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Emergency Medicine Education Programme

Emergency Medicine Education Programme. Severe Abdominal Pain Induction 2010. 67 year old male Sudden onset of severe upper abdominal pain Vomited x 2 What else do you want to know?. Pulse 121 BP 143/109 RR 24 Abdomen – upper half rigid and guarded. Patient One.

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Emergency Medicine Education Programme

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  1. Emergency Medicine Education Programme Severe Abdominal Pain Induction 2010

  2. 67 year old male Sudden onset of severe upper abdominal pain Vomited x 2 What else do you want to know? Pulse 121 BP 143/109 RR 24 Abdomen – upper half rigid and guarded Patient One

  3. Appropriate Environment Resus / Monitored bed IV access FBC U&Es RBS Amylase G&S IV fluids IV Opiate (morphine) IV antiemetic 12 lead ECG Erect CXR E.D Management

  4. Risk factors Alcohol Pancreatitis PUD PMH Medications NSAIDs Allergies Last Ate / Drank Focused History

  5. CXR Discuss with a Senior

  6. Perforation of peptic ulcer Differential Severe Pain Acute Pancreatitis Cholelithiasis Acute peptic ulcer Other perforation Medical cause - ACS Diagnosis

  7. 74 year old man PMH IHD Sudden onset severe pain left loin radiating to groin Cold and Clammy P 124 BP 187/125 No palpable abdominal mass Tender left lumbar and left iliac fossa Case 2

  8. Ruptured Abdominal Aortic Aneurysm Ureteric Colic Differential Diagnosis ‘Renal Colic’ in a patient >60 is a AAA until proved otherwise

  9. ED Management • Get a senior • and get the surgeons • IV access • large bore cannula x2 • FBC, U&Es, RBS, XM 8 (x2 samples SJUH) • IV fluids & Opiate Analgesia ( morphine) • maintain a palpable radial pulse • but do not infuse to restore normal BP if hypotensive

  10. ED Management - Continued • If need to confirm • bedside ultrasound or • CT if haemodynamically stable • Catheter

  11. Vascular Services in Leeds • Centralised at LGI • Ambulance triage to LGI • Patients at SJUH with definite AAA • referred to Vascular SpR or Consultant at LGI • 999 Paramedic transfer to ED Resus • Moribund or ?AAA patients referred to SJUH surgical team

  12. Principles • ABC care • Effective analgesia based on pain score and re-assessments( titrate to pain score) • Think of medical causes • Always check femorals & other hernial orifices • PR/PV if lower abdominal pain • (Chaperone)

  13. Principles • Always do a urine test and PT in female of child bearing age • Blood tests generally unhelpful • do not delay decision making • Erect CXR if you suspect perforation • Abdominal film if you suspect obstruction

  14. Any Questions ?

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