Abdominal Pain/Bleeding

[FireEMT2009]

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

Already, increased BSI is now on, along with your eye protection, horatio.

Negative on fever or nausea.

Edited to add more information.

Edited December 15, 2011 by FireEMT2009

[nypamedic43]

ok...so she is shocky with an elevated pulse and low BP. Car accident that caused a miscarriage, 3 wks ago, and abdominal pain since. How did she cut her arm while cooking? most people cut thier hand or fingers...not thier arm...just sayin.

The rash is kind of strange. Medication reaction maybe? Is she depressed because of the miscarriage? Does she meet your gaze when speaking to her? Does she have a flat affect? ie: no show of emotion.

Something is off with the whole cut on the arm thing. Where is the cut located?

[FireEMT2009]

ok...so she is shocky with an elevated pulse and low BP. Car accident that caused a miscarriage, 3 wks ago, and abdominal pain since. How did she cut her arm while cooking? most people cut thier hand or fingers...not thier arm...just sayin.

The rash is kind of strange. Medication reaction maybe? Is she depressed because of the miscarriage? Does she meet your gaze when speaking to her? Does she have a flat affect? ie: no show of emotion.

Something is off with the whole cut on the arm thing. Where is the cut located?

Sorry about that I mispoke, it was on her hand, not her arm I apologize. She states that she has been on the medication for a couple of years and that she hasn't stopped taking it since it was prescribed. She gets slightly emotional about the miscarriage but does not get over upset. Her reaction is what you expect after something like that. She states she is keeping herself busy by working and doing her normal routine. She shows no signs of depression that you can tell and denies being depressed. She is in high spirits throughout the conversation. She shows signs of worrying and anxiety about the bleeding and the pain.

(By the way the pressure bandage on her hand that we placed has become saturated as well, in case someone missed that in a before post.

Good discussion and assessments so far. So what's next?

[mobey]

Would like to know more about the rash. Is it a palpable rash? or more like petichiae?

How long has she had it?

Does it blanch?

Lets get her on the cot and put on a little 02 and start an I.V.

[FireEMT2009]

Would like to know more about the rash. Is it a palpable rash? or more like petichiae?

How long has she had it?

Does it blanch?

Lets get her on the cot and put on a little 02 and start an I.V.

The rash is not raised but looks to be coming from below the skin, it is dark black and cannot be blanched off. (not much help probably but I will give you the answer once the scenario finishes.)

Do you want 1 IV or 2? What gauge? Fluid? How much O2? and How would you like your patient moved?

[island emt]

HINT: She's on ASA & PLAVIX

now I'll go back to the old folks park and watch the kids play

[mobey]

HINT: She's on ASA & PLAVIX

now I'll go back to the old folks park and watch the kids play

Hey silence you.... I think she has the plague!!

[FireEMT2009]

HINT: She's on ASA & PLAVIX

now I'll go back to the old folks park and watch the kids play

Great pickup and good catch! Keep posting I would like to get alot of different opinions on it.

Hey silence you.... I think she has the plague!!

Haha thats one I haven't heard yet.

[DFIB]

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).

You are correct.

I have to stop the bleeding first. Add an additional compress and increase direct pressure.

Ask how long she has had the rash. Ask if it has been diagnosed before and if she is taking anything for it.

Why is she taking Plavix and ASA after having an abortion?

Did she have a dilation and curettage done after her abortion?

Surprised she doesn’t have fever otherwise I would be very suspect of Toxic shock to me but without fever possibly internal bleeding

Is her abdomen hard? Is there any guarding? Does her abdominal pain radiate?

Are there any palpable abdomninal masses that have a pulse?

Does she have any bleeding in her eyes or other mucous tissue?

Does she have any vaginal bleeding?

As a EMT-B Regardless of finds she is going to be a load and go.

What is my transport time to decide if I need an ALS intercept or even a Helo for transport/

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

Revisiting the vitals I say she is in decompensated hypovolemic shock or very close to it. She needs at least two large bore IVs quick. What is quicker an ALS intercept or the transport to the hospital? Do ALS units carry albumin?

Oh, I am guessing the rash is not a rash at all but a subcutaneous bleed.

Edited December 15, 2011 by DFIB

[FireEMT2009]

You are correct.

I have to stop the bleeding first. Add an additional compress and increase direct pressure.

Ask how long she has had the rash. Ask if it has been diagnosed before and if she is taking anything for it.

Why is she taking Plavix and ASA after having an abortion?

Did she have a dilation and curettage done after her abortion?

Surprised she doesn’t have fever otherwise I would be very suspect of Toxic shock to me but without fever possibly internal bleeding

Is her abdomen hard? Is there any guarding? Does her abdominal pain radiate?

Are there any palpable abdomninal masses that have a pulse?

Does she have any bleeding in her eyes or other mucous tissue?

Does she have any vaginal bleeding?

As a EMT-B Regardless of finds she is going to be a load and go.

What is my transport time to decide if I need an ALS intercept or even a Helo for transport/

Revisiting the vitals I say she is in decompensated hypovolemic shock or very close to it. She needs at least two large bore IVs quick. What is quicker an ALS intercept or the transport to the hospital? Do ALS units carry albumin?

Oh, I am guessing the rash is not a rash at all but a subcutaneous bleed.

Her rash has been developing slowly over the past couple of weeks along with the aches and pains she has been having. Her hand is still bleeding pretty good even with direct pressure, it saturates the gauze you are holding. She has not gone to her doctor yet for a check up, she has that next week but figured something was wrong when her hand wouldn't stop bleeding.

I like the possibilitty of toxic shock, it is very possible with this patient. Her abdomen is distended and rigid has a board of wood. You also notice the strange black rash on it as well, along with ecchymosis. No palpable masses noted, she is still having some vaginal bleeding but her doctor said that it woud be normal after a D&C.

No other bleeding is noted at this time.

And her doctor didn't say whether or not to take them. She has a family history of heart problems including heart attack so her doctor put her on plavix and ASA to act as prophylaxis.

I would agree with your load and go status; as either a BLS or ALS provider. You have already requested ALS care and they were 15 minutes away 10 minutes ago. They are coming from the direction of the hosptial and can meet you en route. You have about a 25 minute transport running emergency lights and sirens to the nearest hospital.

The whirly bird is out on another call right now and won't be back in time to pick your patient up.

Keep going you are doing well, How do you want to move her? What else would you like before you leave? You have been on scene about 15 minutes at this point and you took those vitals right when you first walked in.

Edited December 15, 2011 by FireEMT2009