Acute Abdominal Distress and Related Emergencies Slide Presentation prepared by Randall Benner, M.Ed., NREMT-P

Learning Objectives Describe the special assessment procedures used for a victim of abdominal distress. List the signs and symptoms of abdominal distress. Describe and demonstrate general first aid care for acute abdominal distress. List the signs and symptoms of ruptured esophageal varices. © 2012 Pearson Education, Inc.

Learning Objectives Describe and demonstrate the first aid care of a victim with ruptured esophageal varices. List the signs and symptoms of ruptured abdominal aortic aneurysm. Describe and demonstrate the first aid care for a victim with ruptured abdominal aortic aneurysm. © 2012 Pearson Education, Inc.

Introduction Abdominal pain may originate from one of multiple body systems present in the abdominal cavity. Abdominal distress should be considered life threatening until proven otherwise. The First Aider’s ability to recognize and treat abdominal pain can improve outcomes. © 2012 Pearson Education, Inc.

Abdominal Assessment Abdomen is the entire area between nipples and the groin. Divided into four quadrants Upper right quadrant (URQ) Upper left quadrant (ULQ) Lower right quadrant (LRQ) Lower left quadrant (LLQ) Observe and palpate to determine location and quadrant of pain. © 2012 Pearson Education, Inc.

Abdominal Quadrants © 2012 Pearson Education, Inc.

Example of Guarding A victim who guards their abdominal area provides important clues to the location and extent of pain. © 2012 Pearson Education, Inc.

Abdominal Assessment Determine if patient is restless or quiet. Assess for pain with movement. Confirm any abnormal contours in the abdominal area. Assess for abdominal bloating or distention. Palpate the four quadrants for irregularities. Assess for guarding or rigidity. Determine the location and extent of pain. © 2012 Pearson Education, Inc.

Abdominal Pain: Signs and Symptoms Pain can be local or widespread Abdominal tenderness Rapid breathing and pulse Nausea and/or vomiting Possible drop in blood pressure Abdominal distention Signs of shock (internal bleeding) Unusual bladder or bowel function, including black or bloody stools © 2012 Pearson Education, Inc.

Sources of Acute Abdominal Distress © 2012 Pearson Education, Inc.

Abdominal Pain: First Aid Care Primary goal is to prevent life-threatening complications. Take standard precautions, activate EMS. Assess, secure, and maintain the airway. Provide ventilations if needed. Position the patient comfortably. Treat for shock (keep warm, elevate legs). Never give anything by mouth. Reassess and comfort victim until EMS arrives. © 2012 Pearson Education, Inc.

Nausea and Vomiting Can result from multiple causes First aid care for nausea/vomiting Take precautions, activate EMS if acute. Place victim on side to help with vomiting. If no acute illness, try giving clear fluids by mouth. Do not give meat or dairy products for 48 hrs after vomiting stops. Do not allow consumption of solid food for 48 hours or until hunger returns. © 2012 Pearson Education, Inc.

Diarrhea Passage of loose, watery stools Commonly caused by a GI infection May present with severe dehydration First aid care for diarrhea: Drink 8–10 glasses of clear fluid per day. Progress from fluids to mild foods (soup or gelatin). After mild foods, progress to BRAT diet (bananas, rice, applesauce, toast). Consider OTC anti-diarrheal medications. © 2012 Pearson Education, Inc.

Diarrhea Seek medical attention if any of the following are present: Blood in the stool (fresh or digested) Mucus in the stool (slimy covering) Victim cannot stand without fainting Dehydration Concurrent severe abdominal pain Concurrent fever Diarrhea does not resolve in 24 hours © 2012 Pearson Education, Inc.

Special Considerations Ruptured esophageal varices Bulging, engorged, weakened blood vessels in esophagus Common to heavy alcohol drinkers, liver disease, liver dysfunction, enlarged liver, victims with jaundice Varices can lead to painless GI bleeding, which is often fatal without treatment. © 2012 Pearson Education, Inc.

Special Considerations Ruptured esophageal varices symptoms Vomiting profuse amounts of blood Blood welling up in the back of the throat Abdominal pain (without tenderness) Signs of shock and pallor Possible respiratory distress © 2012 Pearson Education, Inc.

Special Considerations Ruptured esophageal varices treatment Take standard precautions and activate EMS. Immediately secure an open airway. Position patient on left side with face turned down for continuous blood drainage. Treat for shock (keep warm, elevate legs). Reassess and comfort patient until EMS arrives. © 2012 Pearson Education, Inc.

Special Considerations Abdominal aortic aneurysm (AAA) Vascular walls of descending aorta weakens Eventually weakened region will rupture Patient rapidly bleeds into abdominal cavity One of the most lethal causes of abdominal pain Most common in patients with atherosclerosis Two out of ten men over 50 years of age have abdominal aneurysms © 2012 Pearson Education, Inc.

Special Considerations Abdominal aortic aneurysm (AAA) symptoms Sudden, severe pain in the abdomen or back Possible radiation to lower back, flank, or pelvis Possible nausea and vomiting Mottled abdominal skin Decreased or absent pulses in the groin and foot Possible pulsating mass in the abdomen With rupture, abdomen may become distended © 2012 Pearson Education, Inc.

Special Considerations Abdominal aortic aneurysm (AAA) treatment Activate EMS. Examine the abdomen very gently. Do not use any hard pressure during palpation. Assess and manage the airway and breathing components if needed. Treat the patient for shock. Monitor the patient until EMS arrives. © 2012 Pearson Education, Inc.

Summary Primary goal with abdominal pain is to provide first aid, not determine the source of pain. Any severe abdominal pain should be considered an emergency, and EMS should be activated. © 2012 Pearson Education, Inc.