1. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Paramedic Care: Principles & Practice Volume 3 Medical Emergencies

2. 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

3. 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

4. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Pathophysiology

5. 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 –Excessive Alcohol Consumption –Excessive Smoking –Increased Stress –Ingestion of Caustic Substances –Poor Bowel Habits Emergencies –Acute emergencies usually arise from chronic underlying problems

6. 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

7. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Assessment

8. 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

9. 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

10. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ General Treatment

11. 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

12. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Specific Illnesses

13. 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 –Upper Gastrointestinal Tract –Lower Gastrointestinal Tract –Liver –Gallbladder –Pancreas –Appendix Specific Illnesses

14. 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.here

15. 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 –Peptic Ulcer Disease –Gastritis –Varix Rupture –Mallory-Weiss Tear –Esophagitis –Duodenitis

16. 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 –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

17. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Cause –Portal Hypertension Chronic alcohol abuse and liver cirrhosis Ingestion of caustic substances Esophageal Varices

18. 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 –Hematemesis, dysphagia –Painless bleeding –Hemodynamic instability –Classic signs of shock Treatment –Follow general treatment guidelines Aggressive airway management Aggressive fluid resuscitation

19. 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

20. 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 –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

21. 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

22. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology –Erosions caused by gastric acid –Terminology based on the portion of tract affected Duodenal Gastric –Causes: NSAID use Alcohol/tobacco use H. pylori Peptic Ulcers

23. 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

24. 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

25. 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 –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)

26. 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

27. 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

28. 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

29. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology –Causes unknown –Can affect the entire GI tract –Pathologic inflammation: Damages mucosa Hypertrophy and fibrosis of underlying muscle Fissures and fistulas Crohn’s Disease

30. 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

31. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Diverticulitis

32. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ 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 Hemorrhoids

33. Bledsoe et al., Paramedic Care: Principles & Practice, Volume 3: Medical Emergencies, 3rd Ed. © 2009 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology –Blockage of the hollow space of the small or large intestines May be partial or complete –Hernias –Intussusception –Volvulus –Adhesions –Bowel infarction Bowel Obstruction

34. 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

35. 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

36. 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 –Liver –Gallbladder –Pancreas –Vermiform Appendix

37. 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.

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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.

45. 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

46. 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 –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

47. 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