Abdominal pain—pain located between the groin and the bottom of the rib cage—is a common cause for emergency calls. Its sources span a wide variety: illness, injury, infection, organ dysfunction, reaction to medication, stress, and the list goes on. Some causes are more serious than others, but that should never keep someone suffering from seeking medical attention. Telephone triage services can better direct a patient’s efforts to find relief.
Abdominal pain can come and go quickly depending on the cause. Discomfort rooted in overeating is not likely to need medical care, but not all abdominal problems are so fleeting. The most common cause of acute onset abdominal pain is gastroenteritis, the irritation of the intestinal tract. In children especially, it is usually caused by a viral or bacterial source, commonly referred to as food poisoning. Symptoms—including nausea, vomiting, watery diarrhea, and stomach cramps—can last for up to a week, though it is more usual in 2-day intervals.
Appendicitis, the inflammation of the appendix, is rare in patients with abdominal pain who seek emergency rooms, though this fact does not rule it out immediately in the triage process. Appendicitis, which incites pain that may begin in the navel and shift to the lower right of the abdomen, requires emergency attention to avoid organ rupture and subsequent sepsis. Other sources of abdominal pain include testicular torsion, untreated abdominal aortic aneurysm, and bowel obstruction. Hunger pains, overeating, medication use, stress, anxiety, and worry may also be to blame.
A triage nurse does not diagnose patients. However, in order to recommend correct medical action, triage nurses do develop working diagnoses. This can help them narrow down the search in order to follow proper protocol in assessing their patients. The key is to rule out the most emergent symptoms first, never assuming anything.
When assessing the severity of abdominal pain, it is critical for the triage nurse to ask the right questions to get to the heart of the problem in a timely manner. Basic information, including name, age, gender, pregnancy status, and allergies must be established before more specific data: time and details of pain onset; description, severity, and location of pain; any prior pain history; vital signs and symptoms; possible biological or chemical exposure; and medications in use.
With this information in hand, a nurse can make an assessment of acuity and recommend a patient to seek medical treatment. The expertise of a triage nurse is a more valuable source than the vast but nonspecific information floating around the internet. Before accepting WebMD’s assertion that symptoms are imminently deadly, patients should consult a nurse by telephone for professional triage.
A patient’s abdominal pain is considered critical if he or she also experiences severe respiratory trouble or is unresponsive, diaphoretic, pale, confused, or weak. Immediate treatment is called for by a resuscitation team. Medical staff should be continuously attendant.
High-risk patients can experience abdominal pain for many reasons, including exposure to toxins and wounding. Symptoms may include pain that increases and radiates up the back or down the legs, lightheadedness, signs of dehydration, bloody stools, vomiting copious amounts of blood, or altered mental status. Treatment in such cases should not be delayed. Patients should avoid taking anything orally before seeing a physician. Diagnostic testing and frequent medical consultation should be expected.
Abdominal pain is classified as moderate risk if severe pain increases rapidly, vaginal bleeding is heavy, or vomiting is accompanied by abdominal distention. Constipation, nausea, or fever are common. Cases such as these may have ingested something of a plant, drug, or chemical nature. If pregnancy is possible, the care regimen is urgent, and triage nurses will refer patients for treatment as soon as possible. Patients should avoid taking anything orally until examined by a physician.
If a patient has a history of chronic abdominal pain or has recently had surgery in the affected area, the case may be considered low risk if pain is accompanied by fever, nausea, vomiting, painful urination accompanied by blood, or black stools. The patient should seek a medical examination and not take any oral medications until recommended to do so by a physician.
In lower-risk cases, intermittent abdominal pain is the only symptom, likely after overconsumption of foods or fluids or in conjunction with flatulence. A triage nurse for these cases can offer emotional comfort and suggestions for restoring physical relief. A nonimmediate examination may be recommended.