Chapter 21

1. Chapter 21 Acute Abdominal Pain Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

2. Topics 21 • Abdominal structure and function • Acute abdominal pain • Assessment and care • Conditions that cause abdominal pain Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

3. Introduction 21 • Abdominal pain is experienced by most everybody, at some point in time • Acute abdominal pain that causes a person to summon EMS could signal a very serious medical condition Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

4. Abdominal Structure and Function 21 • Abdominal cavity • Located below the diaphragm, and extends to the pelvis • Lined by the visceral and parietal peritoneum • Contains many vital organs within the peritoneal sheath, or retroperitoneal Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

5. Abdominal Structure and Function 21 Relation of the abdominal cavity to other cavities of the body Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

6. Abdominal Structure and Function 21 Abdominalquadrants • Upper right quadrant • Upper left quadrant • Lower right quadrant • Lower left quadrant Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

7. Abdominal Structure and Function 21 Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

8. Abdominal Structure and Function 21 Abdominal quadrants Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

9. Abdominal Structure and Function 21 • The abdomen contains three types of organs: • Hollow organs • Solid • Vascular Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

10. Abdominal Structure and Function 21 Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

11. Acute Abdominal Pain 21 • Abdominal pain is also referred to as “acute abdomen,” or “acute abdominal distress” • All together, there are some 100+ different diagnoses of abdominal pain Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

12. Acute Abdominal Pain 21 • Abdominal pain may be from any one of numerous body systems • Cardiac or pulmonary • Gastrointestinal or urinary • Genital or reproductive Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

13. Acute Abdominal Pain 21 • The actual cause, is usually from one of the following mechanisms • Mechanical forces • Inflammation • Ischemia Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

14. Acute Abdominal Pain 21 • Classification of abdominal pain • Visceral • Parietal • Referred Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

15. Acute Abdominal Pain 21 The lines show where pain may be felt when there is disease or injury to the organ named Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

16. Assessment and Care: Acute Abdominal Pain 21 • Scene size-up • Assess scene for hazards • BSI precautions • Look for MOI/NOI • Determine number of patients • Call for backup if additional resources needed Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

17. Assessment and Care: Acute Abdominal Pain 21 • Initial assessment • Form a general impression, and note if patient is in a “guarded position” Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

18. Assessment and Care: Acute Abdominal Pain 21 • Initial assessment • Ensure the patient has a patent airway and adequate breathing, and support any lost function • Look for signs of hypoperfusion during circulatory assessment Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

19. Assessment and Care: Acute Abdominal Pain 21 • Focused history and physical exam • If the patient is a high priority, complete the rapid medical assessment and vitals, then a SAMPLE history • If the patient is a low priority, complete first the SAMPLE history, then the focused history and physical exam, and obtain a set of vitals Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

20. Assessment and Care: Acute Abdominal Pain 21 • Focused history and physical exam • Pertinent questions of the SAMPLE history Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

21. Assessment and Care: Acute Abdominal Pain 21 • Focused history and physical exam Inspection Identify area of pain Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

22. Assessment and Care: Acute Abdominal Pain 21 • Focused history and physical exam • Palpate furthest away from location of pain first Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

23. Assessment and Care: Acute Abdominal Pain 21 • Markle test: • Also known as “heel jar” or “heel drop” test • Technique used to assess for peritonitis Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

24. Assessment and Care: Acute Abdominal Pain 21 • Heel drop test Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

25. Assessment and Care: Acute Abdominal Pain 21 • Heel jar test Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

26. Assessment and Care: Acute Abdominal Pain 21 • Common signs and symptoms: • Pain or tenderness • Anxiety and fear • Guarded positioning • Rapid and shallow breathing • Rapid pulse, or changes in blood pressure • Nausea, vomiting, or diarrhea • Rigid or distended abdomen Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

27. Assessment and Care: Acute Abdominal Pain 21 • Emergency medical care • Keep airway patent (be alert for vomiting) • Place patient in position of comfort • Administer oxygen at 15 lpm • Calm and reassure the patient • Treat for hypoperfusion if present • Initiate quick transport • NEVER GIVE ANYTHING BY MOUTH Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

28. Assessment and Care: Acute Abdominal Pain 21 • Ongoing assessment • Perform an ongoing assessment during transport • Document and record all vital signs Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

29. Conditions That May Cause Acute Abdominal Pain 21 • Appendicitis • Inflammation of appendix • If left untreated, can lead to swelling and rupture Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

30. Conditions That May Cause Acute Abdominal Pain 21 • Pancreatitis • Inflammation of the pancreas • May be triggered by ingestion of ETOH or large amount of food Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

31. Conditions That May Cause Acute Abdominal Pain 21 • Cholecystitis • Inflammation of the gallbladder • Gallbladder may also become obstructed by gall stones Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

32. Conditions That May Cause Acute Abdominal Pain 21 • Intestinal obstruction • Blockage inside the intestines that stops the normal movement of intestinal contents • Commonly from adhesions, hernias, and tumors Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

33. Conditions That May Cause Acute Abdominal Pain 21 • Hernia • Caused by a small hole forming in the peritoneu. • The “strangulated” tissue may then become necrotic Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

34. Conditions That May Cause Acute Abdominal Pain 21 • Ulcer • Open wounds or sores to the digestive tract • Common to stomach and small intestines • Caused by gastric juices deteriorating walls Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

35. Conditions That May Cause Acute Abdominal Pain 21 • Esophageal varices • Bulging or weakness to veins of esophagus • Commonly from various liver diseases • Can result in profuse, painless bleeding Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

36. Conditions That May Cause Acute Abdominal Pain 21 • Abdominal aortic aneurysm • Weakening of descending aortic wall • Most lethal cause of abdominal pain Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen

37. Conditions That May Cause Acute Abdominal Pain 21 • Vomiting and diarrhea • Not an emergency in and of itself; rather an indication of some other abdominal problem Prehospital Emergency Care, 8th Ed. Mistovich/Karren/Hafen