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EMT Test 4 > Abdominal Emergencies > Flashcards

Abdominal Emergencies Flashcards

1
Q

Abdomen

A

Region between the diaphragm and pelvis

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2
Q

Which organ systems are found in the abdomen

A

– Digestive
– Reproductive
– Endocrine
– Regulatory

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3
Q

What are the solid organs of the abdomen

A

Spleen
Liver
Pancreas
Kidneys

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4
Q

What are the Hollow organs of the stomach

A 
Stomach
Gallbladder
Duodenum
Large Intestine
Small Intestine
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5
Q

Peritoneum

A

thin membrane lining the abdominal cavity and covering each organ.
These organs include the stomach, liver, spleen, appendix, sm & lg intestine and in women the uterus, fallopian tubes & ovaries.

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6
Q

Parietal peritoneum

A

lines abdominal cavity

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7
Q

Visceral peritoneum

A

covers each organ

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8
Q

Which organs are found in the extra-peritoneal space, behind the peritoneum

A

Kidneys
Pancreas
Portion of the Aorta

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9
Q

Which organs lie inferior the the peritoneum

A

bladder

part of the rectum

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10
Q

Which organs are found in within the peritoneal cavity

A 
Spleen (behind the liver)
Liver
Gallbladder
Stomach
Transverse Colon (and ascending & descending colon)
Small Bowel (intestine)
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11
Q

Which organs are within the retroperitoneal cavity

A

Kidney ( and ureters)
Pancreas
Duodenum
Abdominal Aorta

Inferior vena cava
Fallopian tube (and ovaries)
Sigmoid colon
Uterus
Rectum
Urinary Bladder
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12
Q

Abdomen divided into what regions

A

RUQ, LUQ, RLQ, LLQ Epigastric region

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13
Q

Visceral Pain

A
  • Originates from the visceral peritoneum
  • Fewer nerve endings allow for only diffuse sensations of pain
  • Frequently described as “dull” or “achy”
  • Colic (intermittent pain) may result from distention and/or contraction of hollow organs
  • Persistent or constant pain often originates from solid organs
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14
Q

Parietal Pain

A
  • Originates from the parietal peritoneum - parietal tenderness
  • Many nerve endings allow for specific, efficient sensations of pain
  • Frequently described as “sharp”
  • Pain is often severe, constant, and localized to a specific area
  • The pt will describe this kind of pain as worsening upon movement or getting better when still or lies with knees drawn up
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15
Q

Referred Pain

A

• Perception of pain in skin or muscles at distant locations
– Abdomen has many nerves from different parts of the nervous system
– Nerve pathways overlap as they return to the spinal cord
– Pain sensation is transmitted from one system to another

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16
Q

Tearing Pain

A
  • Originates in the aorta
  • Separation of layers of this large blood vessel caused by aneurysm
  • Retroperitoneal location of aorta causes pain to be referred to back as that it is located
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17
Q

Appendicitis: What is it Signs & Symptoms

A 
• Infection of appendix
• Appendectomy is usually indicated
• Signs and symptoms
– Persistent RLQ pain
– Pain often initially referred to umbilical region
– Rupture of appendix
• Sudden, severe increase in pain
• Contents released into abdomen causes severe peritonitis
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18
Q

Peritonitis: What is it Signs & Symptoms

A

• Irritation of peritoneum, usually caused by foreign material in peritoneal space
• Parietal peritoneum is sensitive, especially to acidic substances
• Irritation causes involuntary contraction of abdominal muscles
• Signs and symptoms
– Abdominal pain and rigidity

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19
Q

Cholecystitis: What is it Signs & Symptoms

A

• Inflammation of the gallbladder
• Often caused by blockage of its outlet by gall stones (cholecystolithiasis)
• Symptoms often worsened by ingestion of fatty foods
• Signs and symptoms
– Sharp RUQ or epigastric pain
– Pain often referred to shoulder

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20
Q

Pancreatitis: What is it Signs & Symptoms

A 
• Inflammation of the pancreas
• Common with chronic alcohol abuse
• Signs and symptoms
– Epigastric pain
– Often referred to back or shoulder
– pain is referred as the organ is retroperitoneal
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21
Q

Gastrointestinal (GI) Bleeding: What is it Signs & Symptoms

A
  • Hemorrhage within the lumen of the GI tract
  • May be minor to severe
  • Blood eventually exits (mouth or rectum)
  • Often painless
  • Gastric ulcers (holes in GI system from highly acidic gastric juices) can cause severe pain and peritonitis

• Signs and symptoms
– Dark-colored stool (maroon to black), often “tarry” (Melena)
– Frank blood from rectum (hemorrhoid)
– Vomiting “coffee ground” appearing blood
– Vomiting frank blood
– Pain: absent to severe

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22
Q

Abdominal Aortic Aneurysm (AAA): What is it Signs & Symptoms

A
  • Weakening of inner wall of the aorta
  • Tears and separates from outer layers (dissection)
  • Weakened vessel bulges, may continue to grow
  • May eventually rupture

