Transcript bledsoe_pcpp4_ch06_lecture - McLaren

Paramedic Care: Principles & Practice
Fourth Edition
Volume 4: Medicine
CHAPTER
6
Gastroenterology
Multimedia Directory
Slide 35
Digestive System Exercise
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Standard
• Medicine (Abdominal and
Gastrointestinal Disorders)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Competency
• 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.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• 500,000 gastrointestinal emergencies
every year.
• 300,000 due to gastrointestinal
bleeding.
• Last few years, number of patients over
60 risen from 3% to more than 45%.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Gastrointestinal (GI) emergencies
usually result from underlying
pathological process.
• Risk factors known to physicians; most
self-induced by patients.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Risk factors:
– Excessive alcohol consumption
– Excessive smoking
– Increased stress
– Ingestion of caustic substances
– Poor bowel habits
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Pain hallmark of acute abdominal
emergency.
• Three classifications of abdominal pain:
– Visceral
– Somatic
– Referred
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General Pathophysiology,
Assessment, and Treatment
• Visceral pain: originates in walls of
hollow organs (gallbladder or
appendix), in capsules of solid organs
(kidney or liver), or in visceral
peritoneum.
– Mechanisms that produce pain:
inflammation, distention ischemia.
– Cause varying intensities,
characteristics, locations of pain.
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General Pathophysiology,
Assessment, and Treatment
• Inflammation, distention, ischemia all
transmit pain signal from visceral
afferent neural fibers to spinal column.
– Often described as vague or poorly
localized, dull, or crampy.
– Many hollow organs first cause visceral
pain when distended.
– Then cause specific type of pain when
they rupture or tear.
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General Pathophysiology,
Assessment, and Treatment
• Somatic pain: sharp type of pain that
travels along definite neural routes to
spinal column.
– Pain localized to region or area.
– Bacterial and chemical irritations of
abdomen commonly cause somatic pain.
– Degree of pain initially proportional to
spread of irritant through abdominal
cavity.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Referred pain: originates in region
other than where it is felt.
• Not true pain-producing mechanism.
– For example: dissecting abdominal
aortic artery, produces referred pain felt
between shoulder blades.
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Referred pain patterns: (a) anterior.
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Paramedic Care: Principles & Practice, 4th Ed.
Referred pain patterns: (b) posterior.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Assessment similar to trauma
assessment with expanded history.
• Ensure scene free and clear of any
apparent dangers.
• Always take Standard Precautions.
• Survey scene for potential evidence of
patient's problem (medication bottles,
alcohol containers, ashtrays, buckets
with emesis or sputum)
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Look for mechanism of injury (MOI);
determine whether call is medical or
trauma.
• If trauma, immobilize cervical spine.
• Check responsiveness; airway patency.
• Evaluate respiratory functions; quickly
palpate pulse and check skin color,
temperature, and circulation, including
signs of bleeding and capillary refill.
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General Pathophysiology,
Assessment, and Treatment
• If life-threatening condition, treat it and
rapidly continue assessment to identify
any other life threats.
• Conduct secondary assessment.
• Conduct SAMPLE history (symptoms,
allergies, medications, past medical
history, last oral intake, events) and
more thorough history.
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General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Onset
 Sudden onsets generally caused by
perforations of abdominal organs or
capsules.
 Gradual onset of pain associated with
blockage of hollow organs.
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General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Provocation/palliation
 If pain lessens when patient draws legs
up to chest or lies on side, usually
indicates peritoneal inflammation.
 If walking relieves pain, cause may be in
GI or urinary system.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Quality
 Localized, tearing pain associated with
rupture of organ.
 Dull, steadily increasing pain may
indicate bowel obstruction.
 Sharp pain, particularly in flank, may
indicate kidney stone.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Region/radiation
 Radiated pain common; it involves same
neural routes as referred pain.
 Pain referred to shoulder or neck
associated with irritation of diaphragm.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Severity
 Usually worsens as pathology of organ
advances.
– Time
 Estimation of pain's time of onset
important to determine possible causes.
 Any abdominal pain lasting over 6 hours
considered surgical emergency.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Associated symptoms
 Try to determine content, color, smell of
vomitus.
 Ask if vomitus contained any bright red
blood, “coffee grounds,” or clots.
