The document provides information about assessing and treating patients experiencing abdominal pain or discomfort. It discusses performing a thorough secondary assessment to identify any serious or life-threatening conditions such as appendicitis, cholecystitis, pancreatitis, gastrointestinal bleeding, abdominal aortic aneurysm, hernia, or renal colic. The role of EMTs is to provide treatment and transport rather than make a specific diagnosis. Assessment involves obtaining a detailed history of the present illness and performing a physical exam of the abdomen.
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Planning Your Time: Plan 90 minutes for this chapter.
Abdominal Anatomy and Physiology (15 minutes)
Abdominal Pain or Discomfort (15 minutes)
Abdominal Conditions (30 minutes)
Assessment and Care of Abdominal Pain or Discomfort (30 minutes)
Note: The total teaching time recommended is only a guideline.
Core Concepts:
Understanding the nature of abdominal pain or discomfort
Becoming familiar with abdominal conditions that may cause pain or discomfort
How to assess and care for patients with abdominal pain or discomfort
Teaching Time: 15 minutes
Teaching Tips: The function of abdominal organ systems is an important topic, but it easily can drain time away from other important lessons. Consider taking this lesson out of the classroom by assigning homework and research projects. Use an anatomical model to demonstrate the positioning of abdominal organs. Relate the four quadrants of the abdomen to external landmarks. Demonstrate positioning on an actual abdomen. Refer to mechanism of injury to demonstrate why abdominal anatomy is important.
Covers Objective: 22.2
Covers Objective: 22.2
Point to Emphasize: The abdomen contains a variety of organs that accomplish a range of functions for the body. Digestion, secretion of insulin, filtration of blood, and the removal of toxins from the body are functions performed by abdominal organs.
Knowledge Application: Using a disassembled abdominal anatomy manikin, correctly reassemble the abdominal cavity. Label the organs as they are replaced.
Covers Objective: 22.2
Discussion Topics: List and describe the major organ systems of the abdomen. Discuss the function of each system. How are the abdominal organs of a man different from the abdominal organs of a woman? Describe these differences.
Class Activity: Assign homework. Have students, using a blank anatomy diagram of the abdomen, correctly label and position the major organ systems.
Covers Objective: 22.2
Point to Emphasize: Anatomically, the abdomen is divided into four quadrants, using the midline and umbilicus as dividing points.
Discussion Topic: Describe how the anatomy of the abdomen is divided into quadrants. Discuss external landmarks and the contents of each quadrant.
Covers Objective: 22.2
Point to Emphasize: Anatomically, the abdomen is divided into four quadrants, using the midline and umbilicus as dividing points.
Discussion Topic: Describe how the anatomy of the abdomen is divided into quadrants. Discuss external landmarks and the contents of each quadrant.
Covers Objective: 22.2
Covers Objective: 22.2
Points to Emphasize: Most organs are contained within the peritoneum, but some are located in the retroperitoneal space. Reproductive organs contained within the abdomen are different in women from what they are in men.
Discussion Topic: Explain what is meant by the term retroperitoneal. Discuss examples of retroperitoneal organs.
Knowledge Application: Have students work in small groups. Assign each group a specific abdominal organ. Have each group research and present the organ's location within the abdomen and its major function.
Critical Thinking: Consider penetrating trauma. How might knowledge of abdominal anatomy assist your assessment of mechanism of injury?
Covers Objective: 22.2
Knowledge Application: Using a manikin or programmed patient, use external landmarks to determine location of abdominal organs. Point out where organs would be with regard to visible landmarks.
Teaching Time: 15 minutes
Teaching Tips: Discuss etiology when describing the different classifications of abdominal pain. Give specific examples of organs that cause the particular type of pain. Use first-person testimony to describe the various types of pain. Students in class often have experienced the different pain classifications. Relate the classifications of pain to previous lessons on assessment. How might the memory aid OPQRST assist in assessing abdominal pain?
Covers Objective: 22.3
Points to Emphasize: Both peritoneal and retroperitoneal organs can cause pain in the abdomen. Visceral pain originates in the organs within the abdomen and is often described as dull, achy, or intermittent.
Knowledge Application: Have students work in small groups. Assign each group an abdominal dysfunction. Ask the group to research and present on the type of pain that is likely to be associated with its particular dysfunction.
