 Welcome back to approach to abdominal pain part 4. In this final video, we'll discuss how to put all we've learned in the past three videos together. Like all emergency medicine patients, if the patient is unstable, we want to start resuscitating them first. After that, we want to do a simultaneous approach to investigate and treat at the same time. Resuscitation starts with ABC. We need to make sure the patient's airway is patented and they're protecting their airway. We need to give patients oxygen if they're hypoxic. For circulation, we need to put patients on monitor to monitor their vital signs. If the patient is hypotensive or tachycardic, we need to give them crystalloids such as normal saline or ringers lactate. In the patients who are septic because of abdominal infection, early and aggressive IV fluids is key. Once we've adequately resuscitated the patient, we can start investigation and treatment at the same time. We'll first discuss the investigations. Your investigation will be dictated by what you find on history and physical. The investigation can include lab tests and imaging. In terms of their specific lab, I'll refer you to the previous video for the details. They can include routine labs such as CBC, electrolytes, and kidney functions. Depending on the location of the pain in our clinical suspicion, other tests such as liver markers, lipase, can be added. In certain cases, a urine dip and a beta-HCG is also necessary. As discussed before, our imaging choices can include x-ray, ultrasound, bedside or formal, or CT scan. The choice of the imaging will depend on what we think the problem is and how stable the patient is. As it's often mentioned before, an unstable patient should not be leaving the emergency department until they are more stable. For unstable patients, they might be able to have a portable x-ray in their bed and a bedside ultrasound. For patients who are stable, they will be able to leave the emergency department to get a formal ultrasound or a CT scan. At the same time of our investigation, we also would like to start treating the patient. Our treatment includes the following, medications and definitive surgical repair. We can expedite this by giving patient medications early in the course of their stay in the emergency department and expediting their diagnosis so they get to the appropriate surgical repair faster. We will give patients medications to decrease their pain. Good choices include parenteral opiates. Often an IV route is better because patients will usually be kept NPO prior to surgical repair. Anti-nausea medications can also be given. If we are suspicious of an infectious process, antibiotics should be given to patients early. Antibiotics should cover gram-positive, gram-negative and anaerobic organisms. The regimen will vary from institution to institution and is best to check with your staff. Our goal again in the emergency department is to get the patient to definitive treatment by surgeons as soon as we can. In a stable patient, we can often wait until after a definitive diagnosis is done through imaging before referring the patient. However, in the unstable patient, we may not have time to come up with a definitive diagnosis. In those patients, we like to refer early and we will work together with a surgical team to come up with what we think is the most likely diagnosis. In summary, we discuss how to put it all together in approaching the patient with abdominal pain. We will start with resuscitation ensuring the patient's ABC is fine. And then we will start a parallel approach of investigation and treatment. Based on your history and physical, you then choose the most appropriate lab work and imaging modality. At the same time, treatment should be given to control the patient's pain and discomfort. Antibiotics, if we're worried about an infectious process. And expediting the patient's surgical care by involving the consultants early, particularly in the unstable patient. For specific treatment, I refer you to the other videos in this series. We hope you find this helpful. Thank you for watching.