• Signs and symptoms
– Progressive (often “tearing”) abdominal pain
– Frequently radiates to back (lumbar)
– Palpable abdominal mass, possibly pulsating
– Possible inequality in pedal pulses

• Signs and symptoms
– Sudden, severe increase in pain may indicate
rupture
• High aortic pressure causes rapid internal bleeding
• Sudden progression of shock
• Likely exsanguination (fatal hemorrhage)

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23
Q

Hernia: What is it Signs & Symptoms

A
  • Hole in the abdominal wall, allowing tissue or parts of organs (commonly intestines) to protrude under skin
  • May be precipitated by heavy lifting
  • May cause strangulation of tissue or bowel obstruction
  • May require surgical repair

• Signs and symptoms
– Sudden onset of abdominal pain, often following exertion
– Palpable mass or lump on abdominal wall or crease of groin (inguinal hernia)

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24
Q

Renal Colic: What is it signs & symptoms

A

• Severe pain caused by kidney stones traveling down the ureter
• Signs and symptoms
– Severe, cramping, intermittent pain in flank or back
– Frequently referred to groin
– Nausea, vomiting

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25
Q

Cardiac Involvement: What is it signs & symptoms

A

• Pain of myocardial infarction can produce
– Nausea or vomiting
– Epigastric pain
– Indigestion
• Always consider the possibility of a cardiac emergency as a cause of abdominal symptoms

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26
Q

Assessment and Care of Abdominal Pain or Discomfort

A

• Many potential causes of abdominal pain
• Role of EMT is not to diagnose
• Focus efforts
– Perform thorough history and physical exam
– Identify serious or life-threatening conditions

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27
Q

Scene Size-Up: What should you think of

A
  • Protect self from blood-borne pathogens
  • Be aware of odors
  • Determine if patient’s condition is medical, trauma, or both
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28
Q

Primary Assessment: Steps and what are yo thinking of for the abdominal patient

A
  • General impression
  • ABC’s
  • Level of consciousness

All pt’s with abdominal pain should be given O2 immediately.

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29
Q

History of Present Illness: what kind of questions

A
  • O: “When did it begin? What were you doing?”
  • P: “What makes it better or worse? Movement? Position?”
  • Q: “Describe your discomfort.”
  • R: “Point to its location. Does it radiate or move?”
  • S: “How bad is the pain on a scale of 1–10?”
  • T: “Do you have pain all the time? Is it intermittent? Has it changed?”
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30
Q

History of the Present Illness: Other that OPQRST what kinds of questions would you ask a Female patient.

A 
• Female patients
– “Where in your cycle are you?”
– “Is your period late?”
– “Are you experiencing vaginal bleeding?”
– “Is your flow normal?”
– “Have you experienced this pain before?”
– “Is it possible you are pregnant?”
– “Are you using birth control?”
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31
Q

What nemonic do you use for Past Medical History

A
  • S: Symptoms
  • A: Allergies
  • M: Medications
  • P: Pertinent past history
  • L: Last oral intake
  • E: Events leading to emergency
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32
Q

Geriatric Note: Assessment of Abdominal Issues

A
  • Decreased ability to perceive pain
  • More serious causes of abdominal pain
  • More likely to be life-threatening
  • May be complicated by medications
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33
Q

Elements of the physical exam for an abdominal issue?

A 
• Inspection
– Distention
– Discoloration
– Protrusions
• Palpation (use fingertips; painful area last)
– Rigidity
– Pain
– Guarding
34
Q

How often do you reassess vital signs for the abdominal patient?

A 
• Baseline, then every 5 minutes
– Pulse
– Blood pressure
– Respirations
– Skin condition, color, temperature
– Mental status
35
Q

Patient Care for the Abdominal Patient

A 
• Maintain airway
– Be prepared to suction
• Administer oxygen
– 15 LPM via NRB
• Position of comfort
– LLR for airway protection
• Transport to appropriate facility
36
Q

Think About It:
• An 89-year-old female with a history of diabetes, hypertension, and gallstones is complaining of nausea and dizziness about 20 minutes after eating.

A

• What are the concerns with this patient?
• Is this an abdominal emergency, a diabetic
emergency, or a cardiac emergency?
• How will you know?
• What will your treatment be?

37
Q

Chapter Review: Abdominal

A
  • Abdominal complaints must be treated as serious emergencies requiring transport.
  • Diagnosis is difficult; your responsibility is to assess the patient and report findings.
  • Assessment should include thorough history, physical exam, and vital signs.
38
Q

Chapter Review: Abdominal

A
  • Quickly identify life-threateningemergencies: aneurysms, internal bleeding, shock.
  • Care consists of airway management, oxygen, positioning, transport.
  • Use standard precautions, including disinfecting equipment.
39
Q

Remember: Abdominal

A
  • Abdominal organs provide a variety of important functions to the body.
  • The abdomen can be divided into four quadrants, with reference to the midline and umbilicus.
  • Classifications of pain can help identify specific abdominal dysfunctions.
40
Q

Remember: Abdominal

A
  • Assessment and management always take a higher priority than determining the exact cause of abdominal pain.
  • Knowledge of the characteristics of specific abdominal disorders can aid differential diagnosis when assessing a patient with abdominal pain.
41
Q

Remember: Abdominal

A

• Care for a patient with abdominal pain
should include treatment of immediate life
threats, administration of oxygen, placing
patient in a position of comfort, and
appropriate transport.

