EMT Standing Orders

• Routine Patient Care
• Maintain the patient NPO (nothing by mouth)
• Allow the patient to assume a position of comfort
• Acquire 12-lead ECG, for patients age ≥40.
• Minimize scene time.

If the patient has uncontrolled pain, unstable vital signs, or signs and symptoms of an acute abdomen, Call for AEMT/Paramedic intercept & Assist them in patient care

AEMT/PARAMEDIC STANDING ORDERS Protocol

• Establish IV access
• See Nausea/Vomiting Protocol (47 Medical).
• If the patient is hypotensive, see Shock Protocol - pediatric (60 Medical)
• Contact Medical Direction for additional fluid orders.
• See Pain Management Protocol - pediatric (42 Medical).
• Assess and monitor the cardiac rhythm, treat as indicated.

Obtain a complete abdominal history

• History of pain (OPQRST)
• History of recent trauma
• History of nausea/vomiting (color, bloody, coffee grounds)
• History of bowel movement (last BM, diarrhea, bloody, tarry)
• History of urine output (painful, dark, bloody)
• History of prior abdominal surgery
• History of acute onset of back pain
• History of last menses in female/vaginal bleeding/pelvic pain
• History of anticoagulant medication
• SAMPLE history

Abdominal physical assessment:

• Ask the patient to point to the area of pain (palpate this area last).
• Gently palpate for tenderness, distention, rigidity, guarding, and pulsatile masses. Also, palpate the flank for CVA (costovertebral angle) tenderness.
• An acute abdomen is rigid with guarding, distension, and diffuse tenderness and may indicate a surgical emergency. An acute abdomen can be caused by many things including the following: appendicitis, cholecystitis, duodenal ulcer perforation, diverticulitis, abdominal aortic aneurysm, kidney infection, urinary tract infection