Covers Objective: 22.3
Covers Objective: 22.3
Point to Emphasize: Parietal pain arises from the parietal peritoneum and often is described as sharp, constant, and localized to a particular area.
Discussion Topic: Compare and contrast visceral pain with parietal pain. How are they different? Give specific examples.
Knowledge Application: Using programmed patients, practice assessing abdominal pain. Practice using the mnemonic OPQRST to aid evaluation of pain.
Covers Objective: 22.3
Point to Emphasize: Tearing pain typically refers to a dissection of the abdominal aorta.
Discussion Topic: Describe the etiology of tearing pain. Discuss the most likely cause.
Class Activities: List a classification of pain on a whiteboard. Have students come up and write an adjective that might describe that type of pain. Repeat until the pain is best defined. Assign a research project. Give students (or groups of students) a classification of pain. Ask them to research and present different types of abdominal problems that might be associated with their classification.
Knowledge Application: Describe an abdominal pain. Have students classify the pain, based on your description, and then discuss the possible origin.
Covers Objective: 22.4
Point to Emphasize: Referred pain is felt in a place other than the place where the pain originates.
Discussion Topic: Define referred pain. Give an example of an organ system that is likely to cause referred pain.
Critical Thinking: Are there non-abdominal organs that can cause abdominal pain? List and describe them.
Teaching Time: 30 minutes
Teaching Tips: Emphasize the need to recognize life-threatening emergencies first and diagnose specific disorders second. Link assessment findings and the characteristics of pain to specific disorders. Tie this lesson to the previous discussion of pain classifications. There are excellent multimedia graphics that you can use to illustrate the pathophysiology of specific abdominal disorders. Use first-person testimony to describe specific abdominal problems. Students in class often have experienced abdominal dysfunctions.
Covers Objective: 22.5
Points to Emphasize: Assessment and management always will take a higher priority than determining the exact cause of abdominal pain. Specific assessment findings can point to particular types of abdominal problems. EMTs should use a thorough secondary assessment to work through a differential diagnosis.
Covers Objective: 22.5
Knowledge Application: Have students work in small groups. Assign one type of abdominal dysfunction; then have the group research the pathophysiology and present its findings.
Covers Objective: 22.5
Covers Objective: 22.5
Knowledge Application: Use programmed patients to present a variety of types of abdominal dysfunctions. Practice assessment scenarios.
Covers Objective: 22.5
Point to Emphasize: Bleeding can occur anywhere within the GI system, from the esophagus to the rectum. GI bleeding may be gradual or sudden, and it can be a life-threatening cause of shock.
Covers Objective: 22.5
Critical Thinking: You recognize GI bleeding. What findings might you associate with a life-threatening GI bleed?
Covers Objective: 22.5
Point to Emphasize: Retroperitoneal, tearing pain should be assumed to be caused by an abdominal aortic aneurism. This type of abdominal pain can point to an immediately life-threatening problem.
Knowledge Application: List specific abdominal disorders and have students formulate their own lists of associated assessment findings.
Covers Objective: 22.5
Covers Objective: 22.5
Covers Objective: 22.5
Covers Objective: 22.5
Covers Objective: 22.5
Class Activity: Assign a student an abdominal dysfunction and have the student act out the symptoms in front of the class. Ask the class to diagnose the student's disorder.
Covers Objective: 22.6
Point to Emphasize: Myocardial infarction sometimes can present as abdominal discomfort and should be considered in the assessment and treatment of a patient with abdominal pain.
Discussion Topic: Describe the pathophysiology and likely assessment findings for the following abdominal dysfunctions: appendicitis, cholecystitis, pancreatitis, GI bleeding, abdominal aortic aneurysm, hernia, renal colic, myocardial infarction.
Class Activity: Assign a research project. Give students a topic concerning a particular abdominal dysfunction. Have them research and present their findings to the class.
Covers Objective: 22.5
Video Clip
Abdominal Aortic Aneurysm
Where is the most common location of an abdominal aortic aneurysm?
What causes an AAA?
Discuss what would happen if the aneurysm were to rupture.
What signs and symptoms might a patient with an AAA have?
Teaching Time: 30 minutes
Teaching Tips: Use programmed patients to add a level of realism to practice. Always focus on life threats. Be sure to include critical patients in any practice session. Relate this lesson to patient assessment. Bring OPQRST and SAMPLE to realistic use now. Palpating an abdomen means actually touching. Do not allow verbalization. Practice proper palpation techniques.
