ATS - abdominal emergencies

PowerPoint module from Action Training Systems

1. EMERGENCY MEDICAL TECHNICIAN Abdominal Emergencies

2. Section 1 Introduction

3. Types of Abdominal Incidents: Injuries and acute distress to abdominal organs can occur from a wide range of incidents: Blunt trauma Lacerations Impaled objects Projectiles Disease 3

4. Abdominal Organs: The abdomen houses a large number of vital organs that are not well protected by skeletal structures  4

5. Abdominal Emergencies: When faced with an abdominal emergency, you must be able to: Quickly assess the patient’s condition: Nature Severity Extent Take immediate efforts to stabilize the patient 5

6. Section 2 Assessment of Acute Abdomen

7. Training Objectives: Assessment of Acute Abdomen Acute Abdominal Emergency Care Abdominal Trauma

8. Acute Abdomen: Acute abdomen, or acute abdominal distress, is the sudden onset of severe abdominal pain Any patient with symptoms of acute abdomen requires immediate medical attention 8

9. Acute Abdomen Causes: (cont.) Multiple causes for acute abdomen: Indigestion Serious medical emergencies: Appendicitis Peritonitis Intestinal obstruction Complications from pregnancy 9

10. Causes of Pain: Abdominal pain can occur from several different mechanisms, including: Swelling or distention of the large or small intestine C onditions that cause inflammation or ischemia of the abdominal wall or of other organs 10

11. Many conditions have similar and often vague symptoms, making it difficult to determine the root cause You may not be able to diagnose the root cause of the emergency Take ALL complaints of abdominal pain extremely seriously 11 Acute Abdomen Symptoms:

12. Structures in the Abdomen: The abdominal cavity contains three types of structures : Hollow organs Solid organs Vascular structures 12

13. Describing the Abdomen: Referencing areas of the abdomen: Divided into quadrant Designated by the patient’s left and right side The navel is used as the central reference point: This area extends below the diaphragm to the top of the pelvis 13

14. Left Upper Quadrant: Contains: Small intestines The stomach The spleen The p ancreas Part of the large intestine The left kidney is behind the abdominal lining 14

15. Right Upper Quadrant: Contains: Small intestines Most of the liver Gallbladder The duodenum Part of the large intestine The right kidney is behind the abdominal lining 15

16. Right Lower Quadrant: Contains: Small intestines The appendix Part of the large intestine Female reproductive organs 16

17. Left Lower Quadrant: Contains: Small intestines Part of the large intestine Female reproductive organs 17

18. Types of Pain: Abdominal pain is classified as: Visceral Referred Parietal 18

19. Visceral Pain: Visceral pain is common when the organ itself is involved Most organs do not have nerve fibers: Pain is usually less severe Exact area is not easily identified 19

20. Visceral Pain: (cont.) The pain is often described as dull, aching or oppressive: It may be constant or intermittent Nausea and vomiting are common 20

21. Referred Pain: Referred pain is a result of visceral pain: Due to shared pathways of some organs with sensory nerves Referred pain is felt at another location unrelated to the site of the pain stimulus: Identifying the location or cause of the pain is difficult 21

22. Pain in the patient’s back or shoulders, might actually be a problem with the liver Referred pain results because nerve pathways leading back to the spinal cord share pathways with nerves that signal pain in other areas of the body 22 Referred Pain: (cont.)

23. Parietal pain is associated with the peritoneum Peritoneum lines the abdominal cavity and contains several organs 23 Parietal Pain:

24. Parietal Pain: (cont.) When the peritoneum is irritated or inflamed, it produces a sharp, constant pain: Pain is more localized and intense Often found on one side of the abdomen Patient will usually lie supine Knees flexed up toward the chest 24

25. Common Signs & Symptoms of Acute Abdomen: Abdominal pain Nausea and vomiting Guarding of the abdomen Rigidity of the abdomen Distention of the abdomen 25 Signs and Symptoms:

26. After conducting your initial assessment and SAMPLE history, use the mnemonic OPQRST to determine the condition’s: O nset P rovocation/ P alliation Q uality R egion/ R adiating pain S everity T ime 26 OPQRST:

27. History Gathering : Continue gathering history related to the patient’s condition: Fever Chills Unusual: Urination Bowel movements Any known gastrointestinal disease? 27

28. GI bleeding can occur anywhere in the digestive tract from the esophagus to the rectum 28 Gastrointestinal Bleeding:

29. S/S of GI Bleeding: A black, tarry stool coloratio n B right red blood in the stool Bright red blood in vomitus or a coffee-ground appearance   W eakness S yncope Tachycardia S igns of shock 29

30. Ask about: Menstrual cycle Pregnancy Childbirth history Consider possibility of ectopic pregnancy Patient may not know she is pregnant Ruptures often occur 5-9 weeks 30 Females with Abdominal Pain:

31. A dull aching pain: Is poorly localized and becomes sudden and sharp on one side in one lower quadrant Shoulder pain (referred pain) Vaginal bleeding: Heavy Light Absent 31 S/S of Ectopic Pregnancy:

32. S/S of Ectopic Pregnancy: (cont.) Tender , bloated abdomen Weakness or dizziness Decreased blood pressure An increased pulse Signs of shock 32

