Left Upper Quadrant PainAPPROACH

ABDOMINAL AND GASTROINTESTINAL · 19 SECTIONS

⚲

421 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Abdominal Distension Abdominal Pain, Undifferentiated Acute Abdominal Pain (general)Suspected Incarcerated Or Strangulated Hernia Pancreatitis Concern Biliary Colic And Cholecystitis Concern Appendicitis Concern Diverticulitis Concern Rectal Pain And Anorectal Complaints Dysphagia And Food Bolus Impaction Foreign Body Ingestion Refractory Vomiting And Recurrent Vomiting Syndromes Cannabis Associated Hyperemesis Upper Gastrointestinal Bleeding Symptoms (melena)Lower Gastrointestinal Bleeding And Hematochezia Constipation And Obstipation Diarrhea Acute Hepatitis And Jaundice Concern Right Upper Quadrant Pain Epigastric Pain Left Upper Quadrant Pain Right Lower Quadrant Pain Left Lower Quadrant Pain Suprapubic Pain

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx62

HPI overview

›Core history elements

›Chief concern

›Symptom onset context

›Pattern and trajectory

›Baseline status

›Prior episodes

OPQRST

›OPQRST framework

›Onset

›Sudden

›Gradual

›Provocation and palliation

›Worse with inspiration

›Worse with movement

›Worse after meals

›Relief with antacids

›Relief with leaning forward

›Quality

›Sharp

›Dull

›Burning

›Tearing

›Region and radiation

›Left upper quadrant

›Left shoulder

›Back

›Chest

›Severity

›Mild

›Moderate

›Severe

›Timing

›Constant

›Intermittent

›Postprandial

›Exertional

Associated symptoms

›Symptom associations

›Fever

›Nausea

›Vomiting

›Hematemesis

›Melena

›Diarrhea

›Constipation

›Chest pain

›Dyspnea

›Cough

›Pleuritic pain

›Syncope

›Dysuria

›Flank pain

Context and triggers

›Trigger review

›Blunt abdominal trauma

›Recent vomiting or retching

›Recent endoscopy

›Heavy lifting

›Recent infection

›Recent travel

Special populations

›Population modifiers

›Pregnancy status

›Older adult frailty

›Immunocompromised status

›Anticoagulant use

02Alarm Features/alarm27

Immediate threats

›Resuscitation triggers

›Hypotension

›Shock index greater than 1

›Altered mental status

›Respiratory distress

›Ongoing hematemesis

›Large volume melena

High risk historical features

›Time critical history signals

›Sudden severe pain at onset

›Syncope with pain

›Recent significant trauma

›Known aneurysm

›Anticoagulation with new pain

›Recent MI or stent

High risk exam features

›Exam danger findings

›Peritonitis

›Rigid abdomen

›Rebound tenderness

›Focal neurologic deficit

›New murmur

›Unequal pulses

Vital sign danger thresholds

›Physiologic danger patterns

›Systolic BP less than 90 mmHg

›Heart rate greater than 120 per minute

›Respiratory rate greater than 24 per minute

›Oxygen saturation less than 92 percent on room air

›Temperature 38.5 C or higher

03Medications/meds18

Current and recent meds

›Medication exposure

›Anticoagulants

›Antiplatelets

›NSAIDs

›Steroids

›GLP 1 receptor agonists

›Opioids

›Recent antibiotics

OTC and supplements

›Non prescription exposures

›Bismuth

›Antacids

›Iron supplements

›Herbal supplements

Therapy contraindications

›Key contraindication checks

›NSAID avoidance in suspected GI bleed

›QT prolonging drug combinations

›Contrast precautions

