1. Chapter 23 Abdominal, Gynecologic, Genitourinary, and Renal Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

2. Objectives 1.Define key terms introduced in this chapter. 2.Describe the anatomy and physiology of the structures of the abdominal cavity, including (slides 14-17):slides 14-17 a.Boundaries of the abdominal cavity b.Visceral and parietal peritoneum c.Intraperitoneal and retroperitoneal organs d.Relationship between the topographic anatomy of the four abdominal quadrants and nine abdominal regions to the location of the organs corresponding to them 3.Compare and contrast the general characteristics of hollow and solid organs and vascular structures found in the abdominal cavity (slides 18-19).slides 18-19 4.List the general mechanisms and types of abdominal pain (slides 20-23).slides 20-23

3. Objectives 5.Describe the pathophysiology and the signs and symptoms associated with common causes of acute abdomen, including (slides 24-47):slides 24-47 a.Peritonitis b.Appendicitis c.Pancreatitis d.Cholecystitis e.Gastrointestinal bleeding f.Esophageal varices g.Gastroenteritis h.Ulcers i.Intestinal obstruction j.Hernia k.Abdominal aortic aneurysm

4. Objectives 6.Explain the assessment-based approach to acute abdomen, including assessment and appropriate medical care (slides 48-57).slides 48-57 7.Describe the basic anatomy and physiology of the female reproductive system (slides 59-60).slides 59-60

5. Objectives 8.Describe the pathophysiolgy and the signs and symptoms associated with common gynecologic conditions, including (slides 61-78):slides 61-78 a.Sexual assault b.Nontraumatic vaginal bleeding c.Menstrual pain d.Ovarian cyst e.Endometritis f.Endometriosis g.Pelvic inflammatory disease h.Sexually transmitted diseases 9.Explain the assessment-based approach to acute gynecologic emergencies, including assessment and appropriate medical care (slides 79-86).slides 79-86

6. Objectives 10.Describe genitourinary/renal structures and functions (slides 88-89).slides 88-89 11.Describe the pathophysiology and the signs and symptoms associated with common genitourinary/renal conditions, including (slides 90-97):slides 90-97 a.Urinary tract infection b.Kidney stones c.Kidney failure 12.Describe the purpose of dialysis, how dialysis works, and dialysis emergency management (slides 98-99).slides 98-99 13.Describe the purposes and types of urinary catheters and urinary catheter management (slides 100-101).slides 100-101 14.Explain the assessment-based approach to genitourinary/renal emergencies, including assessment and appropriate medical care (slides 102-106).slides 102-106

7. Multimedia Directory Slide 67Premenstrual Syndrome Video Slide 78Gonorrhea Video Slide 94Different Types of Kidney Stones Video Slide 97Renal Failure Video Slide 107Erectile Dysfunction Video

8. Topics Acute Abdomen Gynecological Emergencies Genitourinary/Renal Emergencies

9. CASE STUDY Dispatch

10. Respond to 323 Leslie Place for a 16-year-old male complaining of “stomach” pain. EMS Unit 58 Time out 0945

11. Greeted by a woman who states, “It’s my son, Parker” Has had a fever for the last couple of days Mom thought it was the flu or something Woke up this morning with a bad pain in his stomach Upon Arrival