33. Obstruction to and inflammation of the appendix A common cause of acute abdomen If untreated, the inflammation may cause the tissue to die and rupture: Causing serious infection in the peritoneum Appendicitis is common in children and elderly 33 Appendicitis:

34. S/S of Appendicitis: Nausea and vomiting Low-grade fever and chills Lack of appetite Abdominal guarding Abdominal pain or cramping 34

35. Appendicitis Pain: Pain associated with appendicitis often begins as dull, diffuse and located around the umbilicus L ater it may become more localized and persistent in the right lower quadrant 35

36. Assessment: Once you have finished your questions and gathered any past medical history information, document your findings B egin a physical exam focusing on the chief complaint 36

37. Section 3 Acute Abdominal Emergency Care

38. M anagement: To manage an acute abdomen: First address any life-threatening conditions involving the ABCs If breathing is adequate, allow the patient to remain in a position of comfort . 38

39. Management: (cont.) Encourage the patient to assume a position of comfort He or she may already be in a guarded position: Arms folded across the abdomen Knees drawn up 39

40. Assessment: Obtain baseline vitals and look for signs of shock This may include: A rapid, thready pulse Restlessness Cool , clammy skin 40

41. Management: (cont.) Provide oxygen according to protocol Palpate the abdomen only if there is no pulsating mass: Use firm pressure Feel for any rigidity Does the patient feel tenderness or pain as you palpate? 41

42. Assessment: Normal findings include: Soft abdomen No tenderness Abnormal findings include: Pain Signs of shock Fever  Nausea, vomiting or diarrhea—note: If excessive If blood was in the vomit or the stool 42

43. 43 Patient Priority: An a cute abdominal distress patient is a priority patient if: Poor general appearance Inability to follow commands Unresponsiveness Showing signs of shock Severe pain

44. Section 4 Abdominal Trauma

45. Abdominal Injury Dangers: Abdominal injuries can be: Extremely serious Life threatening  Damage to internal organs can: Cause severe internal bleeding Quickly lead to shock 45

46. Abdominal Injury Dangers: (cont.) Damage to a hollow organ, such as the intestines or stomach, can cause: Contents to drain into the abdominal and pelvic cavities Significant amount of pain Sepsis, or severe infection in the abdomen Septic shock 46

47. 47 An open wound to the abdomen, pelvis or lower back Indications of blunt trauma to the abdomen or pelvis Pain or cramps in the abdomen or pelvis Guarding of the abdomen Rigid, distended or tender abdomen Abdominal Injury Signs/Symptoms:

48. Penetrating Injury: Penetrating injury such as a gunshot wound: Look for an exit wound: Should be treated first Likely more serious than the entry wound Serious damage can occur to surrounding tissues, not just in the direct path of the penetrating object Open wound: Control the bleeding Dress the wound 48

49. Penetrating Injury: (cont.) Maintain an open airway Administer oxygen if permitted by local protocol Assist the patient into a position of comfort, usually: Lying on his or her side Knees drawn up 49

50. Penetrating Injury: (cont.) Treat patient for shock Continually monitor vital signs  There may be vomiting that patient could aspirate Limit risk of vomiting: Do not give the patient anything by mouth even if asked Be prepared for suctioning 50

51. Evisceration Injury: An evisceration: Open injury to the abdomen Organs protruding from the wound 51

52. Evisceration Injury: (cont.) Do not try to replace the organs Soak a thick dressing with sterile saline and cover the wound Apply an occlusive dressing over the moist dressing if your local protocol permits it 52

53. Evisceration Injury: (cont.) Cover the occlusive dressing with additional dressing to preserve warmth Bandage the dressing in place above and below the evisceration using tape or cloth ties Provide care for shock Do not give the patient anything by mouth 53

54. Impaled Object: Do not attempt to remove an impaled object from the abdomen: Object could be sealing a damaged blood vessel Removal could cause sudden, serious blood loss and further injury Instead, expose the wound, cutting clothing if necessary 54

55. 55 Impaled Object: (cont.) Avoid touching or disturbing the object if possible Control any bleeding by applying direct pressure around the object Be careful not to apply pressure to the tissues along the edges of the object

56. Impaled Object: (cont.) It may be necessary to stabilize or secure the object If it is long or heavy, you may need to hold it in place 56

57. Impaled Object: (cont.) To secure an object: Lay bulky dressing along the: Long axis of the body Opposite sides of the object Hold the dressings in place Stack additional dressing perpendicular across the previously placed layer Continue layering until the object is stabilized 57

58. Impaled Object: (cont.) Alternative method to secure an object: Cut a hole larger than the object in the dressing Lower it carefully over the object Bandage dressings above and below the injury with tape or cloth ties 58

59. Impaled Object: (cont.) Do not give the patient anything by mouth Provide reassurance Keeping the patient calm will help stabilize vital signs Prepare to transport 59

60. Section 5 Summary

61. Summary: Assessment of Acute Abdomen Acute Abdominal Emergency Care Abdominal Trauma

62. Summary Injuries to the abdomen are among the most serious you will encounter The abdomen can be the location of multiple life-threatening, traumatic injuries and diseases that can lead to significant pain and bleeding Without proper emergency care, these conditions can quickly lead to shock and death

63. The End