 Determining if patient has active
gastrointestinal bleed is imperative.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Associated symptoms
 Changes in bowel morphology, color, or
smell can be only indication of lower GI
hemorrhage, gastritis, bleeding
diverticula.
 Patients who have acute abdomen
usually have associated loss of appetite.
©2013 Pearson Education, Inc.
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General Pathophysiology,
Assessment, and Treatment
• OPQRST-ASPN history
– Pertinent negatives
 Absence of symptoms with GI function or
presence of symptoms with urinary
function may be problem in urinary
system.
 Pain in lowest part of abdomen can be
due to problems in reproductive system.
 Cardiovascular history with referred pain.
©2013 Pearson Education, Inc.
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General Pathophysiology,
Assessment, and Treatment
• Ask about patient's last oral intake.
• Gastrointestinal emergencies that
cause chest pain:
– Gastroesophageal reflux
– Gastric ulcers
– Duodenal ulcers
– Gallbladder disease
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General Pathophysiology,
Assessment, and Treatment
• Obtain past medical history.
• Complete physical examination.
– Patient's general appearance and
posture strongly suggest apparent state
of health and severity of complaint.
– Take complete set of vital signs.
– Visually inspect abdomen before
palpating it, auscultating it, moving
patient.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Complete physical examination.
– Distention of abdomen ominous sign.
– Caused by buildup of free air due to
obstruction of bowel or hemorrhage.
– Signs of fluid loss: periumbilical
ecchymosis (Cullen's sign) and
ecchymosis in flank (Grey Turner's
sign).
©2013 Pearson Education, Inc.
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General Pathophysiology,
Assessment, and Treatment
• Complete the physical examination.
– Auscultating abdomen provides little
helpful information.
– Palpating abdomen can define area of
pain and identify associated organ.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Highest priority when treating patient
with abdominal pain: secure and
maintain airway, breathing, circulation.
• Be prepared to suction airway of
vomitus and blood.
• Supplemental oxygen and aggressive
airway management may be indicated,
depending on patient's status.
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Paramedic Care: Principles & Practice, 4th Ed.
General Pathophysiology,
Assessment, and Treatment
• Monitor circulation by placing patient
on cardiac monitor; frequently assess
blood pressure.
• Measurement of hematocrit will give
indirect measure of blood loss.
• Establish large-bore IV line in patients
who complain of abdominal discomfort.
• Avoid masking abdominal pain; will
limit pharmacological interventions.
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General Pathophysiology,
Assessment, and Treatment
• Place patient in comfortable position.
• Provide emotional reassurance.
• Keep voice and actions quiet and
collected.
• Persistent abdominal pain lasting longer
than 6 hours classified as surgical
emergency; always requires transport.
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Specific Illnesses
• Gastrointestinal (GI) tract one long
tube divided structurally and
functionally into different parts.
• Organs: liver, gallbladder, pancreas,
vermiform appendix.
• Converts food into nutrient molecules
that cells can use; excretes solid
wastes from body.
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The gastrointestinal tract is one long tube divided structurally and functionally into different parts.
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Paramedic Care: Principles & Practice, 4th Ed.
Digestive System Exercise
Click here to complete an interactive exercise on the digestive system.
Back to Directory
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Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Upper GI tract
– Mouth, esophagus, stomach, duodenum
(first part of small intestine).
– Physical digestion of food and some
chemical digestion take place here.
– As food passes through lower GI tract
(remainder of small intestine and large
intestine), nutrients absorbed into blood
and solid wastes formed and excreted.
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Specific Illnesses
• Upper Gastrointestinal Bleeding
– Bleeding within gastrointestinal tract
proximal to ligament of Treitz.
– 300,000 hospitalizations per year; 10%
mortality rate.
 Patients treat symptoms with home
remedies/over-the-counter medication.
 Age of population increasing.
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Specific Illnesses
• Six major causes of upper GI
hemorrhage:
– Peptic ulcer disease
– Gastritis
– Variceal rupture
– Mallory-Weiss tear (esophageal
laceration)
– Esophagitis
– Duodenitis
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Specific Illnesses
• Upper Gastrointestinal Bleeding
– Patient may experience hematemesis
(bloody vomitus) or, if it passes through
lower GI tract, melena.
– Blood in emesis bright red or looks like
coffee grounds.
– May be light or brisk and life
threatening.
– May vomit copious amounts of blood.