›Metformin with acute kidney injury concern

04Diet/diet10

Recent intake and triggers

›Dietary pattern

›Recent heavy meal

›High fat intake

›Poor oral intake

›Dehydration indicators

Alcohol and caffeine

›Exposures

›Alcohol binge

›Daily alcohol use

›Energy drinks

›High caffeine intake

05Review of Systems/ros16

GI and constitutional

›GI and systemic symptoms

›Weight loss

›Anorexia

›Early satiety

›Night sweats

›Jaundice

Cardiopulmonary

›Chest and lung symptoms

›Exertional chest pain

›Orthopnea

›Pleuritic pain

›Hemoptysis

Neuro and vascular

›Neurovascular symptoms

›Syncope

›Focal weakness

›Visual changes

›New severe headache

06Collateral History and Family History/chafh9

Collateral and reliability

›Source and reliability

›Family or caregiver history

›EMS report

›Prior records availability

Family history

›Heritable and early disease

›Early coronary artery disease

›Aortic aneurysm or dissection

›Inherited hemolytic disorders

›Inflammatory bowel disease

07Risk Factors/rf19

Vascular and cardiac risks

›Atherosclerotic risk

›Hypertension

›Diabetes mellitus type 2 (E11.9)

›Tobacco use

›Dyslipidemia

Bleeding and splenic risks

›Hemorrhage predisposition

›Anticoagulation

›Thrombocytopenia

›Cirrhosis

›Portal hypertension

Infection and thrombosis risks

›Infection and clot risks

›Asplenia

›Sickle cell disease (D57.1)

›Recent immobilization

›Active malignancy

Exposure risks

›Exposure profile

›Recent travel

›Sick contacts

›Animal exposure

08Differential Diagnosis/ddx67

Life threatening

›Cannot miss diagnoses

›Acute coronary syndrome (I21.9)

›Epigastric or LUQ discomfort equivalent

›Risk increased with exertional symptoms

›Aortic dissection (I71.00)

›Sudden severe pain

›Pulse deficit

›Neurologic symptoms

›Ruptured abdominal aortic aneurysm (I71.3)

›Hypotension

›Syncope

›Back or flank radiation

›Splenic rupture

›Trauma history

›Left shoulder pain

›Hypotension

›Upper GI bleed (K92.2)

›Hematemesis

›Melena

›NSAID exposure

›Perforated viscus (K63.1)

›Peritonitis

›Free air on imaging

›Pulmonary embolism (I26.99)

›Pleuritic pain

›Dyspnea

›Tension pneumothorax (J93.0)

›Sudden dyspnea

›Unilateral absent breath sounds

Common

›High frequency etiologies

›Gastritis or peptic ulcer disease (K29.70)

›Postprandial pain

›NSAID exposure

›Acute pancreatitis (K85.9)

›Epigastric or LUQ pain

›Radiation to back

›Left lower lobe pneumonia (J18.9)

›Fever

›Cough

›Nephrolithiasis (N20.0)

›Flank radiation

›Hematuria

›Constipation

›Reduced bowel movements

›Distension

›Musculoskeletal pain

›Reproducible with palpation

›Worse with movement

Less common

›Lower probability considerations

›Splenic infarct

›Atrial fibrillation

›Hypercoagulable state

›Splenic abscess

›Prolonged fever

›Immunocompromised state

›Gastric volvulus

›Severe retching

›Inability to pass NG tube

›Herpes zoster

›Dermatomal pain

›Rash timing lag

›Mesenteric ischemia (K55.9)

›Pain out of proportion

›Elevated lactate

›Inflammatory bowel disease flare (K50.90)

›Diarrhea

›Weight loss

09Past Medical History/pmh15

Relevant diagnoses and events

›Baseline conditions

›Coronary artery disease (I25.10)

›Heart failure (I50.9)

›Atrial fibrillation (I48.91)

›Chronic kidney disease (N18.9)

