Chapter Goal. Learning Objectives 9/12/2012. Chapter 29. Nontraumatic Abdominal Injuries
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1 Chapter 29 Nontraumatic Abdominal Injuries Chapter Goal Use assessment findings to formulate field impression & implement treatment plan for patients with nontraumatic abdominal pain Learning Objectives Discuss pathophysiology of nontraumatic abdominal emergencies Discuss signs & symptoms of nontraumatic acute abdominal pain Discuss signs & symptoms of peritoneal inflammation relative to acute abdominal pain 1
2 Learning Objectives Describe questioning technique & specific questions EMT-Is should ask when gathering focused history from patients with nontraumatic abdominal pain Describe technique for performing comprehensive physical examination of patients with nontraumatic abdominal pain Recognize signs & symptoms of nontraumatic abdominal pain Learning Objectives Describe management of patients with nontraumatic abdominal pain Describe common causes of GI bleeding Describe proper care for patients with GI bleeding Introduction Acute abdomen abdominal pain not caused by injury Approach toward patient Life-threatening condition? If yes, priority patient If no, stabilize & transport Assume serious condition until proven otherwise 2
3 Anatomy & Physiology Review Pathophysiology & causes Immediately life-threatening diseases AMI AAA Ectopic pregnancy Ruptured viscus Pathophysiology & causes Common causes Bacterial contamination Chemical irritation Peritoneal inflammation Bleeding Obstruction Peptic ulcer disease Gastritis Pneumonia Pancreatitis Kidney stones PID Appendicitis Cholecystitis Pyelonephritis Diverticulitis Bowel obstruction Abdominal wall hernia 3
4 Patient assessment Initial assessment ABCs Disability Chief complaint Patient assessment History Recent weight loss When did patient last eat? Nausea, vomiting Location of pain & radiation Changes in bowel habits Appetite Chills, fever Painful urination Blood in urine, stool, vomitus Vaginal bleeding, discharge Cough Chest pain, dyspnea Referred pain 4
5 Patient assessment Focused physical examination General appearance Abdominal tenderness; guarding Pulsating mass Management & treatment Maintain airway; administer high-concentration O 2 Place patient in position of comfort Give nothing by mouth Start IV Monitor ECG Be prepared for vomiting; suction Consider AMI Transport gently but rapidly Approach GI Bleeding Can result in life-threatening hypovolemic shock Evaluate: Is patient s airway open? Is patient in shock? Is active bleeding present? 5
6 GI Bleeding Causes Upper GI bleeding Peptic ulcer disease Gastritis Esophageal varices esophagitis Lower GI bleeding Diverticulosis Tumors, hemorrhoids, polyps Rectal bleeding High risk Monitor & treat for shock GI Bleeding Patient assessment Use of aspirin, alcohol, antiinflammatory agents Vomit blood appears bright red, coffee-ground Blood passed via rectum appears bright red or like dark, tarry stool Pay special attention to: Airway Shock Abdominal pain Fever GI Bleeding Emergency care Maintain airway; assist breathing as necessary High-concentration O 2 Care for shock Start IV Anticipate vomiting; prepare to suction NPO Assume life-threatening lesion 6
7 Summary Acute abdominal pain not caused by injury Serious condition assumed to be present until proven otherwise Common causes for abdominal pain Potentially life threatening AMI, ruptured abdominal aortic aneurysm, ruptured ectopic pregnancy, & rupture of hollow viscus Summary Other conditions may lead to acute abdomen Initial assessment: evaluate airway, breathing, circulation, & disability and determine chief complaint Focused physical examination pay attention to palpation of abdomen Careful attention to ABCs is essential Summary IV line should be established according to local protocols Avoid administering pain medications & transport to medical facility GI bleeding may result from number of lesions 7
8 Questions? 8
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