Transcript Chapter 20: Abdominal and Gastrointestinal Emergencies

Chapter 20
Abdominal and
Gastrointestinal
Emergencies
National EMS Education
Standard Competencies
Medicine
Integrates assessment findings with principles
of epidemiology and pathophysiology to
formulate a field impression and implement a
comprehensive treatment/disposition plan for
a patient with a medical complaint.
National EMS Education
Standard Competencies
Abdominal and Gastrointestinal
Disorders
Anatomy, presentations, and management of
shock associated with abdominal
emergencies
− Gastrointestinal bleeding
National EMS Education
Standard Competencies
Abdominal and Gastrointestinal
Disorders
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
− Acute and chronic gastrointestinal hemorrhage
− Liver disorders
− Peritonitis
− Ulcerative diseases
− Irritable bowel syndrome
National EMS Education
Standard Competencies
Abdominal and Gastrointestinal
Disorders
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
− Inflammatory disorders
− Pancreatitis
− Bowel obstruction
− Hernias
National EMS Education
Standard Competencies
Abdominal and Gastrointestinal
Disorders
Anatomy, physiology, epidemiology,
pathophysiology, psychosocial impact,
presentations, prognosis, and management of
− Infectious diseases
− Gallbladder and biliary tract disorders
− Rectal abscesses
− Rectal foreign body obstruction
− Mesenteric ischemia
Introduction
• GI problems are rarely life threatening.
− Can lead to systemic problems if untreated
Introduction
• The number of
disorders causing
abdominal pain,
diarrhea, and
nausea is high.
− With the exception
of septicemia, most
GI disorders are
not deadly.
Introduction
• Behaviors and characteristics may
predispose some people to GI disorders.
Anatomy and Physiology
• Digestion begins in
the mouth.
− The chewing
process is called
mastication.
− Enzymes in saliva
begin the chemical
breakdown of food
for absorption by
the body.
Anatomy and Physiology
• Food reaches the esophagus.
− Typically collapsed, allowing air to flow into the
lungs instead of the stomach
− Dilates when food or liquid travels through it
• Explains gastric distention during positive-pressure
ventilation
Anatomy and Physiology
• The esophagus transports food using
peristalsis.
• The portal vein is intertwined around the
esophagus.
− Transports venous blood to the liver.
Anatomy and Physiology
• Food travels through the diaphragm to the
cardiac sphincter.
− Connects the esophagus and the stomach
− Controls amount of food that moves up the
esophagus
Anatomy and Physiology
• Food then enters
the stomach.
− Hydrochloric acid
breaks down the
food even more.
− Chyme exits the
pyloric sphincter.
− Water- and fatsoluble substances
are absorbed.
Anatomy and Physiology
• The main function of the GI system is to
absorb the digested food.
− The duodenum connects the liver, gallbladder,
and pancreas to the digestive system.
− The pancreas secretes enzymes to assist with
digestion and neutralize gastric acid.
Anatomy and Physiology
• The liver:
− Produces bile, which breaks down fats
− Promotes carbohydrate metabolism
− Detoxifies drugs
− Completes the breakdown of dead blood cells
− Stores vitamins and minerals
Anatomy and Physiology
• The small intestine
− Where 90% of
absorption occurs
− Divided into three
sections:
• Duodenum
• Jejunum
• Ileum
Anatomy and Physiology
• Colon (large
intestine)
− Moves undigested
food (feces) to be
eliminated from the
body
Anatomy and Physiology
• The main role of the large intestine is to
complete the reabsorption of water.
• Bacterial digestion also occurs in the colon.
• The journey from mouth to anus takes 8 to
72 hours.
Scene Size-Up
• Ensure safety.
• Look for MOI or NOI.
• Take standard precautions.
• Always have equipment for hygiene.
Primary Assessment
• Form a general impression.
− Where was the patient found?
− What is the patient’s body posture?
− Is there an odor?
Primary Assessment
• Airway and breathing
− Patient who is vomiting may aspirate.
− Open the airway with the appropriate method.
− Remove or suction obstructions.
− Check for unusual odors
Primary Assessment
• Circulation
− Assess skin color, temperature, and moisture.
