Sandbox/algo
< Sandbox
ACS: Acute coronary syndrome; AAA: Abdominal aortic aneurysm; RUQ: Right upper quadrant; RLQ: Right lower quadrant; LUQ: Left upper quadrant; LLQ: Left lower quadrant
Signs of peritonitis or shock ❑ Fever ❑ Abdominal tenderness ❑ Abdominal gaurding ❑ Rebound tenderness (blumberg sign) ❑ Diffuse abdominal rigidity ❑ Confusion ❑ Weakness ❑ Low blood pressure ❑ Decreased urine output ❑ Tachycardia | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs and symptoms suggestive of acute coronary syndrome ❑ Risk factors: >40 years, smoking, diabetes mellitus, hypertension, obesity and high cholesterol ❑ Chest tightness radiating to the left arm and the left angel of the jaw ❑ Diaphoresis ❑ Shortness of breath ❑ Sense of impending death ❑ Nausea and vomiting For more details about management of ACS, click here Signs and symptoms suggestive of abdominal aortic aneurysm ❑ Risk factors: smoking, alcohol, hypertension, high familial prevelance (genetic influences) ❑ Pulsating sensation of the abdomen ❑ Palpable abdominal mass ❑ If ruptured: hypovolemic shock, hypotension, tachycardia, cyanosis, and altered mental status | ❑ Initiate resuscitation ❑ Obtain immediate surgical consultation ❑ Perform bedside ultrasound (evaluate aorta, hemoperitoneum, pericardium and inferior vena cava) ❑ Obtain indicated tests and studies (e.g. x-ray, ECG, lactate, lipase and LFTs) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Surgical consultation ❑ Bedside ultrasound ❑ Abdominal CT For more details about management of AAA, click here | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs and symptoms syggestive of mesenteric ischemia ❑ Abdominal pain out of proportion to examination ❑ Bloody stools ❑ Shock ❑ Metabolic acidosis with dehydration | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Surgical consultation ❑ Abdominal CT For more details about management of mesenteric ischemia, click here | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Signs and symptoms suggestive of bowel obstruction or Intestinal perforation ❑ Diffuse tenderness with distention ❑ Persistent vomiting ❑ Rigidity with absent bowel sounds ❑ Fecal vomiting ❑ Dehydration and electrolyte abnormalities | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abdominal x-ray series ❑ Presence of free air: Consult surgery ❑ Presence of obstruction: Order abdominal CT ❑ Absent free air and absent obstruction: Order abdominal CT | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Where is pain localized | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| RUQ pain | RLQ pain | LUQ pain | Epigastric pain | Hypogastric pain | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Approach to a female of child-bearing age
Signs of peritonitis or shock ❑ Fever ❑ Abdominal tenderness ❑ Abdominal gaurding ❑ Rebound tenderness (blumberg sign) ❑ Diffuse abdominal rigidity ❑ Confusion ❑ Weakness ❑ Low blood pressure ❑ Decreased urine output ❑ Tachycardia | |||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
| Pregnant: Perform a pregnancy test | ❑ Initiate resuscitation ❑ Obtain immediate surgical consultation ❑ Perform bedside ultrasound (evaluate aorta, hemoperitoneum, pericardium and inferior vena cava) ❑ Obtain indicated tests and studies (e.g. x-ray, ECG, lactate, lipase and LFTs) | ||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
| Unilateral adnexal tenderness | Yes | ❑ Perform ultrasound examination (consider ectopic pregnancy, appendicitis) ❑ Perform sterile pelvic examination (not in third trimester vaginal bleeding) ❑ Obtain quantitative HCG and other needed lab tests ❑ Obtain OB/Gyn and surgery consultation if indicated | |||||||||||||||||||||||||||||||||||||||||||
| No | Rule out ovarian torsion or ovarian cyst by ultrasonography. Signs and symptoms suggestive of ovarian torsion or cyst: ❑ Unilateral lower abdominal pain ❑ Nausea and vomiting ❑ Uterine bleeding ❑ Irregular periods ❑ Constitutional symptoms as fatigue or headaches | Intrauterine pregnancy | Ectopic pregnancy: ❑ Risk factors: PID, infertility, usage of intrauterine device, tubal surgery, intrauterine surgery (eg, dilation and curettage) ❑ Vaginal bleeding ❑ Nausea, vomiting and diarrhea ❑ Abdominal distension ❑ Hemorrhagic shock | ||||||||||||||||||||||||||||||||||||||||||
Clinical pelvic inflammatory disease: ❑ Fever ❑ Cervical motion tenderness ❑ Lower abdominal pain ❑ Vaginal discharge ❑ Painful intercourse ❑ Irregular mesntrual bleeding | ❑ Assess appendix with US ❑ Obtain OB/Gyn and surgery consultation as indicated | Obtain OB/Gyn consultation | |||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
| Predominant RLQ pain | Toxic appearing or persistent vomiting | ||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||
| Adminster antibiotics as an outpatient | Admit, start IV antibiotics and consult gynaecology | ||||||||||||||||||||||||||||||||||||||||||||