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

2. 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.

3. 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.

4. 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.
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5. 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.
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6. Abdominal Quadrants
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7. Example of Guarding
A victim who guards their abdominal area provides important clues to the location and extent of pain.
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8. 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.

9. 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
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10. Sources of Acute Abdominal Distress
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11. 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.

12. 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.
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13. 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.
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14. 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
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15. 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.
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16. 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
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17. 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.

18. 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
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19. 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.

20. 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.

21. 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.