− Determine pulse rate.
− Ensure blood pressure reading is accurate.
− Take note of amount of blood.
Primary Assessment
• Transport decision
− Based on primary assessment
− If positive orthostatic vital signs, carefully
consider how to move the patient.
− Choose the mode of ambulance.
History Taking
• Patients may have
a history of issues.
− SAMPLE helps you
gather information.
• Changes in bowel
patterns or stool
• Onset of diarrhea,
constipation, or
nausea/vomiting
• Recent weight loss
• Patient’s last meal
History Taking
Secondary Assessment
• Detailed abdominal
examination
− Keep the muscles
from flexing.
− Check for skin
irregularities.
• Scars
• Striae
© Medical-on-Line Alamy Images
Secondary Assessment
• Asymmetric abdomen could mean:
− Tumors
− Hernia
− Enlarged organs
− Pregnancy
• Check shape of the abdomen.
Secondary Assessment
− Excessive weight
gain
− Ascites
− Pregnancy
− Organ enlargement
© Wellcome Images/Custom Medical Stock Photo
• Protuberance may
be caused by:
Secondary Assessment
• Auscultate for
bowel sounds.
Secondary Assessment
• Percuss the abdomen.
− The abdomen should sound tympanic.
− The upper left and upper right quadrants will
sound duller.
Secondary Assessment
• Palpate the
abdomen.
− Begin farthest
away from the
pain.
− Indent the
abdomen wall
about 2″ to 4″.
− Assess for
discomfort, rigidity,
and masses.
Secondary Assessment
• Abdominal pain may
indicate:
−
−
−
−
−
Trauma
Hemorrhage
Infection
Obstruction
Other serious
problems
• Types of pain include:
− Visceral pain
− Parietal pain
(rebound)
− Somatic pain
− Referred pain
Secondary Assessment
• Rebound tenderness occurs when the
peritoneum is irritated.
− Once a tender area is found:
• Depress the skin with your fingertips 2" to 4".
• Quickly pull your fingers off the abdomen.
− An alternative is the Markle heel drop test.
Secondary Assessment
• If there is pain in the right upper quadrant,
use Murphy sign to assess for cholecystitis.
− Ask the patient to breathe out.
− Palpate deeply along the upper right quadrant.
− Ask the patient to inhale deeply.
− Sharp increase in pain: positive Murphy sign
Secondary Assessment
• Obtain orthostatic vital signs.
− Determine the blood pressure and pulse rate.
• Have the patient change positions and retake.
− Significant blood loss may be indicated by:
• 10-mm Hg drop in blood pressure
• 10-beat increase in pulse rate
Secondary Assessment
• Many GI diseases affect electrolyte levels.
− Use a handheld blood analyzer to test.
• Ultrasonography and intra-abdominal
pressure testing may also be available.
Reassessment
• Routine monitoring includes:
− Pulse rate
− Electrocardiogram
− Blood pressure
− Respiratory rate
− Pulse oximetry
Reassessment
• Pain medication includes:
− Meperidine hydrochloride
− Morphine
− Ketorolac
− Nalbuphine
− Fentanyl
Reassessment
• Nausea medications include:
− Ondansetron
− Diphenhydramine
− Hydroxyzine
− Promethazine
Emergency Medical Care
• Repeat assessment if patient’s condition
suddenly changes dramatically.
• Do not let patients eat or drink anything.
Airway Management
• Airway concerns include possible aspiration
or obstruction due to blood or vomitus.
− Place patient so material can drain from mouth.
• Make sure suction equipment is available.
• You may need to use a nasogastric tube.
Breathing
• Associated with decreased hemoglobin
levels
− Administer high-concentration oxygen.
− Prevent aspiration.
− Auscultate lung sounds.
Circulation
• Concerns: dehydration and hemorrhage
− Fluids depend on circulatory perfusion status.
• Hypotonic solution for stable conditions
• Isotonic solution for profound dehydration
Circulation
• Hemorrhaging care should be directed at
maintaining perfusion of vital organs.
− Titrate fluids to a blood pressure of 90 to
100 mm Hg.
