›Avoid delays to CT if unstable
›If suspected aortic dissection
›Activate appropriate pathway early (cardiothoracic or vascular depending on type and local practice)
›Aggressive pain control
›Reduce shear stress when suspected
›Control heart rate first with a beta blocker when available and appropriate
›Then address blood pressure if still hypertensive
›Avoid vasodilator alone before heart rate control
Analgesia and antiemetics
›Analgesia and antiemetics
›Acetaminophen PO or IV
›1000 mg PO or IV
›Max 3000 mg per day in older adults or liver disease
›Ketorolac IV when renal function acceptable
›15 mg IV
›Avoid in GI bleed risk and pregnancy third trimester
›Hydromorphone IV for severe pain
›0.2 to 0.5 mg IV
›Repeat every 10 to 15 minutes to effect with monitoring
›Ondansetron
›4 mg IV or ODT
›QT risk awareness
›Diagnostic sequencing
›Pregnancy test early in reproductive age with uterus
›ECG and troponin pathway when epigastric atypical ACS concern
›Aortic screen when red flags present
›POCUS aorta for suspected AAA
›CTA chest abdomen pelvis for suspected dissection if stable
›Ultrasound first for right upper quadrant and pelvic etiologies
›CT abdomen pelvis when diagnosis unclear or complications suspected
›Location based pathways
›Right upper quadrant pathway
›Ultrasound first line
›Antibiotics if cholecystitis or cholangitis concern
›ERCP pathway coordination when obstructing stone suspected
›Epigastric pathway
›Lipase and LFTs
›ACS evaluation when risk factors or atypical features
›CTA chest abdomen pelvis if aortic red flags
›Left upper quadrant pathway
›Chest imaging if pulmonary features
›CT if splenic injury or infarct concern
›Right lower quadrant pathway
›Appendicitis scoring support
›Ultrasound in pregnancy and pediatrics
›CT when adult and ultrasound nondiagnostic
›Left lower quadrant pathway
›CT for first episode or severe presentation
›Antibiotics strategy per severity and local guidance
›Consider AAA leak or rupture in older patient with hypotension or back pain
›Suprapubic pathway
›Urinalysis and culture strategy
›Pelvic ultrasound for ectopic or torsion concern
›Reassessment loop
›Pain and vitals reassessment every 30 to 60 minutes in ED
›Abdominal exam repeat after analgesia
›Escalate to CT or consult if worsening or persistent peritoneal signs