👤 By the CinnaEMS Content Team🕐 Updated 2026-09-28🏷️ Secondary Assessment🔖 Free to read, print, and share
Also known as: acute abdomen · abdominal pain · AAA · ectopic pregnancy · GI bleed · referred pain · peritonitis · Kehr sign
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Use this quick-reference guide to recognise, treat and hand over Abdominal Emergencies on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Exam
Painful quadrant last
Gentle palpation
Nothing by mouth
📌 Referred
Gallbladder → R shoulder
Spleen → L shoulder
✅ Don'T Miss
Ectopic pregnancy
Aortic aneurysm
GI bleed · heart attack
🚩 Red Flags
Rigid abdomen
Pulsating mass
Signs of shock
📚 Abdominal Emergencies — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
EMS does not need a diagnosis for abdominal pain — it needs to recognize the causes that kill: hidden bleeding, a rupturing aorta, ectopic pregnancy and a heart attack felt in the belly. The assessment is history, gentle palpation starting away from the pain, and perfusion.
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Key points
Understand these first
Palpate the painful quadrant last, so guarding does not hide findings elsewhere.
Pain may be referred: gallbladder to the right shoulder, spleen to the left shoulder (Kehr sign).
Any woman of childbearing age with abdominal pain may have an ectopic pregnancy.
Pain with a pulsating mass, or tearing pain to the back, suggests an abdominal aortic aneurysm.
Older adults and patients with diabetes may have a heart attack that presents as upper abdominal pain.
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Treatment priorities
What to do, in order
Position of comfort; nothing by mouth.
Treat for shock early when signs of hidden bleeding appear.
Ask about stool and vomit color: coffee-ground vomit or black tarry stool means GI bleeding.
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Red flags — report now
Escalate immediately
Rigid, board-like abdomen
Pulsating mass or tearing back pain
Abdominal pain with signs of shock
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Patient teaching
What patients must know
Do not repeatedly palpate a suspected aneurysm — one gentle check is enough.
❓ Abdominal Emergencies: NREMT FAQs
What are the priority actions for Abdominal Emergencies in the field?
Position of comfort; nothing by mouth. Treat for shock early when signs of hidden bleeding appear. Ask about stool and vomit color: coffee-ground vomit or black tarry stool means GI bleeding.
What findings in Abdominal Emergencies change your plan or your transport decision?
Rigid, board-like abdomen. Pulsating mass or tearing back pain. Abdominal pain with signs of shock.
What do I need to know about Abdominal Emergencies for the NREMT?
Palpate the painful quadrant last, so guarding does not hide findings elsewhere. Pain may be referred: gallbladder to the right shoulder, spleen to the left shoulder (Kehr sign). Any woman of childbearing age with abdominal pain may have an ectopic pregnancy. Pain with a pulsating mass, or tearing pain to the back, suggests an abdominal aortic aneurysm.
What should the crew communicate or document for Abdominal Emergencies?
Do not repeatedly palpate a suspected aneurysm — one gentle check is enough.
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Quick Tip
Palpate the painful quadrant last, so guarding does not hide findings elsewhere.