Essential EMS Training Program – Block 2 Lesson 9 ABDOMINAL PAIN Essential EMS Training Program – Block 2 Lesson 9

Special Note: Abdominal Trauma is covered in Chapter 26 of the MTI Textbook. The following content is additional material requested by the Ministry of Health to give EMT’s a deeper understanding of Medical causes of Abdominal pain Abdominal Pain is a common complaint that will be evaluated by EMT’s Special Thanks to Stanford Emergency Medicine International, Stanford University School of Medicine 2014 for assistance in producing some of these slides

QUESTION? You are transporting a 25-year-old female with lower abdominal pain. What is your main concern as an EMT? 1) Diagnosing the exact cause of pain 2) Providing anti-nausea medication  3) Providing oral pain medication 4) Assessing for high risk features and treating unstable vitals

ANSWER! You are transporting a 25-year-old female with lower abdominal pain. What is your main concern as an EMT? 1) Diagnosing the exact cause of pain 2) Providing anti-nausea medication  3) Providing oral pain medication 4) Assessing for high risk features and treating unstable vitals

Abdominal Trauma A leading cause of preventable trauma death Often goes unrecognized Internal injury difficult to assess in the field Massive blood loss can lead to shock and death Transport to a surgery capable hospital is recommended

What is Abdominal Pain Any pain in the area below the ribs (diaphragm) and above the Pelvis Can be caused by Infection, Trauma, Indigestion, Nausea & Vomiting, cancers, and many other causes May be accompanied by other signs and symptom such as swelling, tenderness, pain on palpation, bruising, rigidity, etc.

Anatomy and Physiology Abdomen is the largest body Cavity in the body Abdomen is separated from Chest Cavity by the diaphragm Most of the Organs are enclosed in a membrane called the peritoneum The Organs behind & outside the Peritoneum are the kidneys, pancreas, and Abdominal Aorta

Abdomen is divided into four Quadrants .

Types of Abdominal Pain Superficial Dermatomal Referred Radiated Deep Rebound Sharp or Dull Somatic Visceral But most patients will just tell you it hurts “badly” Photo: Stanford University School of Medicine

Three main Types of Abdominal Pain 1) Visceral 2) Somatic 3) Referred

Visceral Pain Caused by stimulation of nerve fibers of Organs Often described by patient as Crampy, Comes and Goes, (Colic) or Gassy Tends to be all over and difficult to pinpoint Commonly seen with other signs and symptoms Nausea Vomiting Fast heart Rate

Somatic Abdominal Pain A focal pain that occurs when a nerve is stimulated Arises from the abdominal wall Usually described by the patient as well localized, bright or sharp Photo: Medguidence.com

Referred Abdominal Pain A radiating pain felt away from the point of Origin Pain from a kidney stone may be referred to pelvic or groin area Heart Attack, Pneumonia, and Fractured bones can cause referred pain to the abdominal area

Causes of Abdominal Pain Many Causes but Common causes may be: Inflammation or stretching of an Organ Blockage of a Duct Swelling of a body Structure Loss of Blood Supply to an Organ

Common Ailments Abdominal Aortic Aneurysm (AAA) Appendicitis Bowel Obstruction Cholecystitis Cystitis Diverticulitis Ectopic Pregnancy Esophagitis Intestinal Parasites Kidney stones Stomach Ulcers Urinary Tract Infections Other infections

Assessment & Treatment All patient assessments start with the Primary Survey Airway Breathing Circulation Is the patient in shock? Level of consciousness Skin Pulse Capillary Refill

Initial Assessment After ABC’s Assess Vital Signs including Mental status, Skin signs, and pulse Ox Consider Patients Chief Complaint and Nature of Illness This should be enough information to begin immediate care Begin Rapid Exam

QUESTION? You are performing your exam, which finding is most concerning that your patient may have a life threatening cause of abdominal pain? 1) Pain is in the right upper quadrant 2) Pain is moderate 3) Patient feels nauseated 4) The patient is lightheaded and pale

