Abdominal and Genitourinary Objectives

1. Abdominal and Genitourinary Objectives Upon completion of this lecture, you will be better able to: • Describe specific parameters for assessing abdominal or GU complaints in students • Describe necessary interventions for selected abdominal or GU problems • Accurately triage students presenting with abdominal or GU complaints • Describe the procedure for emergency childbirth at school and interventions for potential complications affecting the mother and infant Illinois EMSC

2. ABDOMINAL ANDGENITOURINARYEMERGENCIES Illinois EMSC

3. SPECIAL CONSIDERATIONS • Very common complaint • Must take all complaints of abdominal pain seriously • History, assessment and cooperation needed • Privacy is essential • Watch facial expression during exam Illinois EMSC

4. TYPES OF ABDOMINAL PAIN Visceral • intermittent • cramping Somatic • severe, sharp Referred • felt away from source Illinois EMSC

5. PQRST - HISTORY • P= Problem (Provoke or palliative) • Q= Quality • R= Radiate • S= Severity (Signs and symptoms) • T= Timing Illinois EMSC

6. FOCUSED ASSESSMENT • Inspection • Skin color • Contour/Symmetry • Auscultation • Bowel sounds • Percussion • Palpation Illinois EMSC

7. Abdominal Assessment Illinois EMSC

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9. TESTS FOR INFLAMMATION • Iliopsoas • Obturator • Heel drop • Rebound Illinois EMSC

10. TRIAGE • EMERGENT • Trauma, rigid abdomen, distention • Absent bowel sounds • URGENT • Abdominal pain less than 24 hours • Tenderness on palpation, guarding • NON-URGENT • Gastroenteritis (without signs or symptoms of hypovolemic shock), constipation, RAP (recurrent abdominal pain) Illinois EMSC

11. SELECTED EMERGENCIES • Appendicitis • Acute Gastroenteritis • Constipation • Recurrent abdominal pain (RAP) • Trauma Illinois EMSC

12. SELECTED EMERGENCIES • Urinary Tract Infection (UTI) • Vaginal Bleeding • Ovarian Cyst • Ectopic Pregnancy • Testicular pain • Pelvic Inflammatory Disease (PID) • Sexually transmitted diseases Illinois EMSC

13. Out of Hospital Delivery Illinois EMSC

14. PREGNANCY HISTORY • Age • Prior pregnancies and deliveries • Expected due date • Prenatal care • Potential for multiple births Illinois EMSC

15. Stages of Labor There are 3 stages of labor: • First stage – begins when contractions become regular and ends when cervix is fully dilated • Second stage – begins when cervix is fully dilated and ends when the infant is fully delivered • Third stage – begins when the infant is fully delivered and ends with delivery of the placenta Illinois EMSC

16. DETERMINATION OF LABOR PROGRESSION • Presence of mucus plug or bloody show • Rupture of membranes • Time between contractions • Feeling of bowel movement Illinois EMSC

17. PREPARATION FOR DELIVERY • Contact EMS and follow school plan for childbirth • Follow universal body substance precautions • Place mother on hard surface • Remove essential clothing • Examine for crowning • Obtain supplies Illinois EMSC

18. DELIVERY • Support the infant’s head • Rupture the sac (if not already broken) • Observe for meconium staining • Observe for the umbilical cord • Suction the infant’s nose and mouth (mouth before nose) Illinois EMSC

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20. DELIVERY • Deliver the shoulders • Cut the umbilical cord once pulsations stop • Deliver placenta Illinois EMSC

21. POSTNATAL CARE OF INFANT • Keep infant warm • Keep airway clear • Assure adequate response • Auscultate respiratory and heart rate • Obtain APGAR score at 1 minute and 5 minutes Illinois EMSC

22. APGAR Score Illinois EMSC

23. Resuscitation Measures In most deliveries, the infant will need no other care beyond maintenance of warmth, airway suctioning and mild stimulation. Positive-pressure ventilation is indicated if any of the following conditions are present: • Apnea or gasping respirations • Heart rate slower than 100 beats/minute • Persistent central cyanosis despite 100% oxygen Illinois EMSC

24. POSTNATAL CARE OF THE MOTHER • Position of comfort • Uterine massage • Keep warm • Facilitate mother-infant bonding Illinois EMSC

25. Premature birth Multiple births Stillbirth Breech birth Prolapsed umbilical cord Pregnancy induced hypertension Hemorrhage Abruptio placentae Placenta previa Spontaneous abortion Trauma in Pregnancy Epistaxis Drug use during pregnancy SPECIAL SITUATIONS Illinois EMSC

26. PREVENTION • Early recognition of emergent and urgent conditions is fundamental to ensure appropriate management of the student with abdominal pain • Educate students about physical changes associated with puberty and encourage adoption of good hygiene and nutritional habits • Encourage safe-sex strategies to reduce the risk of pregnancy and sexually transmitted disease • When pregnancy does occur, students need to understand the importance of prenatal care and anticipate their post-partum needs Illinois EMSC

27. SUMMARY Identifying the location, intensity and quality of abdominal pain can assist in determining the most likely underlying condition, which will facilitate accurate triage and appropriate interventions. If there are pregnant students or staff in your school, be prepared to manage an out-of-hospital delivery. Stock sterile, prepackaged obstetric kits and additional supplies as appropriate. Review delivery procedures so that you will know how to assist the mother if the need should arise. Illinois EMSC

28. ANY QUESTIONS?? Illinois EMSC