− If blood pressure cannot be maintained,
vasoactive medications may be needed.
Specific Abdominal and
Gastrointestinal Emergencies
• The paramedic must have an
understanding of many conditions.
− In the future, paramedics may be asked to help
determine where a patient should be directed.
− The more you understand, the more you can
educate patients.
Specific Abdominal and
Gastrointestinal Emergencies
Specific Abdominal and
Gastrointestinal Emergencies
• Hypovolemia can
be caused by:
− Dehydration from
vomiting and/or
diarrhea
• Electrolyte levels
are affected during
this process.
Specific Abdominal and
Gastrointestinal Emergencies
• Hypovolemia can be caused by (cont’d):
− Hemorrhage
• Potential to be fatal
• Signs of shock are typically present.
• Drop in blood pressure indicates significant volume
loss
Gastrointestinal Bleeding
• GI bleeding is a symptom, not the disease.
− Determine onset and medical history.
− Treatment includes:
• Fluid resuscitation
• Establish an IV line.
Gastrointestinal Bleeding
Upper Gastrointestinal Bleeding:
Esophagogastric Varices
• Pathophysiology
− Caused by pressure increases in blood vessels
surrounding the esophagus and stomach
− Blood cannot easily flow through damaged liver.
• Blood backs up into the portal vessels.
Upper Gastrointestinal Bleeding:
Esophagogastric Varices
• Assessment
− Initial presentation
• Fatigue
• Jaundice
• Anorexia
• Pruritus
• Abdominal pain
− When the varices
rupture:
• Abrupt discomfort in
the throat
• Severe dysphagia
• Vomiting bright red
blood
• Signs of shock
Upper Gastrointestinal Bleeding:
Esophagogastric Varices
• Management
− General management guidelines
• Accurate assessment of blood loss
− In-hospital treatment includes:
• Stopping the bleeding
• Aggressive fluid resuscitation
• Possible endoscopy
Upper Gastrointestinal Bleeding:
Mallory-Weiss Syndrome
• Pathophysiology
− Junction between the esophagus and the
stomach tears
• Generally due to severe vomiting
Upper Gastrointestinal Bleeding:
Mallory-Weiss Syndrome
• Assessment
− Bleeding may be light to severe.
− In extreme cases, patients will have:
• Signs and symptoms of shock
• Epigastric abdominal pain
• Hematemesis
• Melena
Upper Gastrointestinal Bleeding:
Mallory-Weiss Syndrome
• Management
− Aimed at determining the extent of blood loss
− In-hospital management may include:
• Volume resuscitation
• Endoscopy
• Attempt to repair the tear
Upper Gastrointestinal Bleeding:
Peptic Ulcer Disease (PUD)
• Pathophysiology
− Erosion of the mucous that lines the stomach
and duodenum
− Typically occurs over weeks, months, or years
− Variety of causes
• Infection with Helicobacter pylori
• Erosive gastritis
Upper Gastrointestinal Bleeding:
Peptic Ulcer Disease (PUD)
• Assessment
− Burning or gnawing pain in the stomach
• Disappears after eating, but returns hours later
− Other common symptoms may include:
• Vomiting
• Belching
• Heartburn
Upper Gastrointestinal Bleeding:
Peptic Ulcer Disease (PUD)
• Management
− Assess blood loss and manage hypotension.
− Monitor orthostatic vital signs.
− In-hospital management includes:
• Acid neutralization
• Reduction therapies
• Endoscopy if needed
Upper Gastrointestinal Bleeding:
Gastroesophageal Reflux Disease
• Pathophysiology
− Sphincter between the esophagus and stomach
opens, allowing stomach acids to travel up
− Can cause a burning sensation within the chest
− Over time it can cause damage to the
esophageal wall and possible bleeding.
Upper Gastrointestinal Bleeding:
Gastroesophageal Reflux Disease
• Assessment
− Signs and symptoms
• Heartburn
• Coughing or difficulty swallowing
• Bleeding, resulting in hematemesis and melena
Upper Gastrointestinal Bleeding:
Gastroesophageal Reflux Disease
• Management
− Treatment focuses on decreasing acidity.
