Download Paramedic Care: Principles & Practice Volume 3 Medical Emergencies

Paramedic Care:
Principles & Practice
Volume 3
Medical Emergencies
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 6
Gastroenterology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
General Pathophysiology
General Assessment
General Treatment
Specific Illnesses
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Pathophysiology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Pathophysiology
General Risk Factors
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Excessive Alcohol Consumption
Excessive Smoking
Increased Stress
Ingestion of Caustic Substances
Poor Bowel Habits
Emergencies
– Acute emergencies usually arise from chronic
underlying problems
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Abdominal Pain
Types
– Visceral
Often described as
vague or poorly
localized, dull, or
crampy
– Somatic
Sharp type of pain
– Referred
Originates in a region
other than where it is
felt
Causes
– Inflammation
– Distention
– Ischemia
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment
Scene Size-up and Initial Assessment
– Scene clues
– Identify and treat life-threatening conditions
Focused History
– Obtain SAMPLE history
– Obtain OPQRST history
Associated symptoms
Pertinent negatives
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment
Physical Exam
– General Assessment and Vital Signs
– Abdominal Assessment
Inspection, auscultation, and palpation
Cullen’s sign
Grey-Turner’s sign
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Treatment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General Treatment
Maintain the airway
Support breathing
– High-flow, high-concentration oxygen or assisted
ventilations
Maintain circulation
Monitor vital signs and cardiac rhythm
Establish IV access
Transport in position of comfort
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Specific Illnesses
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Specific Illnesses
The Gastrointestinal
System
– Upper Gastrointestinal
Tract
– Lower Gastrointestinal
Tract
– Liver
– Gallbladder
– Pancreas
– Appendix
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Gastrointestinal System
Click here to view an animation the gastrointestinal system.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Upper GI Bleeding
Causes
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Peptic Ulcer Disease
Gastritis
Varix Rupture
Mallory-Weiss Tear
Esophagitis
Duodenitis
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Upper GI Bleeding
Signs and Symptoms
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General abdominal discomfort
Hematemesis and melena
Classic signs and symptoms of shock
Changes in orthostatic vital signs
Treatment
– Follow general treatment guidelines
Begin volume replacement using 2 large-bore IVs
– Differentiate life-threatening from chronic
problem
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Esophageal Varices
Cause
– Portal
Hypertension
Chronic alcohol
abuse and liver
cirrhosis
Ingestion of
caustic
substances
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Esophageal Varices
Signs and Symptoms
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Hematemesis, dysphagia
Painless bleeding
Hemodynamic instability
Classic signs of shock
Treatment
– Follow general treatment guidelines
Aggressive airway management
Aggressive fluid resuscitation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Acute Gastroenteritis
Cause
– Damage to Mucosal GI Surfaces
Pathologic inflammation causes hemorrhage and
erosion of the mucosal and submucosal layers of the
GI tract.
– Risk Factors
Alcohol and tobacco use
Chemical ingestion (NSAIDs, chemotherapeutics)
Systemic infections
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Acute Gastroenteritis
Signs and Symptoms
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–
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Rapid onset of severe vomiting and diarrhea
Hematemesis, hematochezia, melena
Diffuse abdominal pain
Classic signs of shock
Treatment
– Follow general treatment guidelines
– Fluid volume replacement
– Consider administration of antiemetics
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Gastroenteritis
Similar to Acute Gastroenteritis
– Long-term mucosal changes or permanent
damage
Primarily due to microbial infection
More frequent in developing countries
– Follow general treatment guidelines
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Peptic Ulcers
Pathophysiology
– Erosions caused
by gastric acid
– Terminology based
on the portion of
tract affected
Duodenal
Gastric
– Causes:
NSAID use
Alcohol/tobacco use
H. pylori
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Peptic Ulcers
Signs and Symptoms
– Abdominal pain
– Observe for signs of hemorrhagic rupture
Acute pain, hematemesis, melena
Treatment
– Follow general treatment guidelines
– Consider administration of histamine blockers
and antacids
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Lower GI Bleeding
Pathophysiology
– Bleeding distal to the ligament of Treitz
– Causes
Diverticulosis
Colon lesions
Rectal lesions
Inflammatory bowel disorder
Ulcerative colitis
Chrohn’s Disease
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Lower GI Bleeding
Signs and Symptoms
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Determine acute vs. chronic
Quantity/color of blood in stool
Abdominal pain
Signs of shock
Treatment
– Follow general treatment guidelines
Establish IV access with large-bore catheter(s)
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Ulcerative Colitis
Idiopathic (unknown)
inflammatory bowel
disorder
Contributing factors
– Psychological, allergic,
toxic, environmental,
immunological, and
infectious
Severity related directly to