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Specific Illnesses
• Upper Gastrointestinal Bleeding
– Bleeding may cause shock or
compromise airway.
– Tilt test: indicates if patient has
orthostatic hypotension.
– Hypotension suggests decreased
circulating volume.
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Specific Illnesses
• Upper Gastrointestinal Bleeding
– General complaints: malaise, weakness,
syncopal (fainting), near-syncopal
(lightheaded) spells, tachycardia,
indigestion.
– Patient's general appearance may be
best indicator of condition's severity.
– Perform thorough physical examination.
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Specific Illnesses
• Upper Gastrointestinal Bleeding
– Prehospital treatment: maintain patent
airway, oxygenation, circulatory status.
– Place patient in left lateral recumbent or
high semi-Fowler's position.
– Administer high-concentration
oxygenation via nonrebreather mask.
– Establish two large-bore IVs in patient
you suspect of gastrointestinal bleed.
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Specific Illnesses
• Esophageal Varices
– Swollen vein of esophagus.
– Often rupture and hemorrhage.
– When they do, mortality rate over 35%.
– Causes: increase in portal pressure
(portal hypertension), consumption of
alcohol, ingestion of caustic substances.
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Specific Illnesses
• Esophageal Varices
– Alcoholic liver cirrhosis accounts for
two-thirds of cases.
– Patients present initially with painless
bleeding and signs of hemodynamic
instability.
– Care should focus on aggressive airway
management, intravenous fluid
resuscitation, rapid transport.
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Specific Illnesses
• Esophageal Varices
– Airway management top priority.
– Suction emesis frequently and diligently
from airway; endotracheal intubation
may be needed.
– Administer high-concentration oxygen
via nonrebreather mask.
– Octreotide is drug of choice for acute
variceal bleeding.
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Esophageal varices occur when the esophageal veins dilate and emerge from their sheaths.
(Photo: © Dr. Bryan E. Bledsoe)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Acute Gastroenteritis
– Inflammation of stomach and intestines
associated with sudden onset of
vomiting and/or diarrhea.
– Pathological inflammation causes
hemorrhage and erosion of mucosal and
submucosal layers of gastrointestinal
tract.
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Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Acute Gastroenteritis
– Adequate volume replacement
prehospital prevention strategy;
minimize hypovolemia or hypovolemic
shock.
– Individuals who abuse alcohol and
tobacco at high risk.
– Use of nonsteroidal anti-inflammatory
drugs (aspirin) breaks down mucosal
surfaces of stomach and GI tract.
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Specific Illnesses
• Acute Gastroenteritis
– Other causes: stress, chemotherapeutic
agents, ingestion of acidic or alkalotic
agent, infections.
– Onset rapid and usually severe.
– Diarrhea associated with this condition;
fluid loss leads to dehydration.
– Due to dehydration and hemorrhage,
patient hemodynamically unstable.
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Specific Illnesses
• Acute Gastroenteritis
– Treatment: supportive and palliative.
– Be prepared to clear airway of vomit or
secretions.
– Maintaining adequate oxygenation high
priority.
– Avoid hyperoxia; rehydrate patient.
– Exercise extreme caution; use Standard
Precautions.
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Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Chronic Gastroenteritis
– Inflammation of gastrointestinal mucosa
marked by long-term mucosal changes
or permanent mucosal damage.
– Due primarily to microbial infection.
– Far more common in underdeveloped
countries.
– Transmitted via fecal–oral route or
through infected food or water.
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Specific Illnesses
• Chronic Gastroenteritis
– Symptoms: nausea and vomiting, fever,
diarrhea, abdominal pain, cramping,
anorexia, lethargy, shock.
– H. pylori symptoms: heartburn,
abdominal pain, gastric ulcers.
– Prehospital treatment: protecting
yourself and patient from
contamination, monitoring ABCs,
transport.
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Specific Illnesses
• Peptic Ulcers
– Erosions caused by gastric acid; occur
anywhere in gastrointestinal tract.
– Duodenal ulcers occur in proximal
portion of duodenum.
– Occur in males more than females.
– Important to get family history and
estimate of patient's last oral intake.
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Peptic ulcer. (Photo: © Dr. Bryan E. Bledsoe)
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Specific Illnesses
• Peptic Ulcers
– Causes: nonsteroidal anti-inflammatory
medications (aspirin, ibuprofen,
naproxen), acid-stimulating products
(alcohol, nicotine), or Helicobacter pylori
bacteria.
