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Immediate priorities
Stabilization priorities
Airway compromise triggers
Depressed mental status
Recurrent emesis with aspiration risk
Breathing compromise triggers
Hypoxemia
Increased work of breathing
Circulatory compromise triggers
Hypotension
Tachycardia with poor perfusion
Syncope or near syncope
Hemorrhagic shock concern
Shock index greater than 0.9
Persistent abdominal pain with peritoneal signs
Rapidly increasing abdominal distension
Immediate actions if unstable
Two large bore IV access
Cardiac monitor
Frequent BP reassessment
Point of care hemoglobin if available
Early consultations
Obstetrics gynecology consultation triggers
Hemodynamic instability
Hemoglobin trend down
Large hemoperitoneum on imaging
Persistent severe pain despite analgesia
Concern for torsion
Pregnancy with pelvic pain
General surgery consultation triggers
Concern for appendicitis
Peritonitis with unclear source
Time critical exclusions
Ectopic pregnancy until excluded
Positive pregnancy test
No confirmed intrauterine pregnancy
Ovarian torsion until excluded
Sudden severe unilateral pelvic pain
Nausea and vomiting
Adnexal tenderness or mass
Sepsis source consideration
Fever
Rigors
Purulent discharge
Hemodynamic targets and monitoring
Monitoring strategy
Vital sign frequency based on stability
Unstable every 5 to 15 minutes
Stable every 30 to 60 minutes until disposition
Urine output if shock concern
Foley catheter if ongoing resuscitation
Serial abdominal examinations
Worsening tenderness
New rebound or guarding
Resuscitation endpoints
Systolic blood pressure at least 90 mmHg
Heart rate trend down
Mentation baseline
Capillary refill improving
Lactate trend down if elevated
Key concepts
Core framing
Ruptured ovarian cyst as common cause of acute pelvic pain with possible hemoperitoneum
Corpus luteum cyst rupture as typical hemorrhagic source
Bleeding risk higher with anticoagulation or bleeding disorders
Management split by stability
Stable with controlled pain and stable hemoglobin
Unstable or ongoing hemorrhage requiring operative evaluation
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.