DEALING WITH ABDOMINAL ILLNESS AND INJURIES

General Overview

Generalized abdominal complaints are common and lead to challenging differential diagnoses.  Outdoor leaders must be diligent in the interview and examination of this patient focusing on identifying critical evacuation triggers.  Many serious abdominal problems ultimately result in surgery.

Treatment for Abdominal Illness and Injury

If the patient does not trigger the evacuation criteria:

Allow the patient to rest.

Maintain hydration levels with clear fluids.  Rehydrate with an electrolyte solution if the patient is dehydrated.
Bland diet.  The BRAT diet works well: Bananas, rice, applesauce and toast.
Consider antidiarrheals (e.g. Imodium AD ® or Lomotil ®) and/or anti-emetics (e.g. Compazine ® or Phenergan ®) as necessary to maintain hydration levels.

Consider prophylactic anti-motion sickness medication (e.g. meclizine, Dramamine ®) to avoid nausea and vomiting.

If the patient is constipated you must aggressively hydrate and avoid high fat foods and increase grains, vegetables and fruit, attempt to stimulate bowel movements with caffeine or alternating hot and cold liquids and consider a laxative (e.g. ExLax ®).  If treatment is unsuccessful consider manual removal of the hardened stools.
Monitor the patient for worsening signs and symptoms.  If the patient does not show improvement in 12 -24 hours consider evacuation.

If evacuation is possible within a few hours, give nothing by mouth.

Evacuation Guidelines for Abdominal Injury or Illness

Evacuate Rapidly:
Any patient with abdominal pain who also has:

1. Signs and symptoms of shock.
2. Blood in the vomit, feces or urine.
3. Pain persisting greater than 12-24 hours, especially constant pain.
4. Localized pain especially with guarding, tenderness, distension, rebound, movement or vibration, or rigidity.
5. Persistent anorexia, vomiting or diarrhea greater than 24-72 hours.
6. Fever above 102 °F (39 °C).
7. Signs and symptoms of pregnancy (history of sexual activity, amenorrhea, excessive fatigue, breast tenderness, polyuria and nausea).

Evacuate:

• Any patient with abdominal pain that does not improve with treatment in 12-24 hours.
• Any patient with abdominal pain who is unable to stay hydrated.

References:

Emergency Medical Technician-Basic: National Standard Curriculum Module 4 Medical/Behavioral Emergencies and Obstetrics/Gynecology.  22 June 1995.  National Highway Traffic Safety Administration United States Department of Transportation.  2 Dec 2004. <www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pd>

“Gastrointestinal.” United States Special Operations Command.  Special Operations Forces Medical Handbook.  Jackson, Wyoming: Teton NewMedia, 2001. 4-70.

Schimelpfenig, Tod and Linda Lindsey.  “Abdominal Injuries.” Wilderness First Aid 3rd ed.  Mechanicsburg, Pennsylvania: Stackpole Books, 2000.  Chapter 8.

Specific Protocols for Wilderness EMS Abdominal Pain.  Version 1.2 May 19, 1994.  The Wilderness Emergency Medical Services Institute.  2 Dec. 2004.  <http://www.wemsi.org/specific.html>;

The Merck Manual 16th Edition.  Rathaway, New Jersey: Merck & Co., Inc., 1992.

Tilton, Buck.  “Abdominal Injuries.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 11.

Tilton, Buck.  “Abdominal Illnesses.” Wilderness First Responder 2nd ed.  Guilford, Connecticut: The Globe Pequot Press, 2004.  Chapter 29.

Wilkerson, James A.  “Acute Abdominal Pain.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 13.

Wilkerson, James A.  “Abdominal Injuries.” Medicine for Mountaineering 5th ed.  Seattle, Washington: The Mountaineers Books, 2001. Chapter 14.