What are the guidelines for ground transport by a nurse and paramedic for a pediatric patient with new onset abdominal pain?

From the Guidelines

Ground transport of a pediatric patient with new onset abdominal pain by a nurse and paramedic team should prioritize a structured approach focusing on assessment, stabilization, and monitoring, as outlined in the most recent guidelines 1. The transport team should first perform a thorough assessment including vital signs (heart rate, blood pressure, respiratory rate, temperature, and oxygen saturation), pain evaluation using an age-appropriate scale (FLACC for younger children, numeric scale for older ones), and focused abdominal examination. Key considerations for the transport team include:

• Establishing intravenous access using an appropriately sized catheter (22-24G for younger children, 20-22G for adolescents) 1
• Providing fluid resuscitation with isotonic crystalloids (normal saline or Ringer's lactate) at 20 mL/kg boluses if signs of dehydration or hypovolemia are present 1
• Managing pain with acetaminophen (15 mg/kg/dose) or ibuprofen (10 mg/kg/dose) for mild pain, or morphine (0.05-0.1 mg/kg IV) for moderate to severe pain, titrated carefully, as recommended by recent studies on pediatric pain management 1
• Administering ondansetron (0.15 mg/kg IV/oral, maximum 4 mg) for nausea or vomiting, as supported by evidence on the relief of pain and anxiety in pediatric patients in emergency medical systems 1 The transport team should maintain NPO status, position the patient comfortably, continuously monitor vital signs every 15 minutes, reassess pain regularly, and document findings thoroughly. They should be prepared for potential deterioration with appropriate equipment for airway management and emergency medications, as outlined in the recommended essential equipment for basic life support and advanced life support ground ambulances 1. Communication with the receiving facility about the patient's condition and estimated arrival time is essential for continuity of care, and should be guided by the principles of suspected appendicitis in children, as discussed in recent studies 1.

From the Research

Guidelines for Ground Transport

• The goal of emergency management for a pediatric patient with new onset abdominal pain is to identify and treat any life-threatening medical or surgical disease condition and provide relief from pain 2.
• A rapid cardiopulmonary assessment should be performed to ensure hemodynamic stability, followed by a focused history and examination, surgical consult, and radiologic examination to exclude life-threatening surgical conditions 2.
• In cases of moderate to severe pain with localizing abdominal findings, an ultrasound abdomen is the first investigation of choice 2.
• For patients with significant abdominal trauma or features of pancreatitis, a Contrast-enhanced computerized tomography (CECT) abdomen may be a better initial modality 2.

Role of Nurse and Paramedic

• The nurse and paramedic should provide continuous monitoring and repeated physical examinations for the pediatric patient with abdominal pain 2.
• They should also provide adequate analgesia, IV fluids, and other supportive care as needed 2.
• In cases where the patient requires higher-level pediatric care, the nurse and paramedic should consider transport to a hospital with such resources, using criteria such as the need for IV antibiotics, airway management, or surgical intervention 3.

Transport Decisions

• The decision to transport a pediatric patient with abdominal pain to a hospital should be based on the severity of symptoms and the need for emergency medical care 4.
• Parents or guardians may prefer transport by EMS due to concerns about the acuity of illness and the security of EMS transport 4.
• However, they may also accept transport to alternative sites for immediate care, such as an urgent care center or primary care physician's office 4.

Emergency Department Observation Unit

• For pediatric patients with unclear etiology for acute abdominal pain, the emergency department observation unit (EDOU) may be a suitable alternative for monitoring and disposition 5.
• The EDOU can provide a safe and effective environment for patients to receive IV hydration, pain control, and other supportive care while awaiting further evaluation and disposition 5.