- MEDICAL EMERGENCIES
3.1 ABDOMINAL PAIN (non-traumatic)
Acute abdominal pain may have a sudden onset and may present as mild to severe in nature. Abdominal pain may be the result of hemorrhagic etiologies (e.g., gastrointestinal ulcers, abdominal aortic aneurysm, ectopic pregnancy and esophageal varices) that may have immediate life threatening complications or non-hemorrhagic etiologies (i.e., herniation, obstructive and inflammatory conditions).
Abdominal emergencies may classified into three (3) primary categories: Gastrointestinal (upper & lower bowel hemorrhage, pancreatitis, cholecystitis, hepatitis, tumors, appendicitis, diverticulitis, perforated viscus and bowel obstruction), Genitourinary (kidney stones, urinary tract infections, pyelonephritis and acute & chronic renal failure) and Reproductive (female: pelvic inflammatory disease, ruptured ovarian cyst, dysfunctional uterine bleeding, endometriosis, tumors, and ectopic pregnancy; male: testicular torsion, epididymitis and prostatitis).
The acute abdomen refers to the relatively sudden onset of severe abdominal pain (although gradual onset of pain leading to an acute abdomen does occur) signifying a potential abdominal catastrophe. It is often associated with nausea, vomiting, guarding, rebound tenderness and abdominal distention. Prompt evaluation and management along with rapid transport can reduce morbidity and mortality.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of Consciousness, ABCs and Vital Signs. Treat all life threatening conditions as they become identified.
5. Obtain appropriate history related to event, (Provocation, Quality, Region, Radiation, Referred, Severity, and Time), including Past Medical History (surgery, LMP, prior episodes), Medications, Drug Allergies, Substance abuse.
6. Allow the patient to assume a comfortable position, unless contraindicated. Flexion of the knees and hips may help reduce pain.
NOTE: It is unnecessary and potentially detrimental to attempt auscultation and percussion of the abdomen in the pre-hospital setting.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Place patient in supine position. However, you may allow the patient to assume a comfortable position, unless contraindicated. Flexion of the knees and hips may help reduce pain.
5. Activate ALS intercept, if deemed necessary and if available.
6. If patient is in shock or exhibits signs and symptoms of shock: Basic EMT-MASTS contact MEDICAL CONTROL. Medical control may authorize use of a PASG/MAST.
7. Initiate transport as soon as possible with or without ALS.
8. Notify receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Place patient in supine position. However, you may allow the patient to assume a comfortable position, unless contraindicated. Flexion of the knees and hips may help reduce pain.
5. Activate Paramedic intercept if deemed necessary and if available.
6. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline while in transport. If suspect hypovolemic etiology administer 250 cc-500 cc fluid bolus and titrate IV to patients hemodynamic status.
7. Contact MEDICAL CONTROL. Medical Control may order:
a. administration of additional fluid
b. application/inflation of PASG/MAST.
8. Initiate transport as soon as possible with or without Paramedics.
9. Notify receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask as determined by patient's condition.
4. Place patient in supine position. However, you may allow the patient to assume a comfortable position, unless contraindicated. Flexion of the knees and hips may help reduce pain.
5. ALS STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Cardiac monitor/ dysrhythmia recognition. Treat dysrhythmias per protocol.
c. Initiate 1-2 IVs Normal Saline. If suspect hypovolemic etiology administer 250 cc-500 cc fluid bolus and titrate IV to patients hemodynamic status.
6. Contact MEDICAL CONTROL. Medical Control may order:
a. administration of additional IV Saline 250 cc-500 cc or wide open titrated to patient's condition.
b. application/inflation of PASG/MAST.
7. Initiate transport as soon as possible.
8. Notify receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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