First 5 minutes and stabilization
›Immediate priorities
›Cardiac monitor when unstable
›Two large bore IV when shock suspected
›Crystalloid bolus if hypotensive
›NPO if surgical abdomen possible
›Analgesia and antiemetics
›Acetaminophen PO or IV dosing per local protocol
›NSAID if renal function acceptable and no bleeding risk
›Opioid for severe pain with reassessment loop
›Ondansetron dosing per local protocol
›Pregnancy first approach for people who can be pregnant
›Urine pregnancy test early
›Immediate ultrasound pathway if positive pregnancy test and pain
›Appendicitis pathway
›Risk score to guide imaging and consultation
›Ultrasound first in children and pregnancy when feasible
›CT abdomen pelvis when ultrasound nondiagnostic and suspicion persists
›Renal colic pathway
›Urinalysis for hematuria and infection
›Imaging selection based on risk and pregnancy
›Infection with obstruction triggers emergent urology consultation
›Antibiotics when appendicitis complicated or sepsis suspected
›Broad spectrum coverage per local protocol
›Allergy guided alternatives per local protocol
›Pelvic inflammatory disease empiric treatment when criteria met
›Ceftriaxone dosing per local protocol
›Doxycycline dosing per local protocol
›Metronidazole dosing per local protocol
›Renal colic management
›NSAID first line when not contraindicated
›Tamsulosin for distal ureteral stone local protocol dependent
›Hydration guided by volume status
Consultation and reassessment loop
›Consultation triggers
›Surgery for suspected appendicitis with high risk features
›Gynecology for suspected ectopic pregnancy or ovarian torsion
›Urology for obstructing stone with infection or acute kidney injury
›Reassessment loop
›Repeat vitals within 30 to 60 minutes when unstable or escalating pain
›Repeat abdominal exam after analgesia
›Escalate imaging or consult if new peritoneal signs