Bieber Posted September 8, 2012 Posted September 8, 2012 You are working as a paramedic alongside an EMT in a small city approximately 20 minutes away from a larger metropolitan area when you are called to respond to a patient complaining of abdominal pain. The address is right around the block so you go non-emergency traffic and arrive first on scene, though you know BLS fire will be arriving shortly. You are guided into the upper-middle class home by the husband who leads you to a bedroom where you find a forty year old female patient laying completely still in bed alert and oriented x3 though very soft-spoken and appearing to be in a significant amount of pain, based on her facial grimace and unwillingness to move. You also note that the patient is guarding her abdomen with both hands. Go.
ERDoc Posted September 8, 2012 Posted September 8, 2012 Get her out as quick as possible to FD doesn't have a chance to screw things up, assess in the ambulance. I'll let others figure out the assessment. 1
Happiness Posted September 8, 2012 Posted September 8, 2012 Vitals Onset of pain Hx of pregnancy or Ovarian cysts Any new medications Any cardiac hx
cscboulder11 Posted September 9, 2012 Posted September 9, 2012 In addition to what Happiness said, is the abdomen tender? Any recent falls, drops? How long has the pain been going on? Any other complaints?
Bieber Posted September 9, 2012 Author Posted September 9, 2012 Lol, well per Doc, you get the patient out to the ambulance right about the time fire shows up. Vitals are: HR: 46 BP: 74/48 SpO2: 100% BGL: 78 Pain began approximately 5 minutes ago and is localized to the middle and right upper abdomen. History of G5/P5, with the last birth 6 weeks ago. No cardiac history or new meds. No trauma. Only other symptom is complaining of being very cold.
cscboulder11 Posted September 9, 2012 Posted September 9, 2012 Sounds like appendicitis could be a cause. Time to transport her to the nearest hospital that can handle it.
Bieber Posted September 9, 2012 Author Posted September 9, 2012 Csc, what is leading you to appendicitis? Would you want to provide any sort of treatment or just transport?
Chief1C Posted September 9, 2012 Posted September 9, 2012 Masses? Hurt worse pushing or releasing pressure? EKG normal? I know you say the history is clear, but meh, I've found that some folks don't get complete physicals to find out exactly what goes on with their body. Blood in anything recently? Eat anything hot, sharp, toxic? Puking? Color? Poo-ing? Color... Can you smell something like. I can't really describe it. But I can effectively diagnose upper GI bleeding; or heavy lower GI bleeding, by just walking in someones house.
ERDoc Posted September 9, 2012 Posted September 9, 2012 Before we jump to surgery, why don't we complete our H&P? We know we have a 6 week postpartum woman with sudden onset epigastric to RUQ abd pain who is hypotenive, bradycardic and feels cold. What does the pain feel like? Does it radiate anywhere? Nausea/vomiting? Fevers? Pregnancy history (normal pregnancy? c-section? any complications with the pregnancy or birth? Any bleeding or discharge?) What was she doing when the pain started? Can we get a temperature? What is her abd exam like? Heart and lung exam?
cscboulder11 Posted September 9, 2012 Posted September 9, 2012 Csc, what is leading you to appendicitis? Would you want to provide any sort of treatment or just transport? Acute, rapid onset pain and she's clutching the right location. The lowered HR and BP makes me think that it might've burst. Appendicitis requires emergency surgery and I'm not sure what an EMT-B can do for it. I'll find out what medications she's on/allergic to, pertinent history, full assessment if one hasn't been performed already, and other info for the ED. I'm not 100% positive that this involves the appendix, but if it does, I want to limit time on scene and get her to the nearest surgery center that can handle it.
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