the extent and severity of
current inflammation
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Ulcerative Colitis
Signs and Symptoms
– Occasional bloody diarrhea or stool-containing
mucus
– Colicky abdominal pain (cramping)
– Nausea and vomiting
– Occasionally, fever or weight loss
– Severe cases present with signs and symptoms
of shock
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Ulcerative Colitis
Management
– Depends on patient’s physiological status
– Treat for shock, if necessary
– May include antiemetics and antispasmodic
medications
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Crohn’s Disease
Pathophysiology
– Causes unknown
– Can affect the
entire GI tract
– Pathologic
inflammation:
Damages mucosa
Hypertrophy and
fibrosis of underlying
muscle
Fissures and fistulas
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Crohn’s Disease
Signs and Symptoms
– Difficult to differentiate
Clinical presentations vary drastically
– GI bleeding, nausea, vomiting, diarrhea
– Abdominal pain/cramping, fever, weight loss
Treatment
– Follow general treatment guidelines
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Diverticulitis
Pathophysiology
– Inflammation of small
outpockets in the mucosal
lining of the intestinal tract
– Common in the elderly
– Diverticulosis
Signs and Symptoms
– Abdominal pain/tenderness
– Fever, nausea, vomiting
– Signs of lower GI bleeding
Treatment
– General treatment guidelines
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hemorrhoids
Pathophysiology
– Mass of swollen veins in
anus or rectum
– Idiopathic
Signs and Symptoms
– Limited bright red
bleeding and painful
stools
– Consider lower GI
bleeding
Treatment
– General treatment
guidelines
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction
Pathophysiology
– Blockage of the hollow space of the small or
large intestines
May be partial or complete
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Hernias
Intussusception
Volvulus
Adhesions
Bowel infarction
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hernia, Intussusception,
Volvulus, Adhesions
Hernia
Volvalus
Intussusception
Adhesions
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction
Signs and symptoms
– Patients present with diffuse visceral pain
Poorly localized
– May be hemodynamically unstable
– Distention, peritonitis, or free air within the
abdomen
– Bowel sounds
Treatment
– Based on physiological and psychological
support
– Airway management and treat for shock
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Accessory Organ Diseases
GI Accessory Organs
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Liver
Gallbladder
Pancreas
Vermiform Appendix
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Appendicitis
Pathophysiology
– Inflammation of the
vermiform appendix
– Frequently affects
older children and
young adults
– Lack of treatment
can cause rupture
and subsequent
peritonitis
© Photo Researchers, Inc.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Appendicitis
Signs and Symptoms
– Diffuse, colicky pain
Is initially located in the periumbilical region
McBurney point
– Nausea and vomiting
– Low-grade fever
Treatment
– Supportive
– Monitor for shock
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cholecystitis
Pathophysiology
– Inflammation of the
Gallbladder
– Cholelithiasis
– Chronic Cholecystitis
Bacterial infection
– Acalculus Cholecystitis
Burns, sepsis, diabetes
Multiple organ failure
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Cholecystitis
Signs and Symptoms
– URQ abdominal pain
Murphy’s sign
– Nausea, vomiting
– History of cholecystitis
Treatment
– Follow general treatment guidelines
– Pain medications may be indicated
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pancreatitis
Pathophysiology
– Inflammation of the Pancreas
Classified as metabolic, mechanical, vascular, or
infectious based on cause
Common causes include alcohol abuse, gallstones,
elevated serum lipids, or drugs
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Pancreatitis
Signs and Symptoms
– Mild Pancreatitis
Epigastric pain, abdominal distention, nausea/vomiting
Elevated amylase and lipase levels
– Severe Pancreatitis
Refractory hypotensive shock and blood loss
Respiratory failure
Treatment
– Follow general treatment guidelines
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis
Pathophysiology
– Injury to Liver Cells
Typically due to inflammation or infection
– Types of Hepatitis
Viral hepatitis (A, B, C, D, E, and G)
Alcoholic hepatitis
Trauma and other causes
– Risk Factors
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis
Viral Hepatitis
– Hepatitis A
Infectious hepatitis
Spreads by fecal-oral route
Self-limiting
Lasts 2-8 weeks
– Hepatitis B
Serum hepatitis
Effects may be only
minimal, but they can also
range to severe liver
ischemia and necrosis
© Photo Researchers, Inc.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis
Viral Hepatitis
– Hepatitis C
Most commonly responsible for spreading hepatitis
through blood transfusions
– Hepatitis D
Pathogen is dormant until activated by HBV
– Hepatitis E
Waterborne infection
More common in third-world countries
– Hepatitis G
People with hepatitis A, B, or C can be super-infected
with HGV
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis
Signs and Symptoms
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URQ abdominal tenderness
Loss of appetite, weight loss, malaise
Clay-colored stool, jaundice, scleral icterus
Photophobia, nausea/vomiting
Treatment
– Follow general treatment guidelines
– Vaccinations are available for Types A and B
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
General Pathophysiology
General Assessment
General Treatment
Specific Illnesses
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