›Time critical workflow
›Monitor
›Cardiac monitoring if unstable
›SpO2 monitoring
›IV access
›Two large bore IVs if hypotension or bleeding concern
›One IV if stable
›Fluids
›Crystalloid bolus 10 to 20 mL per kg if hypotension
›Reassess after each bolus
›Analgesia early
›IV option if severe pain
›Oral option if mild pain
›Immediate consult triggers
›Surgery for peritonitis or perforation concern
›Vascular surgery for suspected AAA
›OB GYN for suspected ectopic or torsion
›Analgesia
›Acetaminophen PO 1000 mg once
›Ibuprofen PO 400 mg once
›Ketorolac IV 15 mg once
›Morphine IV 0.05 mg per kg once
›Hydromorphone IV 0.5 mg once
›Antiemetic
›Ondansetron ODT 4 mg once
›Ondansetron IV 4 mg once
›Bowel regimen when constipation dominant and no obstruction concern
›Polyethylene glycol PO 17 g daily
›Rectal enema local protocol dependent
›Diverticulitis
›Complicated disease or sepsis
›Piperacillin tazobactam IV 4.5 g once then per protocol
›Ceftriaxone IV 2 g once plus metronidazole IV 500 mg once
›Uncomplicated outpatient pathway local protocol dependent
›Antibiotics not always required in selected low risk patients
›Amoxicillin clavulanate PO 875 mg twice daily 7 days
›Suspected PID
›Ceftriaxone IM 500 mg once
›Doxycycline PO 100 mg twice daily 14 days
›Metronidazole PO 500 mg twice daily 14 days
›Suspected obstructing stone with infection
›Broad spectrum antibiotics
›Ceftriaxone IV 2 g once
›Piperacillin tazobactam IV 4.5 g once
›Urology emergent decompression trigger
›Fever with hydronephrosis
›Sepsis physiology
›Timed reassessment
›Pain score every 30 to 60 minutes until controlled
›Repeat vitals after interventions
›Escalation triggers
›Rising lactate
›Increasing tenderness or new peritonitis
›Persistent vomiting
›New hypotension