42
Q

Questions to consider: What are five signs and symptoms of abdominal distress?

A

.

43
Q

Questions to consider: Describe the difference between visceral and parietal pain. Describe a condition that may be responsible for each.

A

.

44
Q

Questions to consider: What is the emergency care for a patient experiencing abdominal pain or distress?

A

.

45
Q

Questions to consider: Name the four abdominal quadrants. How are the quadrants determined?

A

.

46
Q

Questions to consider: You are called to a patient with abdominal pain. He describes the pain as severe and says it has been “on and off” over the past several days, becoming severe within the last hour.

  • What additional questions would you ask the patient?
  • In what position would he likely be most comfortable?
A

.

47
Q

Retroperitoneal Space

A

the area posterior to the peritoneum between the peritoneum and the back

48
Q

Tell me about your abdominal pain - what does it feel like

could you possibly be pregnant

triple a

Do a thorough assessment

A

.

49
Q

What cells produce insulin

A

beta cell in the islets of langerhans produce insulin.

50
Q

spleen tucked up under the stomach

A

.

51
Q

solid organs - rupture one of these causes bleeding

A

. this is the more immediate concern

52
Q

hollow organs rupture - dumps contents into sterile abdominal cavity - causes peritonitis - severe infection

A

.

53
Q

parietal and visceral - boundary of the lining parietal peritoneal

A

outside in first lining - parietal move in farther on top of the organs themselves visceral pluera

54
Q

some organs outside the peritoneum - retroperitoneal space

A

kidney

a portion of the aorta

55
Q

serous membrane that covers the abdomen

A

.

56
Q

umbillicus divides the four quadrants of the abdomen

A

.

57
Q

bleeding from the inside - start to stretch the receptors on the visceral peritoneum - hurts all over - dull achy - can’t pinpoint -

A

.

58
Q

parietal receptors they know exactly where it hurts

A

.

59
Q

know the difference betwn visceral and parietal pain pg 574

A

.

60
Q

referred pain

A

perception of pain in skin or muscle at distant locations

61
Q

pain into the right shoulder with gall bladder attacks

A

referred pain

62
Q

tearing pain (pg 754)

A

generally originates in the aorta
has three different linings
- weakened area starts to have blood between the
intima, and the media, and adventitia

burning or tearing sensation in the abdomen

63
Q

aaa

A

sometimes complain of unequal pulses in the feet

64
Q

appendix - RLQ pain push in doesn’t hurt - let go it hurts - rebound pain - ruptures get peritonitis - have very rigid abdomen

A

.

65
Q

cholicystitis - stores bile to digest fat - referred pain to the right shoulder

A

.

66
Q

pancreatitis

A

common bile duct - gallstones can also block the pancreas and can also get pancreatitis

67
Q

go bleed - BP low pulse high

A

.

68
Q

with abdominal pain could have cardiac involvment

A

.

69
Q

Esophagus

A

hollow digestive organ structure to carry food from the mouth and pharynx to the stomach

70
Q

Stomach

A

hollow digestive organ, expandable, located below the diaphragm & connected to the esophagus & small intestine, begins the breakdown of food

71
Q

Small Intestine

A

hollow digestive organ consisting of the duodenum, jejunum, and ileum, takes stomach contents and remove nutrients as it passes contents onto the lg intestine

72
Q

Large Intestine (colon)

A

hollow digestive organ, The lg intestine absorbs fluid from it’s contents, creating fecal waste for excretion through the rectum and anus

73
Q

Appendix

A

hollow lymphatic organ, this dead-end sac of bowel rich material in lymphatic tissue has no function in digestion. It may become infected (appendicitis) causing pain & requiring surgery.

74
Q

Liver

A

solid digestive (other functions with regulation of the blood & detoxification) . This organ is involved in regulating levels of carbohydrate & other substances in the blood. It is involved in bile secretion for the digestion of fats, and many other functions including detoxification of the blood.

75
Q

Gallbladder

A

hollow digestive organ, which stores bile before its release into the intestine.

76
Q

Spleen

A

solid lymphatic tissue, which removes abnormal blood cells & is involved in the immune response.

77
Q

Pancreas

A

a solid digestive organ, which releases enzymes that assist in breaking down food in the small intestine into absorbable molecules. In also secretes hormones into the blood that regulate blood sugar levels.

78
Q

Kidneys

A

a solid urinary organ that filters and excretes waste. They also regulate water, blood, and electrolyte levels and assists the liver with detoxification.

79
Q

Bladder

A

hollow urinary organ, that collects urine from the kidneys prior to excretion (urination).

80
Q

What defines the abdominal quadrants

A

the umbilicus

81
Q

visceral pain

A

visceral pain is organ pain and is diffuse
intermittent, crampy, or colicky pain often comes from the hollow organs

pain that is dull & persistent often originates from the solid organs

EMT Test 4 (11 decks)

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