DISPOSITION

..... Admission

Recent studies seem to indicate that it may be possible to

manage patients with confirmed PE and low-risk findings

as outpatients. However, pending further data, the current

standard remains admission for all patients with newly

diagnosed PE. Patients with refractory hypoxia or cardio ­

vascular dysfunction should be admitted to an intensive

care setting.

..... Discharge

Patients with a clear alternative diagnosis may be dis ­

charged based on the severity and appropriate manage ­

ment of the alternate diagnosis.

SUGGESTED READING

ACEP Clinical Policy. Critical issues in the evaluation and management of adult patients presenting to the emergency

department with suspected pulmonary embolism. Ann Emerg

Med. 201 1;57:628-652.e75.

Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep

vein thrombosis. Lancet. 201 2;6736: 1-12.

Kline JA. Thromboembolism. In: Tintinalli JE, Stapczynski JS,

Ma OJ, Cline DM, Cydulka RK, Meckler GD. Tintinalli's

Emergency Medicine: A Comprehensive Study Guide. 7th ed.

New York, NY: McGraw-Hill, 20 1 1, pp. 430-440.

Ouellette DW, Patocka C. Pulmonary embolism. Emerg Med

Clin North Am. 201 2;30:329-375.

Acute Abdominal Pain

David c. Gordon, MD

Key Points

• A primary survey should be conducted to rapidly screen for

vascular catastrophes, abdominal sepsis, or perforated viscus.

• Appendicitis should always be on the differential diagnosis for acute abdominal pain.

• Females of childbearing age with abdominal pain are presumed to have an ectopic pregnancy until proven otherwise.

INTRODUCTION

Abdominal pain is a common presenting complaint and

represents up to 1 0% of all emergency department (ED)

visits. Although the etiology of abdominal pain frequently

goes undiagnosed, the role of the emergency physician is

to first identify and treat any immediate life- or organthreatening conditions. Imminent causes of abdominal

pain that need to be promptly diagnosed are those driven

by a vascular event, infectious process, or perforated viscous (eg, ruptured abdominal aortic aneurysm [AAA],

cholangitis, perforated gastric ulcer). Other disease processes may not pose an immediate threat to the patient but

should be diagnosed before discharge, as delays in treatment can result in patient morbidity ( eg, appendicitis,

pelvic inflammatory disease).

Abdominal pain can be classified as visceral, parietal, or

referred in origin. Depending on the disease process, pain

may begin as visceral and become parietal, as in the

stretching and subsequent rupture of a hollow viscus.

Visceral pain occurs with the stretching of nerve fibers in

the walls of hollow organs or the capsules of solid organs.