National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter 16 Gastrointestinal and Genitourinary Emergencies

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 16.1 List at least six possible causes of emergencies involving the gastrointestinal and genitourinary systems List the signs and symptoms of emergencies involving the gastrointestinal and genitourinary systems Compare and contrast visceral pain and parietal pain. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Objectives 16.4 Describe and demonstrate how to assess the abdomen Describe and demonstrate the management of a patient with a severe GI/GU emergency.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Topics Anatomy and Physiology The Acute Abdomen Common Gastrointestinal Ailments Assessment Management Chapter Summary

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation You are working first-aid duty when a 35-year-old man walks in complaining of severe abdominal pain. You assess the patient. Moments later, he vomits. The vomit is clear and does not appear to contain blood. He apologizes and states that he started feeling ill that morning, but decided to ski with his family. He denies any past medical history, has not suffered any recent trauma, and is not currently taking any medications. He states he has never experienced anything like this before and describes his abdominal pain as “intense.” continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Presentation Copyright Mike Halloran

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology Abdomen and pelvis ◦ Hollow organs ◦ Solid organ

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Anatomy and Physiology

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Acute Abdomen Causes of the acute abdomen: ◦ Appendicitis ◦ Pancreatitis ◦ Hepatitis ◦ Cholecystitis ◦ Pyelonephritis ◦ Nephrolithiasis continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY The Acute Abdomen Causes of the acute abdomen: ◦ Bowel obstruction ◦ Perforated bowel ◦ Peptic ulcerative disease ◦ Esophagitis and gastrointestinal bleeding ◦ Abdominal aortic aneurysm ◦ OB/GYN-related conditions

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Gastrointestinal Ailments Gastroenteritis Indigestion Nausea and vomiting Colic Diarrhea continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Common Gastrointestinal Ailments Viruses, protozoa, and bacteria ◦ Staphylococci ◦ Salmonella ◦ Giardia lamblia and cryptosporidium ◦ Escherichia coli (E coli) Constipation

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Upon examination, you notice that the patient is pale, sweating, and feels warm to the touch. He relates that his pain was originally near his belly-button but has now “moved down and to the right.” Examination of the abdomen reveals severe tenderness in the right lower quadrant. He tells you that every bump on the way to the ski hill felt like “being stabbed in my gut.” The patient has a heart rate of 116, blood pressure is 132/88, and respirations are 20 and shallow. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Update Copyright Mike Halloran

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment Determine what is wrong with the patient: ◦ ABCDs ◦ SAMPLE ◦ OPQRST Physical exam: ◦ Permission ◦ Abdominal palpation continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Assessment

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management In-depth physical examination: ABCDs Position in position of comfort with knees slightly bent Take vital signs frequently Supplemental oxygen if needed Don’t give anything by mouth continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Management Copyright Mike Halloran

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Case Disposition As you examine the patient and listen to his story, you are concerned the patient may have a serious lower abdominal problem. You place the patient on oxygen, keep him comfortable, and have him transported to the hospital. A week later the patient’s wife comes to the patrol room, thanking you and the patrollers that took such great care of her husband. She reports that he had surgery for acute appendicitis and is doing well.

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Recognize those patients whose signs and symptoms suggest the presence of a potential acute abdomen. Implement life- saving measures, and rapidly transport the patient to a definitive care facility. By having a fundamental understanding various abdominal and pelvic structures and knowing the basic causes of common GI/GU problems, you will be prepared to effectively manage most GI/GU-related disorders that you encounter. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary The abdomen and pelvis contain solid and hollow organs, major blood vessels, and nerves. The abdomen is divided into four quadrants. Patients with abdominal-pelvic pain may not present until their signs and symptoms are unbearable. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary Abdominal pain may be the first indication of a life-threatening emergency. Abdominal assessment includes an exam of all four quadrants. All patients with abdominal pain should be taken seriously and referred either to a physician or transported to a hospital. Do not give a patient complaining of abdominal pain anything by mouth. continued

National Ski Patrol, Outdoor Emergency Care, 5 th Ed. ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Chapter Summary A heart attack (AMI) can present with abdominal pain. Acute abdominal pain may be the symptom of delayed presentation of intra-abdominal trauma such as a ruptured spleen or renal injury from the previous day’s fall. Do not give a patient complaining of abdominal pain anything by mouth.