FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Do not use this ondansetron pathway when pregnancy is known or suspected.
- Do not miss a cardiac or vascular cause while treating pain and vomiting.
Initial assessment
- Maintain the airway and suction when needed. Assess onset, location/radiation, associated vomiting, pregnancy possibility, vital signs, and perfusion.
- Upper abdominal discomfort may be an anginal equivalent; consider a 12-lead with cardiac history or suspected cardiac origin.
Perfusion and nausea
- For dehydration or poor perfusion with clear lungs/no CHF, give normal saline 250 mL IV and reassess; repeat to a maximum 1 L as needed for perfusion.
- For nausea or vomiting when pregnancy is neither known nor suspected, give ondansetron 8 mg ODT OR 4 mg IV. For recurrent symptoms, the 4 mg IV dose may repeat once after approximately 3 minutes.
Severe pain
- With systolic BP above 90, morphine is 5 mg (or 4 mg carpuject) IV/IM, with one repeat after 3 minutes as needed. Alternative fentanyl is 50 mcg IV/IM or 100 mcg IN, with one repeat after 3 minutes.
- Choose the applicable pathway, count prior doses, and reassess BP, respiratory effort, oxygenation, mental status, and pain.
Aortic concern and destination
- Sudden abdominal/back/flank pain with shock or abnormal pulse rate can suggest AAA disruption. A pulsatile mass or lost distal pulses may be absent.
- AAA risk factors include age above 50, male sex, hypertension, known or family history of AAA, and vascular disease. Contact base for suspected AAA and possible trauma-center triage.
- Otherwise transport to the nearest ERC, with ALS escort when medication or saline is given, or obtain base direction as needed.
UNDERSTAND THE CARE
Why symptom relief does not finish the abdominal assessment
The purpose of the first assessment is to identify a dangerous cause while addressing pain, vomiting and circulation. Location alone cannot safely separate gastrointestinal illness from a cardiac or vascular presentation. Describe onset, radiation, associated symptoms and perfusion together; upper abdominal discomfort can prompt the cardiac assessment in the source order.
Applying the guidance
Reassessment should return to the original complaint after treatment. Document whether pain changed, whether pressure and breathing tolerated the intervention, and whether the working concern changed. A suspected aneurysm does not require every classic physical finding to be present. Keep the destination discussion active when sudden abdominal or back pain accompanies poor perfusion.
Putting it together
Teaching example: vomiting settles after treatment, but abrupt back/flank pain and poor perfusion remain. The handoff should emphasize the sudden onset and ongoing vascular concern, not just successful symptom control.
Diagram text & teaching checkpoints
- Airway risk
- Vomiting and consciousness determine support.
- Perfusion
- Trend pressure and skin findings.
- Cause
- Look beyond the site of discomfort.
- Destination
- Escalate suspected AAA to base.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.