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 Sigmoid diverticulosis

 Colitis (i.e., inflammatory bowel disease)

 Renal colic

 Abdominal aortic aneurysm

 Inguinal hernia

 Testicular/ovarian torsion

 Ectopic pregnancy

 Pelvic inflammatory disease

 Ovarian cyst

 Endometriosis

Table 19.1 Common sites of referred abdominal pain

Etiology	Region of perceived pain
Biliary colic/cholecystitis	Right scapula
Renal colic	Testicle, labia, inguinal region
Pancreatitis	Midback
Gastric or bowel perforation	Shoulder
Ruptured ectopic pregnancy	Shoulder
Rectal or prostate disorder	Lower back

Useful historical data may be obtained directly from the patient or from a parent or other care provider. Emphasizing a SAMPLE history is encouraged. The OPQRST mnemonic (Box 19.4) highlights important questions regarding signs and symptoms. Ask the patient about allergies prior to medication administration and consider anaphylactic reactions as a source of abdominal discomfort. EMS clinicians should transport all medications, or a comprehensive list, with the patient. Particular attention should be paid to cardiac, diabetic, steroid, and immunosuppressive agents. Medications such as beta‐blockers, anti‐inflammatory agents, and over‐the‐counter medications can affect the patient’s response to infection and inflammation, limiting early vital sign abnormalities. The past medical history may provide clues to the underlying condition. Past surgical history may point toward recurrent pathology such as diverticulitis or a complication of prior procedures such as abdominal wall hernias or bowel obstructions. History taking should include information about previous episodes of similar pain, diagnosis, and management. The patient should be questioned about his/her last oral intake and menstrual period. Finally, the events leading up to the current illness and EMS activation should be elicited.