• Antacids, proton pump inhibitors, H2 blockers
− Symptoms can be confused with myocardial
infarction.
Lower Gastrointestinal
Bleeding: Hemorrhoids
• Pathophysiology
− Swelling and inflammation of blood vessels
around the rectum
− Caused by increased rectal pressure or irritation
Lower Gastrointestinal
Bleeding: Hemorrhoids
• Assessment
− Signs and symptoms:
• Hematochezia
• Rectal itching
• Small mass on rectum
Lower Gastrointestinal
Bleeding: Hemorrhoids
• Management
− Prehospital management is supportive.
− Obtain orthostatic vital signs.
− In-hospital management may include creams.
− Prevention includes eating a high-fiber diet.
Lower Gastrointestinal
Bleeding: Anal Fissures
• Pathophysiology
− Linear tears in the
mucosal lining
near and in the
anus
Lower Gastrointestinal
Bleeding: Anal Fissures
• Assessment
− Painful defecation
• Management
− Place dressing over anus.
− Do NOT pack fissure or anus.
Acute Inflammatory Conditions
• Inflammation helps white blood cells
destroy or seal off an invading agent.
• Localized inflammation will cause localized
signs and symptoms.
Acute Inflammatory Conditions
• If bacteria moves into the bloodstream,
sepsis occurs.
− The body responds with a generalized
inflammatory response.
− Autoimmune condition: the body attacks and
kills its own cells for no defined reason.
Cholecystitis and Biliary Tract
Disorders
• Pathophysiology
− Inflammation of the gallbladder
• Choleangitis—inflammation of bile duct
• Cholelithiasis—stones in the gallbladder
• Cholecystitis—inflammation of the gallbladder
• Acalculus cholecystitis—inflammation without
gallstones
Cholecystitis and Biliary Tract
Disorders
• Pathophysiology (cont’d)
− May arise from decreased flow of biliary
materials
− Patient may present with:
• Murphy sign
• Nausea/vomiting
• Jaundice
Cholecystitis and Biliary Tract
Disorders
• Assessment
− After eating a fatty meal, severe upper right
quadrant abdominal pain develops.
• Management
− Pain medications: meperidine and morphine
− Medication for nausea is often necessary.
Appendicitis
• Pathophysiology
− Fecal and other matter builds up in appendix.
− Build-up of pressure will eventually cause the
organ to rupture, resulting in:
• Peritonitis
• Sepsis
• Death
Appendicitis
• Assessment
− Stages of presentation
• Early—periumbilical pain, nausea, vomiting
• Ripe—pain in lower right quadrant
• Rupture—decrease in pain (decrease in pressure)
− Evaluate for peritonitis with Dunphy sign.
Appendicitis
• Management
− Assess for septicemia.
− Volume resuscitation
• Use dopamine if crystalloids are not effective.
− Administer pain and antinausea medications.
Diverticulitis
• Pathophysiology
− Diverticulum: weak area in the colon that begins
to have pockets (diverticula)
− Diverticulosis: condition of having diverticula
− Diverticulitis: Inflammation of diverticuli
Diverticulitis
• Pathophysiology
− A diet low in fiber creates more solid stool.
− If feces gets trapped in diverticula, inflammation
and infection occur and may cause:
• Scarring
• Adhesions
• Fistula
Diverticulitis
• Assessment
− Signs and symptoms include:
• Abdominal pain, usually localized on the left lower
abdomen
• Classic infection signs
• Constipation or diarrhea
Diverticulitis
• Management
− Ensure severe infection is not present.
− Patients may need fluids and/or dopamine.
− In-hospital treatment includes:
• Antibiotics
• Liquid diet
• Surgery
Pancreatitis
• Pathophysiology
− Inflammation of the pancreas
− Occurs when the tube carrying enzymes
becomes blocked, leading to autodigestion
− Can occur suddenly or over many months
− May be single or episodic attacks
Pancreatitis
• Assessment
− Signs and symptoms may include:
• Sharp pain in the epigastric area or right upper
abdomen
• Pain radiating to the back
• Muscle spasms
− Internal
hemorrhage may
be indicated by:
• Cullen sign
• Grey-Turner sign
© Wellcome Trust/Custom Medical Stock Photo
• Assessment
(cont’d)
© Wellcome Trust/Custom Medical Stock Photo
Pancreatitis
Pancreatitis
• Management
− Directed by general management guidelines
− Assess for signs of severe hemorrhage.
