Abdominal Pain

Management

Unstable Patient

Establish Airway

Establish Breathing

Cardiac monitor, oxygen (2 to 4 L/min via nasal cannula or mask),

Establish Circulation

Large-bore IV access, and an isotonic fluid bolus adjusted for age, weight, and cardiovascular status.

The best isotonic fluid for resuscitation depends on the clinical scenario.:

1. 0.9% Normal Saline (NS)

Pros:
- Widely available and inexpensive
- Preferred in cases of hypovolemia, shock, trauma, and metabolic alkalosis
Cons:
- High chloride content can cause hyperchloremic metabolic acidosis
- May worsen acute kidney injury in large volumes

2. Lactated Ringer’s (LR) / Hartmann’s Solution

Pros:
- More balanced (lower chloride, includes lactate as a buffer)
- Closer to plasma composition
- Good for surgical, trauma, burn, and sepsis patients
Cons:
- Contains potassium and lactate (use cautiously in liver failure or hyperkalemia)
- Not compatible with some medications and blood products

3. Plasma-Lyte

Pros:
- Most physiologic (contains acetate and gluconate buffers)
- Least likely to cause acidosis or electrolyte imbalance
Cons:
- More expensive
- Less widely available

Bottom Line

For most adults in shock or volume depletion: Start with Lactated Ringer’s or Normal Saline depending on the clinical context.
If concerned about acid-base balance or kidney injury: Prefer Plasma-Lyte or LR over NS.
Always consider the patient’s comorbidities, such as renal function, electrolyte status, and liver function.

For critically ill patients, blood samples should be drawn at the time of IV insertion, including, at a minimum, electrolytes, BUN and creatinine, CBC with platelets, clotting studies, and a type and antigen screen of blood. Order cross-matched blood if hemorrhage is suspected or if urgent transfusion is anticipated.

A bedside US should be performed rapidly in an attempt to expedite identification of emergent causes of abdominal pain in the patient with hemodynamic collapse. The presence of an abdominal aortic aneurysm and intra-abdominal hemorrhage can be quickly discovered.2 Bedside US can also be used to help assess hemodynamic status by focused evaluation of heart function and inferior vena cava size and respiratory response. \

Bring the patient to an operating room

Prep the patient's abdomen for possible immediate laparotomy.

If available an operating room capable doing CT, Angiography, and Ultrasound.