›Chronic liver disease

Prior procedures and devices

›Procedure history

›Prior abdominal surgery

›Prior endoscopy

›Coronary stent

›Pacemaker or ICD

Prior similar episodes

›Episode pattern

›Prior pancreatitis

›Prior peptic ulcer disease

›Prior kidney stones

10Physical Exam/exam24

Initial appearance and vitals

›Global assessment

›Toxic appearance

›Diaphoresis

›Perfusion

›Orthostatic vitals when stable

Abdomen

›Abdominal exam cluster

›Focal LUQ tenderness

›Rebound tenderness

›Guarding

›Distension

›Bowel sounds

Cardiopulmonary

›Heart and lung exam

›New murmur

›Crackles

›Decreased breath sounds

›Chest wall tenderness

Vascular and neuro

›Vascular and neurologic screen

›Pulse symmetry

›Blood pressure in both arms when concern

›Focal deficits

›Limb ischemia signs

Skin and zoster check

›Skin findings

›Dermatomal rash

›Ecchymosis

11Lab Studies/labs25

Core labs

›Initial lab set

›CBC

›Electrolytes

›Creatinine

›Glucose

›Liver enzymes

›Bilirubin

›Lipase

›Venous blood gas if ill

Hemorrhage and coagulation

›Bleeding evaluation

›INR

›PTT

›Type and screen

›Type and crossmatch if unstable

Cardiac testing

›Cardiac risk labs

›Troponin with serial strategy

›BNP when heart failure concern

Infection and ischemia clues

›Adjunct tests

›Lactate

›Blood cultures when febrile and septic concern

›Urinalysis

›Pregnancy test when applicable

Interpretation pitfalls

›Common pitfalls

›Normal early lipase in very early pancreatitis

›Lactate may be normal early in mesenteric ischemia

12Imaging/img17

Scoring Systems

›When scores influence imaging choice

›PERC for PE exclusion

›Wells score for PE pretest probability

›HEART score for chest pain risk

MRI

›MRI considerations

›Alternative when CT contraindicated

›Limited role in acute unstable abdominal pain

›MRCP when biliary obstruction concern and stable

›CT pathways

›CT angiography chest abdomen pelvis for dissection concern

›CT abdomen pelvis with IV contrast for perforation or ischemia concern

›CT abdomen pelvis without contrast for renal colic when stable

Ultrasound

›Ultrasound use cases

›POCUS FAST when trauma or hemorrhage concern

›POCUS abdominal aorta screening when hypotension and rupture concern

›Left pleural effusion assessment

›Splenic size and free fluid support findings

13Special Tests/spec7

Bedside and procedural

›Bedside diagnostics

›Rectal exam when GI bleed concern

›Nasogastric aspirate local protocol dependent

›Point of care hemoglobin local protocol dependent

Respiratory focused tests

›Pulmonary adjuncts

›Peak flow when asthma mimic suspected

›D dimer only in low to intermediate PE risk

14ECG/ecg13

Indications and timing

›ECG triggers

›Any upper abdominal pain with cardiac risk

›Diaphoresis

›Dyspnea

›Syncope

High risk patterns

›ECG danger findings

›STEMI criteria

›New ischemic ST depression

›New T wave inversion in contiguous leads

›Ventricular arrhythmia

Serial strategy

›Repetition logic

›Repeat in 15 to 30 minutes if ongoing concern

›Repeat with new symptoms or hemodynamic change

15Assessment/ax13

Problem representation

›Working synthesis

›Hemodynamic status category

›Peritonitis present or absent

›Cardiac and vascular risk context

Risk stratification

›High risk flags

›Shock physiology

›Active bleeding features

›Suspected vascular catastrophe

Complications to exclude

›Complication screen

