›Immediate stabilization
›Airway and breathing
›Oxygen if hypoxemia
›Intubation if impending respiratory failure
›Circulation
›Two large bore IV
›Cardiac monitor
›IV crystalloid bolus if hypotensive
›Time critical consults
›Early surgical consult for suspected incarceration
›Immediate surgical activation for suspected strangulation
Analgesia and antiemetics
›Symptom control
›Opioid options
›Fentanyl IV 25 mcg to 50 mcg
›Repeat every 5 minutes to 10 minutes to effect
›Morphine IV 2 mg to 4 mg
›Repeat every 10 minutes to 15 minutes to effect
›Non opioid options
›Acetaminophen PO 1000 mg
›Acetaminophen IV 1000 mg
›Ketorolac IV 15 mg
›Antiemetic options
›Ondansetron IV 4 mg
›Metoclopramide IV 10 mg
›Resuscitation targets
›Crystalloid bolus
›500 mL to 1000 mL reassess
›30 mL per kg if septic shock local protocol dependent
›Electrolyte repletion
›Potassium replacement if low
›Magnesium replacement if low
›Antibiotics for suspected strangulation or perforation
›Broad spectrum coverage
›Piperacillin tazobactam IV 4.5 g
›Repeat every 6 hours
›Alternative regimen
›Ceftriaxone IV 2 g
›Metronidazole IV 500 mg
›Penicillin allergy regimen
›Ciprofloxacin IV 400 mg
›Metronidazole IV 500 mg
›Renal adjustment prompt
›Dose adjustment if kidney injury
›Pharmacy support when available
›Taxis pathway local protocol dependent
›Prerequisites
›No peritonitis
›No skin discoloration
›No systemic toxicity
›Pain improves with analgesia
›Technique principles
›Supine positioning
›Ice pack to reduce edema
›Gentle steady pressure
›Stop if worsening pain
›Post reduction monitoring
›Observe for recurrent pain
›Reassess abdomen for peritonitis
Imaging and consult sequencing
›Workflow
›Surgical consult before imaging if high suspicion strangulation
›CT abdomen pelvis with IV contrast if diagnosis uncertain or obstruction concern
›Ultrasound adjunct for groin or scrotal differential
›Reassessment
›Vitals every 15 minutes to 30 minutes if unstable
›Pain trajectory
›Abdominal exam changes
›Urine output monitoring