– Treatment in prehospital setting:
antacid treatment and support of any
complications such as hemorrhage.
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Specific Illnesses
• Peptic Ulcers
– Blocked pancreatic duct can contribute
to duodenal ulcers.
– Duodenal ulcers: Zollinger-Ellison
syndrome; acid-secreting tumor
provokes ulcerations.
– Chronic ulcers can cause slow bleed
with resulting anemia; acute, severe
pain due to rupture of ulcer.
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Specific Illnesses
• Peptic Ulcers
– Nausea and vomiting common.
– Massive hemorrhage can occur.
– Patients will appear very ill; signs of
hemodynamic instability.
– Treatment depends on severity of
patient's pain.
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Specific Illnesses
• Lower Gastrointestinal Disease
– Lower GI tract: jejunum and ileum of
small intestine and entire large
intestine, rectum, anus.
– As digestive fluid moves through small
intestine, nutrients absorbed into blood.
– Water absorbed and solid wastes form
in large intestine.
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Specific Illnesses
• Lower GI Bleeding
– Occurs in GI tract distal to ligament of
Treitz in conjunction with chronic
disorders and anatomic changes
associated with advanced age.
– Causes: diverticulosis, colon lesions,
rectal lesions, anal fissures,
inflammatory bowel disorders
(ulcerative colitis and Crohn's disease).
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Specific Illnesses
• Lower GI Bleeding
– Symptoms: cramping, nausea,
vomiting, changes in stool.
– Most patients with lower GI bleeds have
not lost significant amounts of blood;
hemodynamic stability.
– Management will depend on physiologic
status.
– Watch airway and oxygenation status.
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Specific Illnesses
• Ulcerative Colitis
– Classified as idiopathic inflammatory
bowel disorder (IBD); unknown origin.
– 75% of ulcerative colitis involves rectum
or rectosigmoid portion of large
intestine.
– Pancolitis: if it spreads throughout
entire colon.
– Proctitis: if limited to rectum.
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Specific Illnesses
• Ulcerative Colitis
– Contributing factors: psychological,
allergic, toxic, environmental,
immunologic, infectious.
– Recurrent disorder with bloody diarrhea
or stool-containing mucus.
– Abdominal pain (cramping), nausea and
vomiting, fever, weight loss.
– Significant hemorrhage common.
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Specific Illnesses
• Ulcerative Colitis
– Management depends on physiologic
status.
– Transport patient who presents with
lower GI bleeding or colicky pain to
emergency department.
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Ulcerative colitis.
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Specific Illnesses
• Crohn's Disease
– Idiopathic inflammatory bowel disorder.
– Tends to run in families; white females;
frequent stress; in Jewish population.
– Can occur anywhere from mouth to
rectum.
– Severe cases may involve any portion of
GI tract.
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Specific Illnesses
• Crohn's Disease
– Complete intestinal obstruction, a
surgical emergency, can occur.
– Significant lower GI bleeding rare.
– Signs and symptoms: GI bleeding,
recent weight loss, intermittent
abdominal cramping/pain, nausea and
vomiting, diarrhea, fever.
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Specific Illnesses
• Crohn's Disease
– Onset of a flare-up usually rapid.
– If patient is hemodynamically stable,
prehospital treatment largely palliative.
– Management depends on patient's
physiologic status.
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Specific Illnesses
• Diverticulitis
– Common complication of diverticulosis.
• Diverticulosis
– Presence in intestine of diverticula,
small outpouchings of mucosal and
submucosal tissue that push through
outermost layer of intestine, the muscle.
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Specific Illnesses
• Diverticulitis
– Inflammation of diverticula secondary to
infection.
– Lower left-sided pain; fever; increased
white blood cell count; nausea and
vomiting; tenderness on palpation.
– Prehospital treatment supportive.
– Hospital treatment: antibiotic therapy,
endoscopy, radiologic tests.
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Specific Illnesses
• Hemorrhoids
– Small masses of swollen veins that
occur in anus (external) or rectum
(internal).
– Develop during fourth decade of life.
– Idiopathic (unknown cause); can result
from pregnancy or portal hypertension.
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Hemorrhoids are small masses of swollen veins.
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Specific Illnesses
• Hemorrhoids
– Internal hemorrhoids bleed during
defecation due to straining and then
thrombose into closed state again.