›Pancreatitis complications

›Perforation

›Sepsis

›ACS equivalent

16Plan/plan31

First 5 minutes

›Immediate stabilization

›Cardiac monitor

›Pulse oximetry

›Two large bore IVs if unstable

›Oxygen if saturation less than 92 percent

›Massive transfusion activation local protocol dependent

Diagnostic sequencing

›Test prioritization

›ECG within 10 minutes when cardiac concern

›Bedside ultrasound in unstable patient

›CTA when dissection concern and stable enough

Analgesia and antiemetics

›Symptom control options

›Acetaminophen PO 1000 mg once

›Hydromorphone IV 0.5 mg

›Titrate every 10 minutes as needed

›Ondansetron IV 4 mg

›Avoid NSAIDs in suspected GI bleed or renal injury

Condition directed therapy

›Targeted treatments

›Suspected GI bleed

›Pantoprazole IV 80 mg bolus

›Then 8 mg per hour infusion local protocol dependent

›Suspected pancreatitis

›Balanced crystalloid bolus 10 mL per kg if hypovolemic

›Avoid routine antibiotics unless infected necrosis concern

›Suspected ACS

›Aspirin PO 160 mg chewable if no contraindication

›Nitrates contraindicated with hypotension or RV infarct concern

Reassessment loop

›Recheck cadence

›Pain score after each intervention

›Vitals every 15 minutes if unstable

›Abdominal exam repeat after analgesia

›Escalate level of care for deterioration

17Disposition/dispo19

ICU and monitored care

›Higher acuity criteria

›Ongoing hypotension after fluids

›Vasopressor requirement

›Active GI bleeding with transfusion need

›Suspected dissection

Inpatient admission

›Admission indications

›Pancreatitis with organ dysfunction

›Pneumonia with hypoxia

›Splenic injury

›Uncontrolled pain or vomiting

Observation pathway

›Observation candidates

›Low risk chest pain pathway eligible

›Stable renal colic with pain control

Discharge criteria

›Safe discharge requirements

›Stable vitals

›Pain controlled with oral meds

›Oral intake tolerated

›No peritonitis

›Reliable follow up

18Discharge Instructions/di23

Copy discharge instructions

›Diagnosis summary

›Left upper abdominal pain evaluation today did not show an emergency cause on the tests performed

›Some conditions can evolve over time and may not show early on initial testing

›Medications

›Use acetaminophen as directed on the label

›Avoid NSAIDs if you have stomach bleeding risk or kidney problems

›Take prescribed nausea medicine only as directed

›Activity

›Avoid heavy lifting until symptoms improve

›Hydration with frequent small sips

›Follow up

›Primary care or clinic follow up within 24 to 72 hours

›Return sooner if symptoms worsen

›Return to ED now for

›Fainting

›Chest pain

›Trouble breathing

›Vomiting blood

›Black stools

›Fever with worsening pain

›New severe sudden pain

›Weakness on one side

›Inability to keep fluids down

19References/r6

Key sources

›Evidence base

›American College of Cardiology and American Heart Association guideline for acute coronary syndromes 2025

›American Heart Association scientific statement on aortic dissection evaluation and management 2022

›American College of Gastroenterology guideline for upper gastrointestinal and ulcer bleeding 2021

›American College of Gastroenterology guideline for acute pancreatitis 2024

›ACEP clinical policy for suspected pulmonary embolism evaluation 2018

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Left Upper Quadrant PainAPPROACH