− Meperidine is the choice for pain management.
Ulcerative Colitis
• Pathophysiology
− Generalized inflammation of the colon
− Causes a thinning of the intestinal wall and a
weakened rectum
− Peaks between ages 15 and 25 years and 55
and 65 years
Ulcerative Colitis
• Assessment
− Signs and symptoms may include:
• Gradual onset of bloody diarrhea
• Hematochezia
• Mild to severe abdominal pain
• Skin lesions
Ulcerative Colitis
• Management
− Determine the degree of hemodynamic
instability.
− Administer fluids, if necessary.
− Follow the general management guideline.
Irritable Bowel Syndrome (IBS)
• Pathophysiology
− Patients often show:
• Hypersensitivity of bowel pain receptors
• Hyperresponsiveness of the smooth muscle
• Psychiatric disorder connection
Irritable Bowel Syndrome (IBS)
• Pathophysiology (cont’d)
− Hyperresponsiveness can cause spasm.
• Can cause constipation and bloating or diarrhea
− Typically begins during childhood
− Can be triggered by various stimuli
Irritable Bowel Syndrome (IBS)
• Assessment
− You will typically be called when the patient is
having a flare-up of symptoms.
• Management
− Mainly supportive
− Assessment should include the patient’s mood.
Crohn Disease
• Pathophysiology
− Involves the entire GI tract
− A series of attacks leaves a scarred, narrowed,
and weakened portion of the small intestine.
• Can cause bowel obstruction
Crohn Disease
• Assessment
− Signs and symptoms may include:
• Rectal bleeding
• Weight loss
• Skin disorders
Crohn Disease
• Management
− Prehospital care should focus on general
management guidelines, including:
• Volume resuscitation
• Control of nausea and pain
Acute Infectious Conditions
• GI infection occurs when contaminated food
is ingested or when the GI tract ruptures.
− People that have a difficulty combating
infection:
• Immunocompromised
• Very old
• Very young
Acute Infectious Conditions
• Damage may allow contents to be released
into surrounding tissues.
− The body will begin to defend itself.
− If the infection continues, it may leave the GI
system and enter the bloodstream.
• This is known as sepsis.
Acute Gastroenteritis
• Pathophysiology
− Conditions
involving infection
with fever,
abdominal pain,
diarrhea, nausea,
and vomiting
− Can be caused by
various organisms
• Typically enter via
the fecal-oral route
Acute Gastroenteritis
• Assessment
− Symptoms may show anywhere from several
hours to several days from contact
− Can last two or three days, or several weeks
Acute Gastroenteritis
• Assessment (cont’d)
− Signs and symptoms may include:
• Diarrhea of various types
• Nausea and vomiting
• Anorexia
− Assess for dehydration, hemodynamic
instability, and electrolyte imbalance.
Acute Gastroenteritis
• Management
− Determine the degree of fluid deficit.
− Obtain orthostatic vital signs.
− Analgesic and antiemetic medications
− Teach patients about safe food and water use.
Rectal Abscess
• Pathophysiology
− Caused when the ducts carrying mucus to the
rectal area become blocked
• Allows bacteria to grow and spread to the anus
Rectal Abscess
• Assessment
− Symptoms may include:
• Rectal pain that increases with defecation
• Rectal drainage
• Constipation
• Management
− Focus on keeping the patient comfortable.
Liver Disease: Cirrhosis
• Pathophysiology
− Early liver failure, which may be hallmarked by:
• Portal hypertension
• Deficiencies with coagulation
• Diminished detoxification
Liver Disease: Cirrhosis
• Assessment
− First stage may include:
• Weakness and fatigue
• Nausea and vomiting
• Anorexia
• Pruritus
Liver Disease: Cirrhosis
• Assessment
(cont’d)
− 2nd stage may
include:
• Alcoholic stools
• Dark urine
• Icteric conjunctiva
• Ascites
• Enlarged liver
Courtesy of Dr. Thomas F. Sellers/Emory University/CDC
Liver Disease: Cirrhosis
• Assessment (cont’d)
− Common blood tests:
• Aminotransferases
• Alkaline phosphatase
• Albumin
• Bilirubin
Liver Disease: Cirrhosis
• Management
− Prehospital care should be supportive.