– External hemorrhoids result from
thrombosis of vein, often following
lifting or straining, causing bright red
bleeding with bowel movement.
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Specific Illnesses
• Hemorrhoids
– Rarely cause significant hemorrhage.
– Physical assessment usually reveals
hemodynamically stable patient with
relatively normal appearance.
– Significant hemorrhage or bleeding
hemorrhoids in alcoholic patient warrant
closer monitoring and transport for
immediate follow-up.
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Specific Illnesses
• Rectal Foreign Body
– Foreign body inserted into rectum with
patient's knowledge for various reasons
(sexual gratification or psychosis).
– Most swallowed foreign bodies pass
readily, but others may not.
– Rectal pain or pressure; infection or
shock.
– Prehospital treatment: supportive.
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Specific Illnesses
• Bowel Obstruction
– Blockages of hollow space (lumen)
within small and large intestines; partial
or complete.
– Hernias, intussusception, volvulus,
adhesions are the four most frequent.
– Common causes: foreign bodies,
gallstones, tumors, adhesions from
abdominal surgery, bowel infarction.
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Inguinal hernia.
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Intestinal volvulus.
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Specific Illnesses
• Bowel Obstruction
– Most common location for obstructions
is small intestine.
– Obstruction may be chronic; decreased
appetite, fever, malaise, nausea and
vomiting, weight loss, or if rupture
occurs, peritonitis.
– Onset sudden and acute: ingestion of
foreign body.
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Specific Illnesses
• Bowel Obstruction
– Frequently vomit, with vomitus often
containing significant amount of bile.
– Diffuse visceral pain, usually poorly
localized to any one specific location.
– May be hemodynamically unstable.
– Distention, peritonitis, or free air within
abdomen secondary to rupture of
strangulated segment of intestine.
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Specific Illnesses
• Bowel Obstruction
– Look for scars from previous surgery.
– Bowel sounds may be present as highpitched obstruction sound.
– Palpation will reveal tenderness.
– Treatment: airway management,
oxygenation via nonrebreather mask,
position of comfort or shock position,
fluid resuscitation to prevent shock.
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Specific Illnesses
• Mesenteric Ischemia
– When one of mesenteric arteries
becomes narrowed or occluded.
 Superior mesenteric artery (SMA)
 Inferior mesenteric artery (IMA)
– When blood flow through either of these
vessels reduced or stopped, abdominal
pain occurs.
– Nausea, vomiting, diarrhea common.
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Specific Illnesses
• Mesenteric Ischemia
– Bowel will become ischemic and die,
causing infection.
– Prehospital treatment: hydration, pain
control, antiemetics.
– Treatment usually surgical.
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Specific Illnesses
• Appendicitis
– Inflammation of vermiform appendix,
located at junction of large and small
intestines.
– 10 to 20% of population; young adults.
– Acute appendicitis most common
surgical emergency in field.
– Appendix no known anatomic or
physiologic function.
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Specific Illnesses
• Appendicitis
– Can become inflamed; if untreated can
rupture, spilling contents into peritoneal
cavity and setting up peritonitis.
– Obstruction of appendiceal lumen by fecal
material.
– Common site of pain: McBurney's point, 1
to 2 inches above anterior iliac crest
along direct line from anterior crest to
umbilicus.
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McBurney point is a common site of pain in appendicitis.
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Specific Illnesses
• Appendicitis
– Once appendix ruptures, pain becomes
diffuse due to development of
peritonitis.
– Do not repeatedly palpate for rebound
tenderness; pressure that this exerts
can cause inflamed appendix to rupture.
©2013 Pearson Education, Inc.
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Specific Illnesses
• Appendicitis
– Prehospital care
 Place patient in position of comfort
 Give psychological support
 Manage airway to prevent aspiration
 Establish intravenous access
 Transport
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Cholecystitis
– Inflammation of gallbladder.
– Cholelithiasis: formation of gallstones;
causes 90% of cholecystitis cases.
– Cholesterol-based stones: obese,
middle-aged women with more than one
biological child.
– Antibiotic therapy, laparoscopic surgery,
lithotripsy, surgery.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The gallbladder is located below the liver.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Cholecystitis
– Caused by gallstones; chronic or acute.
– Acalculus cholecystitis results from
burns, sepsis, diabetes, multiple organ
failure.