ABDOMINAL AND GASTROINTESTINAL · 19 SECTIONS

⚲

421 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx62

HPI overview

›Core history elements

›Chief concern

›Symptom onset context

›Pattern and trajectory

›Baseline status

›Prior episodes

OPQRST

›OPQRST framework

›Onset

›Sudden

›Gradual

›Provocation and palliation

›Worse with inspiration

›Worse with movement

›Worse after meals

›Relief with antacids

›Relief with leaning forward

›Quality

›Sharp

›Dull

›Burning

›Tearing

›Region and radiation

›Left upper quadrant

›Left shoulder

›Back

›Chest

›Severity

›Mild

›Moderate

›Severe

›Timing

›Constant

›Intermittent

›Postprandial

›Exertional

Associated symptoms

›Symptom associations

›Fever

›Nausea

›Vomiting

›Hematemesis

›Melena

›Diarrhea

›Constipation

›Chest pain

›Dyspnea

›Cough

›Pleuritic pain

›Syncope

›Dysuria

›Flank pain

Context and triggers

›Trigger review

›Blunt abdominal trauma

›Recent vomiting or retching

›Recent endoscopy

›Heavy lifting

›Recent infection

›Recent travel

Special populations

›Population modifiers

›Pregnancy status

›Older adult frailty

›Immunocompromised status

›Anticoagulant use

02Alarm Features/alarm27

Immediate threats

›Resuscitation triggers

›Hypotension

›Shock index greater than 1

›Altered mental status

›Respiratory distress

›Ongoing hematemesis

›Large volume melena

High risk historical features

›Time critical history signals

›Sudden severe pain at onset

›Syncope with pain

›Recent significant trauma

›Known aneurysm

›Anticoagulation with new pain

›Recent MI or stent

High risk exam features

›Exam danger findings

›Peritonitis

›Rigid abdomen

›Rebound tenderness

›Focal neurologic deficit

›New murmur

›Unequal pulses

Vital sign danger thresholds

›Physiologic danger patterns

›Systolic BP less than 90 mmHg

›Heart rate greater than 120 per minute

›Respiratory rate greater than 24 per minute

›Oxygen saturation less than 92 percent on room air

›Temperature 38.5 C or higher

03Medications/meds18

Current and recent meds

›Medication exposure

›Anticoagulants

›Antiplatelets

›NSAIDs

›Steroids

›GLP 1 receptor agonists

›Opioids

›Recent antibiotics

OTC and supplements

›Non prescription exposures

›Bismuth

›Antacids

›Iron supplements

›Herbal supplements

Therapy contraindications

›Key contraindication checks

›NSAID avoidance in suspected GI bleed

›QT prolonging drug combinations

›Contrast precautions

›Metformin with acute kidney injury concern

04Diet/diet10

Recent intake and triggers

›Dietary pattern

›Recent heavy meal

›High fat intake

›Poor oral intake

›Dehydration indicators

Alcohol and caffeine

›Exposures

›Alcohol binge

›Daily alcohol use

›Energy drinks

›High caffeine intake

05Review of Systems/ros16

GI and constitutional

›GI and systemic symptoms

›Weight loss

›Anorexia

›Early satiety

›Night sweats

›Jaundice

Cardiopulmonary

›Chest and lung symptoms

›Exertional chest pain

›Orthopnea

›Pleuritic pain

›Hemoptysis

Neuro and vascular

›Neurovascular symptoms

›Syncope

›Focal weakness

›Visual changes

›New severe headache

06Collateral History and Family History/chafh9

Collateral and reliability

›Source and reliability

›Family or caregiver history

›EMS report

›Prior records availability

Family history

›Heritable and early disease

›Early coronary artery disease

›Aortic aneurysm or dissection

›Inherited hemolytic disorders

›Inflammatory bowel disease

07Risk Factors/rf19

Vascular and cardiac risks

›Atherosclerotic risk

›Hypertension

›Diabetes mellitus type 2 (E11.9)

›Tobacco use

›Dyslipidemia

Bleeding and splenic risks

›Hemorrhage predisposition

›Anticoagulation

›Thrombocytopenia

›Cirrhosis

›Portal hypertension

Infection and thrombosis risks

›Infection and clot risks

›Asplenia

›Sickle cell disease (D57.1)

›Recent immobilization

›Active malignancy

Exposure risks

›Exposure profile

›Recent travel

›Sick contacts

›Animal exposure

08Differential Diagnosis/ddx67

Life threatening

›Cannot miss diagnoses

›Acute coronary syndrome (I21.9)

›Epigastric or LUQ discomfort equivalent

›Risk increased with exertional symptoms

›Aortic dissection (I71.00)

›Sudden severe pain

›Pulse deficit

›Neurologic symptoms

›Ruptured abdominal aortic aneurysm (I71.3)

›Hypotension

›Syncope

›Back or flank radiation

›Splenic rupture

›Trauma history

›Left shoulder pain

›Hypotension

›Upper GI bleed (K92.2)

›Hematemesis

›Melena

›NSAID exposure

›Perforated viscus (K63.1)

›Peritonitis

›Free air on imaging

›Pulmonary embolism (I26.99)

›Pleuritic pain

›Dyspnea

›Tension pneumothorax (J93.0)

›Sudden dyspnea

›Unilateral absent breath sounds

Common

›High frequency etiologies

›Gastritis or peptic ulcer disease (K29.70)

›Postprandial pain

›NSAID exposure

›Acute pancreatitis (K85.9)

›Epigastric or LUQ pain

›Radiation to back

›Left lower lobe pneumonia (J18.9)

