Abdominal Pain Red Flags
Objective: Screen abdominal pain for life threats you can actually change: shock, AAA, ectopic, GI bleed, and a hard surgical abdomen.
Why This Is Hard
Everyone with a bellyache wants to stay home. Some of them have a rupturing AAA or an ectopic. ACEP and NASEMSO: prehospital abdominal pain is a risk screen plus supportive care, not a diagnosis.
- Ask pregnancy in every person who can be pregnant. Ectopic does not care that they “cannot be.”
- Two-arm pulses if tearing back/flank pain in an older patient.
- GI blood, black stool, syncope — that is the GI bleed lesson.
Field Rules (Education)
- AAA theme: older, tearing back/flank, shock out of proportion, unequal femorals. Fluids per DCR if they are bleeding out — destination to surgery.
- Ectopic: pelvic/abdominal pain, syncope, shoulder pain, known pregnancy or missed period. Shock can be the first sign.
- Perforation / peritonitis: board-like, fever, still — surgical abdomen, not an antacid.
- Analgesia per protocol does not hide a surgical belly from the receiving team if you document the exam before and after.
Field Pitfalls
- “Just gastritis” in a hypotensive 72-year-old with back pain.
- Skipping pregnancy history.
- Clinic refusal for syncope plus abdominal pain.
Practice
60-second drill
Partner: (1) 68-year-old tearing flank pain, BP 78; (2) 28-year-old syncope, missed period; (3) 20-year-old after nachos, soft belly, stable. Destination vs home.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language; protocol still wins
- ACEP 2016 early-pregnancy clinical policy — ectopic stays on the list until imaging says otherwise — field job is shock and destination, not a CT
- You will not CT on the truck. Red flags and destination are the paramedic job.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.