Covers Objective: 22.7
Point to Emphasize: The focus of the assessment of a patient with abdominal pain should be to perform an accurate history and physical examination and to identify potentially serious conditions.
Covers Objective: 22.7
Covers Objective: 22.7
Points to Emphasize: Primary assessment findings will rapidly identify signs of a critical patient. After treating immediate life threats, conduct a secondary assessment to help differentiate abdominal disorders.
Discussion Topic: Describe findings in the primary assessment of a patient with abdominal pain that might indicate immediate life threats.
Knowledge Application: Describe assessment findings and ask students to identify the patient whose abdominal pain is critical.
Covers Objective: 22.7
Discussion Topic: Discuss how the history of the present illness can help in making a differential diagnosis of a patient with abdominal pain.
Covers Objective: 22.7
Discussion Topic: Discuss how the history of the present illness can help in making a differential diagnosis of a patient with abdominal pain.
Covers Objective: 22.8
Discussion Topic: Describe specific questions that you might ask a female patient who complains of abdominal pain.
Covers Objective: 22.8
Covers Objective: 22.7
Covers Objective: 22.7
Critical Thinking: What role might advanced life support play when dealing with a patient with abdominal pain?
Covers Objective: 22.7
Discussion Topic: Describe the technique for palpating the abdomen. What findings might be important?
Class Activity: Have students practice palpating the abdomen of the student sitting next to them.
Knowledge Application: Have students work in small groups. Using a programmed patient, practice assessing and treating patients with abdominal pain.
Point to Emphasize: Always palpate the area that has pain or discomfort last.
Covers Objective: 22.7
Discussion Topic: Describe the technique for palpating the abdomen. What findings might be important?
Class Activity: Have students practice palpating the abdomen of the student sitting next to them.
Knowledge Application: Have students work in small groups. Using a programmed patient, practice assessing and treating patients with abdominal pain.
Point to Emphasize: Always palpate the area that has pain or discomfort last.
Covers Objective: 22.7
Discussion Topic: Describe the pathophysiology and likely assessment findings for the following abdominal dysfunctions: appendicitis, cholecystitis, pancreatitis, GI bleeding, abdominal aortic aneurysm, hernia, renal colic, myocardial infarction.
Class Activity: Write out the details of an assessment of a patient with abdominal pain. Provide a set of complaints; then ask students to list the steps that they would take to assess this patient further.
Knowledge Application: Using programmed patients, set up mock calls. Include scene clues and bystander information. Ask students to identify critical patients and to make differential diagnoses of abdominal pain.
Covers Objective: 22.7
Point to Emphasize: Care for the patient with abdominal pain is often similar, regardless of the origin. Treat immediate life threats, administer oxygen, place the patient in a position of comfort, and initiate appropriate transport.
Discussion Topic: Describe the general treatment steps for a patient who is experiencing abdominal pain.
Covers Objective: 22.7
Covers Objective: 22.8
Talking Points: Could this be life-threatening? If it is cardiac, yes, and this patient is at high risk. While focusing on cardiac, your detailed assessment (with vitals, glucose level, and abdominal exam) should reveal the true cause. Treatment would include initial assessment, history, vitals, detailed physical exam, oxygen, position, call ALS, transport to appropriate facility.
Talking Points: Signs and symptoms of abdominal distress include nausea, vomiting, diarrhea, pain, and distention.
Visceral pain arises from organs in the visceral peritoneum is general and nonspecific; the patient will not be able to localize it or point to a specific area. Parietal pain arises from organs in the parietal peritoneum and often is described as sharp, constant, and localized to a particular area.
Talking Points: Emergency care for patient with abdominal distress involves monitoring for airway problems if the patient is vomiting, placing the responsive patient in a position of comfort, placing the unresponsive patient or the patient who is having difficulty maintaining an airway in a left lateral recumbent position for drainage from the mouth.
The four abdominal quadrants are LUQ, RUQ, LLQ, and RLQ. These are determined by a midline on the umbilicus.
Talking Points: Questions should focus on where the pain is, where it starts from, and so on. Questions asked will be determined by the history of the present illness and other steps in the assessment. Best position is likely to be the one where least pressure is put on the painful area.