›Fever

›Cough

›Nephrolithiasis (N20.0)

›Flank radiation

›Hematuria

›Constipation

›Reduced bowel movements

›Distension

›Musculoskeletal pain

›Reproducible with palpation

›Worse with movement

Less common

›Lower probability considerations

›Splenic infarct

›Atrial fibrillation

›Hypercoagulable state

›Splenic abscess

›Prolonged fever

›Immunocompromised state

›Gastric volvulus

›Severe retching

›Inability to pass NG tube

›Herpes zoster

›Dermatomal pain

›Rash timing lag

›Mesenteric ischemia (K55.9)

›Pain out of proportion

›Elevated lactate

›Inflammatory bowel disease flare (K50.90)

›Diarrhea

›Weight loss

09Past Medical History/pmh15

Relevant diagnoses and events

›Baseline conditions

›Coronary artery disease (I25.10)

›Heart failure (I50.9)

›Atrial fibrillation (I48.91)

›Chronic kidney disease (N18.9)

›Chronic liver disease

Prior procedures and devices

›Procedure history

›Prior abdominal surgery

›Prior endoscopy

›Coronary stent

›Pacemaker or ICD

Prior similar episodes

›Episode pattern

›Prior pancreatitis

›Prior peptic ulcer disease

›Prior kidney stones

10Physical Exam/exam24

Initial appearance and vitals

›Global assessment

›Toxic appearance

›Diaphoresis

›Perfusion

›Orthostatic vitals when stable

Abdomen

›Abdominal exam cluster

›Focal LUQ tenderness

›Rebound tenderness

›Guarding

›Distension

›Bowel sounds

Cardiopulmonary

›Heart and lung exam

›New murmur

›Crackles

›Decreased breath sounds

›Chest wall tenderness

Vascular and neuro

›Vascular and neurologic screen

›Pulse symmetry

›Blood pressure in both arms when concern

›Focal deficits

›Limb ischemia signs

Skin and zoster check

›Skin findings

›Dermatomal rash

›Ecchymosis

11Lab Studies/labs25

Core labs

›Initial lab set

›CBC

›Electrolytes

›Creatinine

›Glucose

›Liver enzymes

›Bilirubin

›Lipase

›Venous blood gas if ill

Hemorrhage and coagulation

›Bleeding evaluation

›INR

›PTT

›Type and screen

›Type and crossmatch if unstable

Cardiac testing

›Cardiac risk labs

›Troponin with serial strategy

›BNP when heart failure concern

Infection and ischemia clues

›Adjunct tests

›Lactate

›Blood cultures when febrile and septic concern

›Urinalysis

›Pregnancy test when applicable

Interpretation pitfalls

›Common pitfalls

›Normal early lipase in very early pancreatitis

›Lactate may be normal early in mesenteric ischemia

12Imaging/img17

Scoring Systems

›When scores influence imaging choice

›PERC for PE exclusion

›Wells score for PE pretest probability

›HEART score for chest pain risk

MRI

›MRI considerations

›Alternative when CT contraindicated

›Limited role in acute unstable abdominal pain

›MRCP when biliary obstruction concern and stable

›CT pathways

›CT angiography chest abdomen pelvis for dissection concern

›CT abdomen pelvis with IV contrast for perforation or ischemia concern

›CT abdomen pelvis without contrast for renal colic when stable

Ultrasound

›Ultrasound use cases

›POCUS FAST when trauma or hemorrhage concern

›POCUS abdominal aorta screening when hypotension and rupture concern

›Left pleural effusion assessment

›Splenic size and free fluid support findings

13Special Tests/spec7

Bedside and procedural

›Bedside diagnostics

›Rectal exam when GI bleed concern

›Nasogastric aspirate local protocol dependent

›Point of care hemoglobin local protocol dependent

Respiratory focused tests

›Pulmonary adjuncts

›Peak flow when asthma mimic suspected

›D dimer only in low to intermediate PE risk

14ECG/ecg13

Indications and timing

›ECG triggers

›Any upper abdominal pain with cardiac risk

›Diaphoresis

›Dyspnea

›Syncope

High risk patterns

›ECG danger findings

›STEMI criteria

›New ischemic ST depression

›New T wave inversion in contiguous leads

›Ventricular arrhythmia

Serial strategy

