Abdominal Pain/Bleeding

[FireEMT2009]

You are dispatched to a patient with abdominal pain, with bleeding. You arrive to find a one story house with one car in the yard. You knock on the door announcing that you are EMS and here to help.

She hollars that the door is open and to come on in. You arrive at the patient, a 37 year old caucasian female, in the foyer of the house sitting down in a chair.

Go from here...

[CPhT]

I'd be nervous about entering a scene like that, but that's because I'm new.

So, I'll treat it like I'm new (bear in mind, I'm a basic. Certified as of today, but not licensed/ registered as of yet).

Scene safety, are my spidey senses tingling that something isn't right?

General impression; how does my patient look as I approach? Is she tracking me visually? Does she acknowledge my presence? Skin tone? Posture? Do I see any blood? Any evidence of trauma?

Making the assumption that this is a normal patient, I would probably begin taking vitals while my lead does the questioning. BP, Resp (rate,regularity, quality), Pulse (rate, regularity, quality), pupils, cap refill?

Regardless of findings, I would probably load her into the truck, hook up some O2 @12L via NRB, and head for the hospital, conducting my detailed physical exam and ongoing exam en-route. My findings would just determine how fast I would have my partner drive.

So... how'd I do? I'll be back to read the Paramedic response to the situation later.

[nypamedic43]

What does the house look like? Does it look like there's been an altercation? Is the patient alone in the house? Get a quick run down of what's going on. Where is the pain? Where is she bleeding from? How does the patient present? Is she doubled over? Sitting Up? Does she watch me come in the door? Any physical signs of trauma? Until those questions are answered I don't take a step further inside the door and am prepared to back out and wait for PD.

Too many variables to just go barging in on this one.

[FireEMT2009]

What does the house look like? Does it look like there's been an altercation? Is the patient alone in the house? Get a quick run down of what's going on. Where is the pain? Where is she bleeding from? How does the patient present? Is she doubled over? Sitting Up? Does she watch me come in the door? Any physical signs of trauma? Until those questions are answered I don't take a step further inside the door and am prepared to back out and wait for PD.

Too many variables to just go barging in on this one.

She does watch you, No signs of an altercation, She is bleeding from her arm, she is slightly bent over. Look below for the full general impression.

I'd be nervous about entering a scene like that, but that's because I'm new.

So, I'll treat it like I'm new (bear in mind, I'm a basic. Certified as of today, but not licensed/ registered as of yet).

Scene safety, are my spidey senses tingling that something isn't right?

General impression; how does my patient look as I approach? Is she tracking me visually? Does she acknowledge my presence? Skin tone? Posture? Do I see any blood? Any evidence of trauma?

Making the assumption that this is a normal patient, I would probably begin taking vitals while my lead does the questioning. BP, Resp (rate,regularity, quality), Pulse (rate, regularity, quality), pupils, cap refill?

Regardless of findings, I would probably load her into the truck, hook up some O2 @12L via NRB, and head for the hospital, conducting my detailed physical exam and ongoing exam en-route. My findings would just determine how fast I would have my partner drive.

So... how'd I do? I'll be back to read the Paramedic response to the situation later.

Nothing unusual, Your patient tracks you through the room and acknowledges your presence. You find your patient pale with a strange black rash throughout her arms. She is clothed in a T shirt and blue jeans, she also has the rash on her face. She is holding a towel that is saturated in blood on her arm. She states that she cut herself cooking and it refuses to stop bleeding and her abdomen is hurting terribly

You are "the" lead on this call, just because you don't have a medic don't mean you don't know how to run it. You are an EMT where i come from that is pretty much the highest level of care. (i'm from a rural area with a county of less than 15 ALS providers.) You can call for ALS intercept if you need them. Keep your treatmetn going from there, I'm a EMT-B working on my Paramedic right now so I will be interested to see your treatment plan.

PD has arrived and declared the scene safe. No one else is in the house and there is no other signs of trauma except for the cut that she has already told you about. You are cleared to start assessing.

[nypamedic43]

I would love to go ahead and run with this scenario but I'm going to wait for some more responses from basic providers

[CPhT]

If she's pale, I'm going to make the assumption that she's lost a lot of blood. I can't really place the "strange rash" except for maybe burns. My treatment is as follows:

Direct pressure (along with elevating the wound) to stop the bleeding, tourniquet as needed. Dress and bandage. Prepare the patient for transport. O2 via NRB @12L (seems like she's lost a lot of blood if she's pale, O2 probably won't hurt at this point). Watch for signs of respiratory distress in case it is a burn (airway compromised).

Vitals and Hx in the truck on the way to the nearest facility. Probably run a Priority 2 unless she has really poopy vitals, or starts losing going unconscious, then Priority 1.

Just for giggles, what are her vitals? BP, Resp, Pulse, SPO2?

[FireEMT2009]

I would love to go ahead and run with this scenario but I'm going to wait for some more responses from basic providers

Oh I wouldn't back out just yet.