− Involves bleeding control and medication
− Use lower ends of medication dose range.
Liver Disease: Hepatic
Encephalopathy
• Pathophysiology
− Brain impairment due to diminished liver
function
− Underlying causes:
• Increased levels of ammonia
• Diminished cellular energy supplies
• Change in blood-brain barrier permeability
Liver Disease: Hepatic
Encephalopathy
• Assessment
− Can range from mild memory loss to coma
− May be precipitated by:
• Infection
• Renal failure
• GI bleeding
• Constipation
Liver Disease: Hepatic
Encephalopathy
• Management
− Mainly supportive
− Ensure that LOC status is not from other cause.
• Check blood glucose levels.
• Assess for trauma and overdose.
• Take a medical history.
Obstructive Conditions
• Intestines are unable to move material
through the digestive tract.
− Two main reasons:
• Paralysis of the intestines
• Intestinal lumen diameter compromise
Small-Bowel Obstruction
• Pathophysiology
− Most often caused by post-operative adhesions
− Other causes include:
• Cancer
• Crohn disease
• Hernias
• Foreign bodies
Small-Bowel Obstruction
• Assessment
− Signs and symptoms may include:
• Crampy and intermittent abdominal pain
• Initial diarrhea, nausea, and vomiting
• Increased pressure
• Constipation
Small-Bowel Obstruction
• Management
− Monitor blood pressure, and perform volume
resuscitation.
− Administer dopamine as needed.
− Consider using a nasogastric tube.
− Antiemetics are indicated.
Large-Bowel Obstruction
• Pathophysiology
− Caused by either mechanical obstruction or
colon dilation
− Imaging studies determine the location and
extent of obstruction.
• Once located, can be easily treated
Large-Bowel Obstruction
• Assessment
− Signs and symptoms may include:
• Nausea and vomiting
• Distended abdomen
• Absent bowel sounds
• Peritonitis signs if bowel has ruptured
Large-Bowel Obstruction
• Management
− Same as for small bowel obstruction
Hernia
• Pathophysiology
− Organ/structure protrusion into adjacent cavity
− To check for an inguinal hernia:
• Place fingers on lower abdomen.
• Instruct patient to cough.
• Weakness in abdominal wall will present as bulging.
Hernia
• Pathophysiology (cont’d)
− Caused by any condition that causes intraabdominal pressure:
• Obesity
• Standing for long periods
• Straining during bowel movements
• Chronic obstructive pulmonary disease
Hernia
• Assessment
− Four types
• Reducible
• Incarcerated
• Strangulated
• Incisional
Hernia
• Management
− Focus on supportive measures.
− Pain management
− Assess for sepsis
Rectal Foreign Body
Obstruction
• Pathophysiology
− Originates from upper GI tract or anal insertion
• Assessment
− Presents with sudden rectal pain with
defecation
− Determine if the rectum has been perforated.
Rectal Foreign Body
Obstruction
• Management
− Do NOT attempt to remove object.
− Prehospital management should be limited to
patient comfort.
• Treat with analgesia if indicated.
• Closely monitor vital signs.
Mesenteric Ischemia
• Pathophysiology
− Interruption of the blood supply to the
mesentery
− Can be caused by:
• Arterial embolism
• Thrombosis
• Profound vasospasm
Mesenteric Ischemia
• Assessment
− Gradual or sudden onset
− Symptoms include:
• Severe pain with ill-defined location
• Nausea, vomiting, and diarrhea
• Possible blood in stool
Mesenteric Ischemia
• Management
− Patients require rapid transportation.
− Monitor closely.
− Check vitals for signs of sepsis.
− Fluid resuscitation in cases of shock
− Give analgesics as needed.