›Repetition logic

›Repeat in 15 to 30 minutes if ongoing concern

›Repeat with new symptoms or hemodynamic change

15Assessment/ax13

Problem representation

›Working synthesis

›Hemodynamic status category

›Peritonitis present or absent

›Cardiac and vascular risk context

Risk stratification

›High risk flags

›Shock physiology

›Active bleeding features

›Suspected vascular catastrophe

Complications to exclude

›Complication screen

›Pancreatitis complications

›Perforation

›Sepsis

›ACS equivalent

16Plan/plan31

First 5 minutes

›Immediate stabilization

›Cardiac monitor

›Pulse oximetry

›Two large bore IVs if unstable

›Oxygen if saturation less than 92 percent

›Massive transfusion activation local protocol dependent

Diagnostic sequencing

›Test prioritization

›ECG within 10 minutes when cardiac concern

›Bedside ultrasound in unstable patient

›CTA when dissection concern and stable enough

Analgesia and antiemetics

›Symptom control options

›Acetaminophen PO 1000 mg once

›Hydromorphone IV 0.5 mg

›Titrate every 10 minutes as needed

›Ondansetron IV 4 mg

›Avoid NSAIDs in suspected GI bleed or renal injury

Condition directed therapy

›Targeted treatments

›Suspected GI bleed

›Pantoprazole IV 80 mg bolus

›Then 8 mg per hour infusion local protocol dependent

›Suspected pancreatitis

›Balanced crystalloid bolus 10 mL per kg if hypovolemic

›Avoid routine antibiotics unless infected necrosis concern

›Suspected ACS

›Aspirin PO 160 mg chewable if no contraindication

›Nitrates contraindicated with hypotension or RV infarct concern

Reassessment loop

›Recheck cadence

›Pain score after each intervention

›Vitals every 15 minutes if unstable

›Abdominal exam repeat after analgesia

›Escalate level of care for deterioration

17Disposition/dispo19

ICU and monitored care

›Higher acuity criteria

›Ongoing hypotension after fluids

›Vasopressor requirement

›Active GI bleeding with transfusion need

›Suspected dissection

Inpatient admission

›Admission indications

›Pancreatitis with organ dysfunction

›Pneumonia with hypoxia

›Splenic injury

›Uncontrolled pain or vomiting

Observation pathway

›Observation candidates

›Low risk chest pain pathway eligible

›Stable renal colic with pain control

Discharge criteria

›Safe discharge requirements

›Stable vitals

›Pain controlled with oral meds

›Oral intake tolerated

›No peritonitis

›Reliable follow up

18Discharge Instructions/di23

Copy discharge instructions

›Diagnosis summary

›Left upper abdominal pain evaluation today did not show an emergency cause on the tests performed

›Some conditions can evolve over time and may not show early on initial testing

›Medications

›Use acetaminophen as directed on the label

›Avoid NSAIDs if you have stomach bleeding risk or kidney problems

›Take prescribed nausea medicine only as directed

›Activity

›Avoid heavy lifting until symptoms improve

›Hydration with frequent small sips

›Follow up

›Primary care or clinic follow up within 24 to 72 hours

›Return sooner if symptoms worsen

›Return to ED now for

›Fainting

›Chest pain

›Trouble breathing

›Vomiting blood

›Black stools

›Fever with worsening pain

›New severe sudden pain

›Weakness on one side

›Inability to keep fluids down

19References/r6

Key sources

›Evidence base

›American College of Cardiology and American Heart Association guideline for acute coronary syndromes 2025

›American Heart Association scientific statement on aortic dissection evaluation and management 2022

›American College of Gastroenterology guideline for upper gastrointestinal and ulcer bleeding 2021

›American College of Gastroenterology guideline for acute pancreatitis 2024

›ACEP clinical policy for suspected pulmonary embolism evaluation 2018

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.