Abdominal Pain in Adults — EMT Side

Host 1: Hey, welcome back. Today is abdominal pain in adults, EMT side. This is the basic life support version, so no IVs, no ALS meds. Just what you do as an EMT, and what the National Registry expects you to do.

Host 2: By EMT Tutor, sponsored by Forrest Munden and EMT Tutor. I train people for the National Registry exam.

Host 1: This is education, not medical direction. Follow your local protocols.

Host 2: And here's the good news for EMTs. You don't have to diagnose the belly. Nobody expects you to tell gallbladder from pancreas in the back of the ambulance. Your job is to recognize a sick patient, treat what you can, and get them to the right hospital.

Host 1: Right. The Registry is testing whether you can spot shock, protect the airway, keep the patient comfortable, and not delay transport.

Host 2: So let's walk the call. Scene size-up first. Scene safety and B S I. With belly pain, you're dealing with vomit, diarrhea, and sometimes blood. Gloves at minimum. Eye protection and a mask if they're vomiting.

Host 1: And look around. Buckets, vomit, medication bottles, alcohol, blood in the toilet. The scene tells you a story.

Host 2: Then the general impression, and this is where your eyes do a lot of work. How is the patient lying?

Host 1: Lying very still, knees pulled up, guarding the belly, scared to move? That's often irritation of the abdominal lining, like peritonitis. Moving hurts.

Host 2: Restless, rolling around, can't get comfortable? That's more like colic, kidney stone being the classic example.

Host 1: Now the visual signs. Skin first. Pale, cool, clammy skin is a shock sign until proven otherwise. Yellow skin or yellow eyes is jaundice, which points to the liver.

Host 2: Look at the abdomen itself. Is it distended, swollen? Any bruising? Bruising around the belly button or on the flanks can mean bleeding inside the abdomen. Those are called Cullen's sign and Grey Turner's sign, and you just report what you see.

Host 1: Look at what's come out. Vomit that looks like coffee grounds is old, partially digested blood. Bright red blood is active bleeding. Black, tarry stool, if the patient tells you about it, is also a sign of bleeding higher up in the G I tract.

Host 2: Then the primary assessment. Airway first. And on these calls, the airway hazard is vomiting. A patient who's vomiting with a decreased level of consciousness can aspirate.

Host 1: So have suction ready. Literally, set it up and turn it on before you need it. If they're vomiting and not fully alert, put them on their side, in the recovery position, so the vomit drains out instead of going down into the lungs.

Host 2: Breathing. Look at the rate and the effort. Give oxygen if they're hypoxic or showing signs of shock, per your protocol.

Host 1: Circulation. Pulse rate and quality, skin, and cap refill. And now you're asking the big question. Is this patient in shock?

Host 2: Early shock signs. Fast heart rate. Anxiety, restlessness. Pale, cool, sweaty skin. Thirst. Delayed cap refill. The blood pressure can still look normal early, so don't wait for it to drop.

Host 1: Late shock signs. Falling blood pressure. Altered mental status. Weak or absent radial pulses.

Host 2: And treating shock as an EMT. Lay them flat. Keep them warm, put a blanket on them, even if the room feels warm. Give oxygen per protocol. Nothing by mouth. Request ALS per your protocol. And rapid transport.

Host 1: Some protocols let you raise the legs a little if there's no trauma. That's a local protocol call. And no Trendelenburg, the old tilt-the-whole-stretcher position.

Host 2: Now, if they're not in shock, position of comfort. Most belly pain patients want to lie on their side or on their back with their knees bent. Let them. That's one of your best pain management tools.

Host 1: Now the history. OPQRST for the pain. Onset, provocation, quality, region and radiation, severity, and time. Then SAMPLE.

Host 2: And for any woman of childbearing age, ask about her last menstrual period and the chance she could be pregnant. Belly pain plus a missed period plus signs of shock, think ectopic pregnancy, and that's a rapid transport.

Host 1: Then the physical exam. Gently palpate all four quadrants, and save the painful one for last. If you press the painful area first, they'll guard everywhere and you won't learn anything.

Host 2: Feel for tenderness, rigidity, and distension. If you feel a pulsating mass, stop. Don't keep pressing on it. That could be an abdominal aortic aneurysm, and that's a load and go patient.

Host 1: Now let's talk about dehydration, because a lot of belly pain patients have been vomiting or having diarrhea for hours or days.

Host 2: Signs of dehydration. Dry mouth and dry mucous membranes. Poor skin turgor. Fast heart rate. Dizziness or lightheadedness, especially when they stand up. Not peeing much. And in older adults, confusion can be the main sign.

Host 1: And dehydration can turn into shock, especially in the very old and the very young. So the same rules apply. Watch the vitals, treat for shock, nothing by mouth.

Host 2: Diarrhea and vomiting also mean infection control. Some bugs, like C. diff, aren't killed well by alcohol hand gel. Soap and water after the call. And clean your stretcher and your ambulance per your agency's policy.

Host 1: Okay, pain management within EMT scope. This is a common test question, and the answer is not a medication.

Host 2: Right. In the National EMS Scope of Practice, EMTs aren't giving pain medication for this. Your pain management tools are position of comfort, a calm voice, reassurance, explaining what you're doing, coaching their breathing, a smooth ride, and getting them to definitive care.

Host 1: If your state or agency adds something to your scope, that's local protocol. For the Registry, think non-medication comfort measures and transport.

Host 2: And rate their pain on a zero to ten scale. Document it, and reassess. A good rule is reassessing vitals every five minutes for an unstable patient and every fifteen for a stable one.

Host 1: One more red flag. Upper belly pain or indigestion in an older patient, a diabetic, or a woman can be a heart attack. If it sounds cardiac, follow your chest pain protocol.

Host 1: Let's do a quick practice scenario, Registry style. You're called to a twenty-eight-year-old woman with sudden lower abdominal pain on her right side. She's pale, sweaty, and anxious. Her heart rate is one-twenty, and her pressure is still normal. She says her period is late. What do you do first?

Host 2: First, don't get distracted by the normal pressure. She's tachycardic, pale, and sweaty. That's early shock. And belly pain with a late period, you think ectopic pregnancy.

Host 1: So, primary assessment, airway and breathing, oxygen per protocol. Lay her flat, keep her warm, nothing by mouth. Request ALS per protocol, and rapid transport. Reassess every five minutes.

Host 2: And notice what's not in that answer. You're not spending ten minutes on scene doing a detailed exam. The Registry wants you moving.

Host 2: Alright, the quick EMT recap. Scene safety and B S I. Read how they're lying. Look for shock, and remember the pressure drops late. Protect the airway, suction ready, recovery position if they're vomiting and not alert. Oxygen per protocol. Treat shock. Lay them flat, keep them warm, nothing by mouth. Position of comfort if they're stable. Ask every woman of childbearing age about pregnancy. Palpate gently, painful area last, and don't push on a pulsating mass. Watch for dehydration. And rapid transport for anybody who looks sick.

Host 1: You don't need a diagnosis to save this patient. You need good BLS.

Host 2: By EMT Tutor, sponsored by Forrest Munden and EMT Tutor. I train people for the National Registry exam.

Host 1: This is education, not medical direction. Follow your local protocols. Take care of each other out there.