07-21-2008, 11:11 AM
A. analgesics
B. CT scan of the abdomen and pelvis with IV contrast
C. diagnostic peritoneal lavage
D. observation
E. ultrasonography
Current recommendation use analgesic immediatly in severe pain (answer A);
In the most recent edition of Cope's Acute Abdomen, the authors recommend that analgesia not be withheld. "The realization, likely erroneous, that narcotics can obscure the clinical picture has given rise to the unfortunate dictum that these drugs should never be given until a diagnosis has been firmly established."
from: Silen W. Cope's Early Diagnosis of the Acute Abdomen. New York (NY): Oxford; 2000:5.
PLUS.....
Ann Emerg Med. 2006 Aug;48(2):150-60, 160.e1-4.
Randomized clinical trial of morphine in acute abdominal pain.
Gallagher EJ, Esses D, Lee C, Lahn M, Bijur PE.
Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10463, USA. jgallagh@montefiore.org
STUDY OBJECTIVE: Administration of analgesia to patients with acute abdominal pain is controversial. We test the hypothesis that morphine given to emergency department (ED) patients with acute abdominal pain will reduce discomfort and improve clinically important diagnostic accuracy. METHODS: Pain was measured with a standard 0- to 100-mm visual analog scale. ED patients with acute abdominal pain were randomized in a double-blind fashion to 0.1 mg/kg intravenous morphine or placebo. The primary endpoint was the difference between the 2 study arms in clinically important diagnostic accuracy. Clinically important diagnostic accuracy was defined a priori by its complement, clinically important diagnostic error, using 2 independent, blinded investigators to identify any discordance between the provisional and final diagnoses that might adversely affect the patient's health status. The provisional diagnosis was provided by an ED attending physician, who examined the patient only once, 15 minutes after administration of the study agent. The final diagnosis was obtained through follow-up at least 6 weeks after the index ED visit. RESULTS: We randomized 160 patients, of whom 153 patients were available for analysis, 78 patients in the morphine group and 75 patients in the placebo group. Baseline features were similar in both groups, including initial median visual analog scale scores of 98 mm and 99 mm. The median decrease in visual analog scale score at 15 minutes was 33 mm in the morphine group and 2 mm in the placebo group. There were 11 instances of diagnostic discordance in each group, for a clinically important diagnostic accuracy of 86% (67/78) in the morphine group and 85% (64/75) in the placebo group. The difference in clinically important diagnostic accuracy between the 2 groups was 1% (95% confidence interval [CI] -11% to 12%). Analysis by efficacy and intention to treat yielded similar results. Kappa for interobserver concordance in classification of clinically important diagnostic accuracy was 0.94 (95% CI 0.79 to 1.00). No patients required naloxone. CONCLUSION: Although administration of intravenous morphine to adult ED patients with acute abdominal pain could lead to as much as a 12% difference in diagnostic accuracy, equally favoring opioid or placebo, our data are most consistent with the inference that morphine safely provides analgesia without impairing clinically important diagnostic accuracy.
plus....
: J Opioid Manag. 2007 Jan-Feb;3(1):11-4
Opioid administration for acute abdominal pain in the pediatric emergency department.
Klein-Kremer A, Goldman RD.
Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
The use of opioid analgesia for acute abdominal pain of unclear etiology has traditionally been thought to mask symptoms, alter physical exam findings, delay diagnosis, and increase morbidity and mortality. However, studies in children and adults have demonstrated that administering intravenous opioids to patients with acute abdominal pain induces analgesia but does not delay diagnosis or adversely affect diagnostic accuracy. This review discusses the effects of opioid administration on pain relief and diagnostic accuracy in children with moderate to severe acute abdominal pain who have been evaluated in the emergency department. We hold that current evidence supports the administration of opioids to children with acute abdominal pain, and future trials will help determine safe and effective timing and dosing related to opioid administration.
Publication Types:
Review
PMID: 17367089 [PubMed - indexed for MEDLINE]
OK I did my all I can its up to each