NON-TRAUMATIC ABDOMINAL EMERGENCIES

INTRODUCTION

Optimal patient care requires that the EMT-I understand pathophysiology and principles of management of the patient with a non-traumatic abdominal emergency. The following topics

will be discussed during this lesson:

· Anatomy and physiology of the abdomen.

· Assessment of the abdomen.

· Abdominal pathophysiology.

· Prehospital care of patients with abdominal pain.

LESSON OBJECTIVES

At the end of this lesson the participants will be able to:

1. Identify the four quadrants of the abdominal cavity.

2. Name major organs located in each of the four quadrants.

3. State what should be included in the initial assessment and detailed history and physical exam assessment.

4. Describe the pertinent questions to be included in the history assessment of a patient with abdominal pain.

5. State the signs/symptoms and field treatment of different GI emergencies.

6 Recognize the signs/symptoms of different GU emergencies.

7. Identify signs/symptoms of reproductive emergencies including field treatment.

8. State the general principles of field treatment for the patient experiencing abdominal pain.

9. Discuss the EMT-I responsibilities when dealing with a patient experiencing abdominal

pain.

10. Discuss transport decisions for non-traumatic abdominal emergencies.

SKILLS

Orthostatic vital signs

KEY VOCABULARY

The following terms will be used during this lesson:

· Abdominal Aneurysm - tear in between layers of the aorta creating a balloon

effect which may rupture causing massive bleeding

· Anorexia - lack or loss of appetite

· Anemia - a decrease in blood hemoglobin

· Appendicitis - inflammation/infection of the appendix

· Diverticula - small pouches on the colon from degeneration of the muscle layer

· Esophageal Varices - enlarged (dilated) blood vessels in the esophagus which may

be easily ruptured causing severe bleeding; usually caused by liver disease

· Hematemesis - vomiting blood

· Hematuria - blood in the urine

· Hemorrhoid - enlarged blood vessels near the anus

· L.M.P. - abbreviation for last menstrual period

· Melena - black, tar like feces caused by gastrointestinal bleeding

· N.P.O. - an abbreviation that means nothing by mouth

· Peritoneum - a fibrous sac surrounding the abdominal cavity

· Peritonitis - an inflammation of the peritoneum

· Periumbilical - area surrounding the umbilicus.

· Ulcer - erosion of the stomach or intestinal lining which causes pain and/or

bleeding

KEY CONCEPTS

The following section provides information and space for taking notes on the key concepts discussed by the instructor.

ABDOMINAL ANATOMY

Boundaries of the Abdomen

· Diaphragm

· Anterior abdominal wall

· Pelvic skeletal structure

· Vertebral column

· Muscles of the abdomen and flank

Surface Anatomy

· Upper quadrants (2)

o Right and left

o Upper border - xiphoid

· Lower quadrants

o Right and left (2)

o Lower border - symphysis pubis

The point of intersection is the umbilicus.

Left Upper Quadrant

· Spleen

· Tail of the pancreas

· Stomach

· Left kidney

· Part of the colon

Right Upper Quadrant

· Liver

· Gall bladder

· Head of the pancreas

· Right kidney

· Part of the duodenum

· Part of the colon

Left Lower Quadrant

· Small intestines

· Descending colon

· Left ovary and fallopian tubes

Right Lower Quadrant

· Appendix

· Ascending colon

· Small intestine

· Right ovary and fallopian tube

Structure and Function of the Gastrointestinal System

· Function: The gastrointestinal system is responsible for converting raw food into an energy form that the body can use.

· Organs of digestion:

o Oral cavity

o Esophagus

o Intestines

· Accessory Organs of Digestion

o Salivary glands

o Teeth

o Liver

o Gallbladder

o Pancreas

o Appendix

INITIAL ASSESSMENT AND FOCUSED HISTORY AND DETAILED PHYSICAL

EXAMINATION FOR NON-TRAUMATIC ABDOMINAL EMERGENCIES

1). Assess environment: (may need to manipulate the environment)

· Safety of rescuers and environment

Environmental factors

Medications (may offer clues to past medical history)
Witnesses (may help to explain circumstances)

3). Breathing: assess the rate and quality of respirations

5). Skin signs: assess color, temperature and moisture

Pale, cool, moist skin and delayed capillary refill are due to peripheral vasoconstriction

If signs of poor perfusion, consider placing patient supine

7). Determine chief complaint:

4). Circulation: palpate for pulse noting rate/rhythm/quality

2). Airway: determine responsiveness and patency of airway

FOCUSED HISTORY AND DETAILED PHYSICAL EXAMINATION

6). Assess Neurological Status:

Assess level of consciousness using the GCS, and neuro deficits

3). Vital Signs

Blood pressure—not a reliable early indicator of shock; assess for more subtle signs (capillary refill, heart rate, altered LOC)

Orthostatic vital signs if indicated

Pulse—rate and quality

Respirations—rate, depth, tidal volume, and lung sounds (present, absent, or abnormal)

Pupils—(pupillary size and reaction to light)

1). Elicit history of chief complaint or problem (PQRST)

P         provoking factor

Q         quality of pain

R         radiation or region

S         severity

T          time of onset

4). Special Questions

Ask questions specific to chief complaint:

Nausea/vomiting

Diarrhea/constipation

Hematuria

Melena

Anorexia

Fever

Weakness/syncope

2). Elicit personal history (HAM)

H medical history/under a doctors care

A   allergies/age

M   medications-current over the counter and prescription

5). Pertinent Body Check:

Medical or minor trauma—perform body check pertinent to chief complaint