Gastrointestinal Conditions in
Pediatric Patients
• GI complaints are common in children.
− Prolonged vomiting, diarrhea, or bleeding can
lead to severe changes in sodium and
potassium levels.
Gastrointestinal Conditions in
Pediatric Patients
• Congenital GI
anomalies
© M. Ansary/Custom Medical Stock Photo
− Gastrochisis:
portions of the GI
system lie outside
the abdominal wall
Gastrointestinal Conditions in
Pediatric Patients
• Congenital GI
anomalies (cont’d)
− Intestinal
malrotation:
intestines rotated
incorrectly during
development
Gastrointestinal Conditions in
Pediatric Patients
• Congenital GI
anomalies (cont’d)
− Pyloric stenosis:
hypertrophy of the
pyloric sphincter of
the stomach
• GI bleeding can
occur in children.
Gastrointestinal Conditions in
Pediatric Patients
• Careful assessment is critical.
− Check skin turgor, pulse rate, and peripheral
pulse status.
− Severe fluid loss may cause diminished LOC.
• Standard fluid resuscitation: 20 mL/kg isotonic fluid
− Get a detailed medical history from the parent.
Gastrointestinal Conditions in
Pediatric Patients
• Patients may have a gastrostomy tube.
− If dislodged, place a sterile dressing over it.
− If clogged, talk about ways to clear the tube.
− If the blockage cannot be easily managed, turn
off the feeding, clamp the tube, and transport.
Gastrointestinal Conditions in
Older Adults
• GI diseases more prevalent in older adults
• Abdominal pain can also be a symptom of a
cardiac condition.
− Obtain a thorough history and physical exam.
− Consider a 12-lead ECG.
− Monitor vital signs.
Prevention Strategies
• Many behaviors
can prevent or limit
severity of GI
diseases.
Prevention Strategies
Summary
• GI illnesses are rarely life threatening, but
systemic illnesses can occur if left untreated
or undertreated.
• The structures and functions of the GI
system perform digestion, which begins in
the mouth and ends in the anus.
• It is likely you will come in contact with
blood or other body fluids. A complete
scene size-up requires a survey of PPE.
Summary
• Observe a patient presenting with GI
symptoms to form a general impression.
• Maintain airway and circulation; determine
extent of bleeding.
• Weigh patient stability and risk of injury
when deciding on rapid transport.
• The field impression and gathered
information can determine cause of
complaint.
Summary
• The secondary assessment should include
a physical examination.
• Orthostatic vital sign changes of 10-beat
pulse rate increase and 10-mm Hg drop in
blood pressure is a likely sign of significant
volume loss.
• Reassess the patient by monitoring
changes in condition.
Summary
• Pain and nausea management can be
given to most patients with GI emergencies.
• Compassionate care and clear
documentation are essential parts of
delivering excellent patient care.
• Perform new assessments and
examinations if patient condition changes.
Summary
• Perform airway management if necessary.
• If circulation is compromised by dehydration
or hemorrhage, fluid resuscitation is
essential.
• Paramedics must understand GI diseases
to educate patients and to perform an
increasing level of responsibilities.
Summary
• The four major conditions responsible for
abdominal and GI emergencies are:
− Hypovolemia
− Acute or chronic inflammation
− Infection
− Obstruction
Summary
• GI tract bleeding is a symptom and can
reflect many GI diseases.
• Pediatric patients face special challenges
because of their size, physiology, and
possible GI congenital anomalies.
• Treating older adults with GI emergencies is
complicated by comorbidities, multiple
medications, and other factors.
Credits
• Chapter opener: © Wellcome Trust/Custom Medical Stock
Photo
• Backgrounds: Blue—Jones & Bartlett Learning. Courtesy
of MIEMSS; Gold—Jones & Bartlett Learning. Courtesy of
MIEMSS; Red—© Margo Harrison/ShutterStock, Inc.;
Green—Courtesy of Rhonda Beck
• Unless otherwise indicated, all photographs and
illustrations are under copyright of Jones & Bartlett
Learning, courtesy of Maryland Institute for Emergency
Medical Services Systems, or have been provided by the
American Academy of Orthopaedic Surgeons.