You recognise this patient needs hospital treatment quickly and don’t waste time. What other treatment are you going to provide (providing it does not delay you on scene)?

Would this patient potentially benefit from an enhanced medical team if a resource was nearby?

What pain relief would be most appropriate for this patient?

What initial dose of IV fluids is indicated for this patient?

What systolic blood pressure should we aim for in the management of this patient?

As this patient is non-traumatic, the principles of ‘the lethal (or death) triangle’ do not apply to this scenario?

Does the absence of melaena in a patient excludes the differential of suspected intra-abdominal bleeding?