ANSWER! You are performing your exam, which finding is most concerning that your patient may have a life threatening cause of abdominal pain? 1) Pain is in the right upper quadrant 2) Pain is moderate 3) Patient feels nauseated 4) The patient is lightheaded and pale

Goal of Our Assessment Many Causes but we DO NOT need to know exactly which one Your goal is to decide if a patient is SICK or Not SICK You should begin to provide supportive care You DO NOT have to diagnose the cause

Assessment Goal You should try to determine three (3) things 1) Quality of Pain 2) Location of Pain 3) Any abnormalities Swelling Distension Lumps Photo: Stanford University School of Medicine

Physical Exam ABC’s First (and repeat often) Always immediately address Life Threats Assess Patients attitude & posture Check skin Assess quality and location of Pain Look for Guarding, fetal position Look for Abnormalities, swelling, lumps

Important Exam Note Always be alert to signs of Hypotension or shock. Shock can be caused by Blood loss or Infection. Restlessness is the first sign of shock Rapid Pulse Slow Capillary Refill time (CRT > 2 sec) Fast Breathing Decreasing or low Blood Pressure

Patient Examination Ask Patient location of Pain Place Patient Supine Check Quadrants not affected first Palpate Painful area last Be gentle, Note Guarding Photo: Stanford University School of Medicine

Identifying High Risk Patients Ridged Abdomen Distention/swelling Vomiting Abdominal Pain with symptoms of: Dizziness/Giddiness Pallor Sweating (diaphoresis) Confusion

Identifying High Risk Patients Vital signs HR>90 SBP<90 OR Suggests severe cause

Non Life Threatening Causes of Abdominal pain Many Causes of Abdominal Pain are not life threatening. Some Non Life threatening causes are: Menstrual Cramps Indigestion Gastritis Hepatitis “A” Cholecystitis Kidney Infections (Mild) PID

QUESTION? You are taking a history from your 25-year-old female patient. What information is essential to obtain? 1) Recent dietary changes 2) Any recent travel 3) Pain medications tried at home 4) Dates of last menstrual period

ANSWER! You are taking a history from your 25-year-old female patient. What information is essential to obtain? 1) Recent dietary changes 2) Any recent travel 3) Pain medications tried at home 4) Dates of last menstrual period

Additional High Risk Patients Pregnancy Assess for trauma if pregnant Consider Other Complications (In OB lectures) Obtain History news.thousanddays.org/maternal-child-health/future-nutrition

Additional High Risk Signs Blood in Vomitus Blood in Stool (can be dark & tarry or bright red) www.medrevise.co.uk/wiki/Haematemesis

QUESTION? You are transporting a 25-year-old female with abdominal pain. She has a blood pressure of 85/60 and a HR of 120, what are the next actions you should take? 1) Place an IV and bolus IV fluid 2) Sit upright 3) Repeat abdominal exam 4) Provide pain control medications

QUESTION? You are transporting a 25-year-old female with abdominal pain. She has a blood pressure of 85/60 and a HR of 120, what are the next actions you should take? 1) Place an IV and bolus IV fluid 2) Sit upright 3) Repeat abdominal exam 4) Provide pain control medications

Pain Control Note: Most Abdominal Pain can be transported to Hospital without Pain Control Medications Opiate abuse of prescribed medication for other pain can cause abdominal pain by paralyzing the normal intestinal peristalsis

Additional Treatment Treatment of high risk patients Place large bore IV Bolus 500cc NS Reassessment (often) Recheck vitals If SBP < 90 or HR>100 repeat fluid bolus

Summary for Abdominal Pain There are many causes of abdominal pain The job of the EMT is to: Be Professional, treat with Compassion Gather basic history Assess for serious signs and symptoms Recognize unstable vitals Treat Life threats immediately Transport to hospital

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