Abdominal Pain – ADTMC

Abdominal pain is a very common complaint that ranges in severity from benign and fleeting to issues which are severe and surgical. “Abdominal pain is the great masquerader,” as I was told in PA school. The complaint comes with a wide range of symptoms and is often vague.

As medics, corpsmen, or credentialed providers….we must be able to determine who needs prompt treatment or referral, and who may be managed more conservatively. This is a challenge, of course. This post will focus on an algorithm based approach and give a broad overview. There are also some videos on exam techniques and tips at the bottom of the page.

As with any complaint, a good history is important. Remember the basics:

Because abdominal pain is so vague and can represent a wide variety of problems, a good history is extremely important. Review the videos above to make sure you have a system. It’s important to be methodical, especially in the complaint of abdominal pain. It is too easy to miss something.

REFERENCE THE SMOG

A helpful resource for immediate red flag issues is the Standard Medical Operating Guidelines for Flight Paramedics. We can start here to think about the critical complaints.

For a more measured and less time sensitive complaint, most medics should use the ADTMC (Algorithm Directed Troop Medical Care) algorithm specific to the complaint. The primary objective of the ADTMC is to permit treatment for less severe conditions at the 68W Medic level, but also appropriately triage complaints.

Below are the Algorithms for Various Related Complaints

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Abdominal Examination

Below is a fairly good abdominal examination video that goes way beyond a typical acute care visit. No provider does this extensive of an exam on most occasions. However, the video is good because in some ways because it highlights the breadth of issues that can occur, and it provides some helpful clues to how many conditions can present.

The extent of my typical abdominal exam for an acute complaint is:

• Inspection
• Listening to bowel sounds
• Light palpation and deep palpation
• Any special tests (see tests for appendicitis below)

Summary

There is some variation in the techniques of these tests. They are not perfect. The primary objective is to detect any peritoneal signs. I will often have young Soldiers stand on their toes and drop down on their heels to elicit a a jarring motion. Or, I will ask them to jump up and down, if they can handle it. Classically, the patients describe “every bump on the drive to the ER hurt,” and so I try to recreate that situation. This is not perfect, and it is meant to be evaluated by a credentialed provider. However, this website is about austere situations or scenarios in which care is not readily available. Stateside, the patient should be referred to a provider based on the algorithms. Overseas, a medic may use these tests to categorize evacuation priority based on tests performed.

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

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