12. How would you proceed to assess and care for this patient?

13. Back to Topics Acute Abdomen

14. Abdominal Structures and Functions Back to Objectives

15. Peritoneum –Visceral –Parietal –Intraperitoneal –Retroperitoneal Abdominal aorta

16. Abdominal Structures and Functions Abdominal Quadrants or Regions

18. Abdominal Structures and Functions Types of Abdominal Structures Back to Objectives

19. Hollow organs Solid organs Vascular structures

20. Abdominal Pain Pathophysiology of Abdominal Pain Back to Objectives

21. Pathophysiology of Abdominal Pain Mechanical forces Inflammation Ischemia

22. Abdominal Pain Types of Abdominal Pain

23. Visceral Parietal Referred

24. Conditions That May Cause Acute Abdominal Pain Peritonitis Back to Objectives

25. Peritonitis Cause Signs and symptoms Palpation Markle test

26. Conditions That May Cause Acute Abdominal Pain Appendicitis

27. Cause Age group affected Signs and symptoms

28. Conditions That May Cause Acute Abdominal Pain Pancreatitis

29. Cause Complications Signs and symptoms

30. Conditions That May Cause Acute Abdominal Pain Cholecystitis

31. Cause Age group affected Complications Signs and symptoms

32. Conditions That May Cause Acute Abdominal Pain Gastrointestinal Bleeding

33. Causes based on location Age affected Signs and symptoms

34. Conditions That May Cause Acute Abdominal Pain Esophageal Varices

35. Common group affected Cause Signs and symptoms Esophageal Varices

36. Conditions That May Cause Acute Abdominal Pain Gastroenteritis

37. Cause Complications Signs and symptoms

38. Conditions That May Cause Acute Abdominal Pain Ulcers

39. Cause Complications Signs and symptoms

40. Conditions That May Cause Acute Abdominal Pain Intestinal Obstruction

41. Cause Complications Signs and symptoms

42. Conditions That May Cause Acute Abdominal Pain Hernia

43. Cause Complications Signs and symptoms

44. Conditions That May Cause Acute Abdominal Pain Abdominal Aortic Aneurysm

45. Cause Complications Signs and symptoms

46. Conditions That May Cause Acute Abdominal Pain Vomiting/Diarrhea/ Constipation

47. Common with many conditions Should be assessed for dehydration

48. Assessment-Based Approach: Acute Abdomen Scene Size-Up Back to Objectives

49. Scene Size-Up Safety Mechanism of injury Look for scene clues

50. Assessment-Based Approach: Acute Abdomen Primary Assessment

51. Guarded position ABCs Signs of shock Priority criteria

52. Assessment-Based Approach: Acute Abdomen Secondary Assessment

53. History Physical Exam –Involuntary guarding –Rigidity –Voluntary guarding Signs and symptoms

54. Assessment-Based Approach: Acute Abdomen Emergency Medical Care

55. ABCs Place patient in position of comfort Administer O 2 Give nothing by mouth Calm and reassure Treat for shock Transport

56. Assessment-Based Approach: Acute Abdomen Reassessment

57. Document and record all vital signs Communicate findings

58. Gynecologic Emergencies Back to Topics

59. Female Reproductive Structures and Functions Back to Objectives

60. Place figure 23-14 here – don’t have it this time – wds

61. Gynecological Conditions Sexual Assault Back to Objectives

62. Sexual Assault Report to authorities Physical and psychological effects Guidelines

63. Gynecological Conditions Vaginal Bleeding

64. Vaginal Bleeding (Nontraumatic) Possible causes Spontaneous abortion Signs and symptoms

65. Gynecological Conditions Menstrual Pain

66. Dysmennorhea Mittelschmerz

67. Premenstrual Syndrome Return to Directory Click here to view a video on the topic of premenstrual syndrome.here

68. Gynecological Conditions Ovarian Cyst

69. Cause Signs and symptoms

70. Gynecological Conditions Endometritis

71. Cause Signs and symptoms

72. Gynecological Conditions Endometriosis

73. Cause Signs and symptoms

74. Gynecological Conditions Pelvic Inflammatory Disease

75. Cause Risk factors Signs and symptoms

76. Gynecological Conditions Sexually Transmitted Diseases

77. An infectious disease transmitted through sexual contact Most caused by bacteria, viruses, parasites, or fungi Risk factors Signs and symptoms

78. Gonorrhea Return to Directory Click here to view a video on the topic of gonorrhea.here

79. Assessment-Based Approach: Gynecological Emergencies Scene Size-Up and Primary Assessment Back to Objectives

80. Scene Size-Up and Primary Assessment Safety Standard Precautions Look for possible mechanism of injury Administer O 2 if needed Look for signs of shock Safety Standard Precautions Look for possible mechanism of injury Administer O 2 if needed Look for signs of shock

