ATS - abdominal emergencies

Emergency Medical Technician
22 - Abdominal Emergencies
© 2014
• Injuries and acute
distress to abdominal
organs can occur from a
wide range of incidents:
– Blunt trauma
– Lacerations
– Impaled objects
– Projectiles
– Disease
3

© 2014
• The abdomen houses a
large number of vital
organs that are not well
protected by skeletal
structures
4

© 2014
• 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

© 2014
• Assessment of Acute Abdomen
• Acute Abdominal Emergency Care
• Abdominal Trauma

© 2014
• 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

© 2014
• Multiple causes for
acute abdomen:
– Indigestion
– Serious medical
emergencies:
 Appendicitis
 Peritonitis
 Intestinal obstruction
 Complications from
pregnancy
9

© 2014
• Abdominal pain can
occur from several
different mechanisms,
including:
– Swelling or distention
of the large or small
intestine
– Conditions that cause
inflammation or
ischemia of the
abdominal wall or of
other organs
10

© 2014
• 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

© 2014
• The abdominal cavity
contains three types of
structures:
– Hollow organs
– Solid organs
– Vascular structures
12

© 2014
• 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

© 2014
• Contains:
– Small intestines
– The stomach
– The spleen
– The pancreas
– Part of the large
intestine
– The left kidney is
behind the abdominal
lining
14

© 2014
• Contains:
– Most of the liver
– Gallbladder
– The duodenum
intestine
– The right kidney is
behind the
abdominal lining
15

© 2014
• Contains:
– The appendix
intestine
– Female reproductive
organs
16

© 2014
• Contains:
intestine
– Female reproductive
organs
17

© 2014
• Abdominal pain is
classified as:
– Visceral
– Referred
– Parietal
18

© 2014
• 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

© 2014
• The pain is often
described as dull,
aching or
oppressive:
– It may be constant
or intermittent
• Nausea and
vomiting are
common
20

© 2014
• 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

© 2014
• 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

© 2014
• Parietal pain is associated with the
peritoneum
• Peritoneum lines the abdominal cavity
and contains several organs
23

© 2014
• 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

© 2014
• Common Signs & Symptoms of Acute
Abdomen:
– Abdominal pain
– Nausea and vomiting
– Guarding of the abdomen
– Rigidity of the abdomen
– Distention of the abdomen
25

© 2014
• After conducting your initial
assessment and SAMPLE history, use
the mnemonic
OPQRST to determine the condition’s:
– Onset
– Provocation/Palliation
– Quality
– Region/Radiating pain
– Severity
– Time
26

© 2014
• Continue gathering
history related to the
patient’s condition:
– Fever
– Chills
– Unusual:
 Urination
 Bowel movements
• Any known
gastrointestinal
disease?
27

© 2014
• GI bleeding can occur anywhere in the
digestive tract from the esophagus to
the rectum
28

© 2014
• A black, tarry stool
coloration
• Bright red blood in the
stool
• Bright red blood in
vomitus or a coffee-
ground appearance
• Weakness
• Syncope
• Tachycardia
• Signs of shock
29

© 2014
• 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

© 2014
• 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

© 2014
• Tender, bloated
abdomen
• Weakness or dizziness
• Decreased blood
pressure
• An increased pulse
• Signs of shock
32

© 2014
• 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

© 2014
• Nausea and vomiting
• Low-grade fever and
chills
• Lack of appetite
• Abdominal guarding
• Abdominal pain or
cramping
34

© 2014
• Pain associated with
appendicitis often
begins as dull, diffuse
and located around the
umbilicus
• Later it may become
more localized and
persistent in the right
lower quadrant
35

© 2014
• Once you have finished
your questions and
gathered any past
medical history
information, document
your findings
• Begin a physical exam
focusing on the chief
complaint
36

© 2014
• 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

© 2014
• 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

© 2014
• Obtain baseline vitals
and look for signs of
shock
• This may include:
– A rapid, thready pulse
– Restlessness
– Cool, clammy skin
40

© 2014
• 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

© 2014
• 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

© 2014
43
• 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

© 2014
• Abdominal injuries can
be:
– Extremely serious
– Life threatening
• Damage to internal
organs can:
– Cause severe internal
bleeding
– Quickly lead to shock
45

© 2014
• 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

© 2014
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

© 2014
• 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

© 2014
• 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

© 2014
• 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

© 2014
• 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

© 2014
• 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

© 2014
• 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

© 2014
55
• 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

© 2014
• 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

© 2014
• 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

© 2014
• 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

© 2014
• Do not give the patient
anything by mouth
• Provide reassurance
• Keeping the patient
calm will help stabilize
vital signs
• Prepare to transport
59

© 2014
• 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

ATS - abdominal emergencies

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