Special Operations Forces Medical Handbook

3-4

Basic ToolsVital Signs AppearanceGastric Contents[examine if (+) history of melena or hematemesis]Abdomen Rectal Examination

Clinical Findings•^

Pulse > 100 beats per minute

• 
  

Systolic BP < 90

• 
  

Orthostatic change in VS (systolic BP drop of 20 mm Hg or pulse

rise 20 beats per minute)

-^

Temperature (above 101.5 F)

-^

Pallor of anemia, diaphoresis

NG aspirate•^

Bile; no blood or coffee grounds

-^

Coffee ground

-^

Bright red blood

-^

Rigid abdomen with guarding

-^

Abdominal distention without bowel sounds

-^

Abdominal distention with high pitched and tinkling bowel sounds

-^

Disproportionate pain to abdominal exam

-^

Melena (black, sticky, and tar-like stool)

Interpretations•^

Probable hypovolemia

-^

Probable hypovolemia

-^

Signicant hypovolemia

-^

Suggests infection or inammation

-^

Suggests signicant blood loss

-^

No active bleeding

-^

Recent bleeding

-^

Active bleeding

-^

Peritonitis

-^

Ileus

-^

Small bowel obstruction

-^

Intestinal ischemia, infarction, sickle crisis, or abdominal

aneurysm

-^

Recent UGI bleeding

Table 3-2 Abdominal Pain Objective Signs.