If she's pale, I'm going to make the assumption that she's lost a lot of blood. I can't really place the "strange rash" except for maybe burns. My treatment is as follows:

Direct pressure (along with elevating the wound) to stop the bleeding, tourniquet as needed. Dress and bandage. Prepare the patient for transport. O2 via NRB @12L (seems like she's lost a lot of blood if she's pale, O2 probably won't hurt at this point). Watch for signs of respiratory distress in case it is a burn (airway compromised).

Vitals and Hx in the truck on the way to the nearest facility. Probably run a Priority 2 unless she has really poopy vitals, or starts losing going unconscious, then Priority 1.

Just for giggles, what are her vitals? BP, Resp, Pulse, SPO2?

Alright, so your thinking hypovolemia due to paleness. Well you apply a pressure bandage, it appears controlled. You go ahead and get SAMPLE and OPQRST

S- Bleeding, rash, and abdominal pain

A- NKDA

M- ASA, Plavix

P- She has a family history of heart disease and the doctor put her on meds as prophylaxis, Previously pregnant X 3 weeks ago. Lost child after a gestational period of 11 weeks.

L- Bacon, egg, and cheese biscuit this morning, was making lunch when she cut herself.

E- Pain has been going on for about 2-3 weeks, worsening over time.

O- Bleeding started after she cut herself while cooking.

P- Pressure seems to control bleeding.

Q- Abdominal pain is a constant pressure feeling.

R- Aches throughout the body, but mostly in the abdomen.

S- 9/10

T- 10 minutes ago.

The rash is not burns, it is different than what you have seen before.

Her vitals are as follows: Pulse- 140, BP- 80/40, Respirations- 20 shallow, BGL- 110, SpO2- 98.

Continue on assessing, You are getting close, but before you jump into your treatment plans get a full view of the picture. I like the treatment plans you have shown me so far for various things, but tunnel vision can kill your patient if you are not careful. Also from what I have heard, raising the extremity in the air has been taken out of standard practice. (I will do research to verify that though).

[Jessi]

Forgive me if I repeat, been too long since I've jumped in on a scenario.

First and foremost.. BSI. Scene safety. Dogs? Anything/anyone that could possibly hurt me or my partner?

What's around her? Pill bottles? Anything that could possibly be perceived as a weapon? Clean home? A total wreck?

Lung sounds? Double check the pressure to make sure. She's getting shocky. Plan to treat accordingly. I personally would be calling for an ALS intercept. Fluids aren't gonna hurt her at this point.

Blood? How much? Where? On the clothes? Floor? Do we know how big of a laceration? Any bleeding noted from anywhere else?

Where is the location of the pain? The entire abdomen? Any specific quadrant?

What's the rash look like? Blisters? Open sores? How long has she had the rash?

Are the bandages still controlling the bleeding?

Any loss of consciousness PTA?

Do we know what caused the miscarriage?

At this point most of my questions are going to be answered en route. Load and go situation. Plan to meet ALS en route. If no ALS, high flow oxygen high flow diesel. Treat for shock.

Maintain... Maintain... Maintain.

Edited December 14, 2011 by Jessi

[FireEMT2009]

Forgive me if I repeat, been too long since I've jumped in on a scenario. First and foremost.. BSI. Scene safety. Dogs? Anything/anyone that could possibly hurt me or my partner? What's around her? Pill bottles? Anything that could possibly be perceived as a weapon? Clean home? A total wreck? Lung sounds? Double check the pressure to make sure. She's getting shocky. Plan to treat accordingly. I personally would be calling for an ALS intercept. Fluids aren't gonna hurt her at this point. Blood? How much? Where? On the clothes? Floor? Do we know how big of a laceration? Any bleeding noted from anywhere else? Where is the location of the pain? The entire abdomen? Any specific quadrant? What's the rash look like? Blisters? Open sores? How long has she had the rash? Are the bandages still controlling the bleeding? Any loss of consciousness PTA? Do we know what caused the miscarriage? At this point most of my questions are going to be answered en route. Load and go situation. Plan to meet ALS en route. If no ALS, high flow oxygen high flow diesel. Treat for shock. Maintain... Maintain... Maintain.

Not a problem, check on scene safe/BSI, no threats to your welfare are found or suspected. House neatly kept, she is clothed appropriately for the season and appears to be of no threat and no pill bottles are noted in the foyer. Lung sounds are clelar, pressure is double checked and is as listed. ALS is en route to your location to intercept (if you are not already a medic). Towel is saturated, and your pressure bandage is now saturated completely as well. Laceration is approximately 2 inches long and not deep at all, just bleeding profusely. No other bleeding is noted. Pain is in the abdomen and it is diffused throughout the abdomen, although she has aches and pains all over her body. The rash looks black, not burns and it is throughout her arms and face. She tells you that the rash is all over her body.

No loss of consciousness, and she had a car accident three weeks ago that caused the seatbelt to cause an abrupto placentae. She was discharged a week later. Do you want to wait for ALS to get there or do you want to intercept en route, sicne they are en route to your location now? They are 15 minutes away and your nearnest hospital is 25 minutes away.

[mobey]

Fever? Nausea?

Back the f up! I am putting on a gown... and maybe another pair of gloves! of course I always wear eye protection too.....

mostly because my Oakley's look frickin cool