81. Assessment-Based Approach: Gynecological Emergencies Secondary Assessment

82. History Vital signs Signs and symptoms Physical exam

83. Assessment-Based Approach: Gynecological Emergencies Emergency Medical Care

84. Maintain spine stabilization ABCs Administer O 2 if necessary Control major bleeding if present Put patient in position of comfort Calm and reassure Transport

85. Assessment-Based Approach: Gynecological Emergencies Reassessment

86. Assess mental status ABCs Repeat as needed Communicate findings

87. Genitourinary/Renal Emergencies Back to Topics

88. Genitourinary/Renal Structures and Functions Back to Objectives

90. Genitourinary/Renal Conditions Urinary Tract Infection Back to Objectives

91. Urinary Tract Infections Cause Signs and symptoms

92. Genitourinary/Renal Conditions Kidney Stones

93. Renal calculi Causes Complications Signs and symptoms

94. Different Types of Kidney Stones Return to Directory Click here to view a video on the topic of kidney stones.here

95. Genitourinary/Renal Conditions Kidney Failure

96. Acute renal failure –Causes –Reversible if recognized early Chronic renal failure –Causes –Permanent, can be life threatening –Requires dialysis or kidney transplant Complications Signs and symptoms

97. Renal Failure Return to Directory Click here to view a video on the topic of renal failure.here

98. Genitourinary/Renal Conditions Dialysis Back to Objectives

99. Dialysis Dialysate Types of dialysis Complications Emergency medical care

100. Genitourinary/Renal Conditions Urinary Catheters Back to Objectives

101. Urinary Catheters Types Function Side effects Catheter management

102. Assessment-Based Approach: Genitourinary/Renal Emergencies Scene Size-Up and Primary Assessment Back to Objectives

103. Scene Size-Up and Primary Assessment Scene safety Look for possible mechanism of injury Form general impression ABCs Administer O 2 Assess for shock Determine transport priority

104. Secondary Assessment History Signs and symptoms Physical exam

105. Maintain manual spine stabilization if necessary ABCs Administer O 2 if necessary Control bleeding Place patient in position of comfort Calm and reassure Initiate transport Emergency Medical Care

106. Reassessment Mental status ABCs Vital signs Communicate findings

107. Erectile Dysfunction Return to Directory Click here to view a video on the topic of erectile dysfunction.here

108. CASE STUDY Follow-Up

109. Primary Assessment Lying on left side, curled up, holding his stomach Appears ill Breathing slightly rapid; skin flushed; radial pulse strong and rapid Administer oxygen at 15 lpm via a nonrebreather mask CASE STUDY

110. Secondary Assessment O – Began around 5:00 am P – Nothing makes it better; lying flat makes it worse Q – Dull cramping around navel R – To RLQ S – “The worst stomach pain” T – Constant since this morning BP: 108/60 mmHg; P: 130; RR: 28 CASE STUDY

111. Treatment and Reassessment Reassess for signs of shock, vitals, and LOC Successfully arrive at the hospital Give report to ED staff Later you find out patient had surgery to remove appendix CASE STUDY

112. 26-year-old male vomiting up blood with epigastric abdominal pain Vital signs: BP: 86/68 mmHg Radial pulse is 132 bpm and very weak RR: 22 per minute with good tidal volume Skin is extremely pale, cool, and clammy Critical Thinking Scenario

113. S – Alert but sluggish answering questions; began to vomit blood today; has black, tarry stools A –Denies any allergies M –Takes no medications P –Alcoholic and has been drinking for a week or so L – Has not eaten for a few days E – Pain worsened over past several days Critical Thinking Scenario

114. O – Unclear; began vomiting blood today P – Nothing relieves the pain; it worsens after drinking alcohol Q – Sharp, stabbing, and constant R – Does not radiate S – 10/10 T – Present for three to four weeks but has worsened over the last several days Critical Thinking Scenario

115. 1.What emergency care would you provide during the primary assessment? 2.What assessment findings would lead you to suspect the patient is experiencing an acute abdomen? 3.What are the vital signs indicating? 4.Based on the assessment findings and history information, what might the patient be suffering from? 5.What is the significance of the bowel movement findings? Critical Thinking Questions

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