General Approach to All Patients

Abdominal Pain/GI Bleeding

Basic Life Support

  • Nothing by mouth

Advanced Life Support

  • If pain above the umbilicus perform cardiac monitoring and 12 lead ECG
  • IV 0.9% NaCl KVO or IV lock
    • If evidence of dehydration (tachycardia, dry mucous membranes, poor skin turgor) administer boluses of 0.9% NaCl at 250 ml (hold at 500 ml total if no hypotension)
  • For patients with severe nausea or vomiting
    • Ondansetron (Zofran), 4 mg slow IV or 4 mg Oral Disintegrating Tablet (ODT) by mouth

Kidney Stone Highly Suspected

  • Limit treatment to patients meeting the following criteria:
    • Age ≤ 55 years
    • Not known to be currently pregnant
    • Prior history of kidney stone
    • Pain consistent with prior kidney stone episodes
    • Pain isolated to the flank with or without radiation to the groin
    • No history of fever (> 100.4 F)
    • Systolic blood pressure ≥ 120
    • No abdominal mass or significant tenderness
  • For patients with severe pain meeting the Kidney Stone criteria above:
    • Fentanyl (Sublimaze) 1 mcg/kg (maximum 50 mcg) slow IV; repeat once after 5 minutes as needed (maximum 100 mcg total dose) OR 100 mcg intranasal via MAD (divide dose equally between nostrils)