First 5 minutes critical pathway
›Immediate priorities
›Monitoring
›Continuous pulse oximetry if unstable
›Cardiac monitor if unstable
›IV access
›Two large bore IV if shock concern
›Blood draw with first access
›Fluids
›Isotonic crystalloid bolus for hypotension
›Reassess after each bolus
›Transfusion
›Massive hemorrhage protocol local protocol dependent
›Type specific blood when available
Analgesia and symptom control
›Pain and nausea control
›Acetaminophen PO or IV
›NSAID if no contraindication
›Opioid for severe pain
›Antiemetic selection with QT risk check
›Testing sequence
›Pregnancy test early for all reproductive potential patients
›Transvaginal ultrasound first if pregnancy possible
›CT pathway if GI or urinary source suspected and pregnancy excluded
Condition specific management
›Suspected ectopic pregnancy
›OB GYN consult
›Rh immune globulin for Rh negative with bleeding local protocol dependent
›Avoid discharge until ectopic excluded or plan for serial hCG
›Suspected ovarian torsion
›Urgent gynecology consult
›Time critical ultrasound with Doppler
›NPO status
›Suspected PID
›Empiric antibiotics per guideline local protocol dependent
›Partner treatment plan referral
›Consider admission if TOA concern
›Suspected ruptured hemorrhagic cyst
›Serial vitals
›Hemoglobin trend
›Ultrasound free fluid assessment
›Recheck triggers
›Vitals every 15 to 30 minutes if unstable
›Repeat abdominal exam after analgesia
›Repeat hemoglobin if bleeding concern
›Escalate if rising pain or new peritoneal signs
›Specialty involvement
›OB GYN for pregnancy related emergencies torsion TOA
›General surgery for appendicitis obstruction peritonitis
›Urology for obstructing stone with infection
›ICU for shock or sepsis