EM Basic ABD Pain

Question 1

ABD pain what to ask them?

Answer 1

N/V/D
Chest pain/back pain
Urinary symptoms
F - vaginal bleeding?
PO intake —> appetite or not 
GERD? Surgical history?

Question 2

What is psoas sign?

Tests for what?

Answer 2

Pt LEFT lateral recumbent, take RIGHT leg and extend it all the way back
Or if they are supine, can have them lift up against your knee
+ Test = Pain in LLQ

Appendicitis

Question 3

What is the Obturator sign?

Answer 3

Flex and IR right leg

Question 4

What should you make to ask/check for?

Answer 4

Testicular torsion

Question 5

What are the main DDx?

Answer 5

Appendicitis
Cholecystitis 
Pancreatitis
Diverticulitis
Bowel Obstruction/Perforation
Mesenteric ischemia
Kidney Stones
Gastroenteritis 
AAA

Question 6

What to order for ABD pain?

Answer 6

CBC - anemia, wbc (r/o appendicitis)
Chem10 - hypoK+ —> ileus, Cr for CT w/Contrast
Coags +/-
Lipase - pancreatitis
VBG w/lactate - screen for mesenteric ischemia

Question 7

What is the some meds you give for ABD pain?

Answer 7

Morphine 4mg PRN pain q15min x 3 total
If rash —> 12.5 mg IV Benadryl
Zofran 8 mg

Question 8

Gastroenteritis needs what?

Answer 8

Vomiting and Diarrhea

Question 9

Female ABD pain ddx?

Answer 9

Ectopic 
Threaten abortion/miscarriage
Normal pregnancy 
STI
PID
Ovarian torsion 
Tubo-ovarian abscess
Ovarian cyst
BV / candida

Question 10

When do you see heartbeat in pregnancy? (B-hCG level)?

Answer 10

5,000