– Inflamed gallbladder causes acute
attack of upper right quadrant
abdominal pain.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Cholecystitis
– Often pain occurs after meal high in fat
content; nausea and vomiting common.
– Distention and ecchymosis rare.
– Palpation may reveal diffuse right-sided
tenderness or point tenderness under
right costal margin; positive Murphy's
sign.
– Prehospital treatment: mainly palliative.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Pancreatitis
– Inflammation of pancreas.
– Four categories based on cause:
 Metabolic
 Mechanical
 Vascular
 Infectious
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Pancreatitis
– Metabolic causes, specifically
alcoholism, account for 80% of cases.
– Mechanical obstructions caused by
gallstones or elevated serum lipids.
– Vascular injuries caused by
thromboembolisms or shock.
– Infectious caused by infectious diseases.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Pancreatitis
– Mortality high (30–40%) due to
accompanying sepsis and shock; can
lead to multisystem organ failure.
– Digestive enzymes inflame pancreas
and cause edema; reduced blood flow.
– Decreased blood flow causes ischemia
and acinar destruction; acute
pancreatitis based on rapidity of onset.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy of the pancreas and surrounding structures.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Pancreatitis
– Acinar tissue destruction causes second
form, chronic pancreatitis.
– Due to chronic alcohol intake, drug
toxicity, ischemia, infectious diseases.
– Lesion can erode and hemorrhage;
causes intense abdominal pain.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Pancreatitis
– Nausea followed by uncontrolled
vomiting; can aggravate hemorrhage.
– Patient will appear acutely ill with
diaphoresis, tachycardia, possible
hypotension.
– Prehospital treatment: supportive,
maintaining ABCs.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Hepatitis
– Any injury to hepatocytes (liver cells)
associated with inflammation or
infection.
– High mortality rate.
– Six viruses: hepatitis types A, B, C, D,
E, G; most common causes.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Hepatitis
– Risk factors
 Crowded and unsanitary living conditions
 Poor personal hygiene that invites oral–
fecal transmission
 Exposure to bloodborne pathogens
 Chronic alcohol intake
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Hepatitis
– Symptoms' severity can range from
mild to complete liver failure and death.
– Hepatitis A (HAV): best known;
infectious hepatitis.
– Hepatitis B (HBV): “serum hepatitis";
transmitted as bloodborne pathogen.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Hepatitis
– Hepatitis C (HCV): pathogen commonly
responsible for spreading hepatitis
through blood transfusions; chronic and
often debilitating damage to liver.
– Hepatitis D (HDV): less common;
pathogen dormant until activated by
HBV.
– Hepatitis E (HEV): waterborne infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Hepatitis
– Hepatitis G (HGV): developed hepatitis
after transfusion; people with hepatitis
A, B, C can be super-infected with HGV.
– Possibly with jaundiced appearance;
upper right quadrant abdominal
tenderness.
– Severe nausea and vomiting, malaise,
photophobia, pharyngitis, coughing.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Specific Illnesses
• Hepatitis
– Palpation may reveal enlarged liver.
– Prehospital treatment: mainly palliative.
– Secure ABCs and establish intravenous
access for fluid resuscitation or
antiemetic administration.
– Vaccinations available for hepatitis A
and B.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Abdominal pain can originate from wide
variety of causes; abdominal organs or
areas outside abdominal cavity.
• Patient's description of pain (sharp,
dull, burning, tearing, cramping) may
help narrow differential diagnosis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Prehospital management priorities:
maintain airway, breathing, circulation.
• Diagnosis can include multitude of
causes that cannot be identified without
laboratory and radiographic analysis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Correction of most life-threatening
conditions generally requires surgical
intervention.
• Airway management paramount
importance; patients suffer from severe
bouts of nausea and vomiting.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Be prepared to turn patient onto side if
necessary to clear large amounts of
vomitus from airway.
• Oxygenation can be adequately
stabilized by placing patient on highconcentration oxygen via nonrebreather
mask.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Fluid loss, hemorrhage, sepsis may
compromise circulatory status.
• Initiate fluid resuscitation for
hemodynamically unstable patient in
field, but never delay transport.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Patients who have abdominal pain
lasting over 6 hours should always be
evaluated by physician.
• Key to successful treatment of
gastrointestinal ailments: prompt
recognition, treatment, rapid transport.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.