Transcript Chp.-32-Powerpoint - McLaren

Division 4
Medical Emergencies
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 32
Gastroenterology
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
General Pathophysiology,
Assessment, and Management
Specific Illnesses
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Pathophysiology
General risk factors
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Excessive alcohol consumption
Excessive smoking
Increased stress
Ingestion of caustic substances
Poor bowel habits
Emergencies
– Acute emergencies usually arise from
chronic underlying problems.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Abdominal
Pain
Types
– Visceral
– Somatic
– Referred
Causes
– Inflammation
– Distention
– Ischemia
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment (1 of 2)
Scene size-up and initial assessment
– Scene clues
– Identify and treat life-threatening
conditions.
Focused history
– Obtain SAMPLE history.
– Obtain OPQRST history.
Associated symptoms
Pertinent negatives
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment (2 of 2)
Physical exam
– General assessment and vital signs
– Abdominal assessment
Inspection, auscultation, and palpation
Cullen’s sign
Grey-Turner’s sign
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Treatment
Maintain the airway.
Support breathing.
– High-flow, high-concentration oxygen or
assisted ventilations
Maintain circulation.
Monitor vital signs and cardiac rhythm.
Establish IV access.
Transport in position of comfort.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Specific Illnesses
The Gastrointestinal System
– Upper gastrointestinal tract
– Lower
gastrointestinal
tract
– Liver
– Gallbladder
– Pancreas
– Appendix
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Upper Gastrointestinal
Bleeding (1 of 2)
Causes
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Peptic ulcer disease
Gastritis
Varix rupture
Mallory-Weiss tear
Esophagitis
Duodenitis
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Upper Gastrointestinal
Bleeding (2 of 2)
Signs and symptoms
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General abdominal discomfort
Hematemesis and melena
Classic signs and symptoms of shock
Changes in orthostatic vital signs
Treatment
– Follow general treatment guidelines.
Begin volume replacement using 2 large-bore
IVs.
– Differentiate life-threatening from chronic
problem.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Esophageal Varices (1 of 2)
Cause
– Portal hypertension
Chronic alcohol
abuse and liver
cirrhosis
Ingestion of
caustic
substances
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Esophageal Varices (2 of 2)
Signs and symptoms
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Hematemesis, dysphagia
Painless bleeding
Hemodynamic instability
Classic signs of shock
Treatment
– Follow general treatment guidelines.
Aggressive airway management
Aggressive fluid resuscitation
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Acute Gastroenteritis (1 of 2)
Cause
– Damage to mucosal GI surfaces
Pathologic inflammation causes hemorrhage
and erosion of the mucosal and submucosal
layers of the GI tract.
– Risk factors
Alcohol and tobacco use
Chemical ingestion (NSAIDs,
chemotherapeutics)
Systemic infections
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Acute Gastroenteritis (2 of 2)
Signs and symptoms
– Rapid onset of severe vomiting and
diarrhea
– Hematemesis, hematochezia, melena
– Diffuse abdominal pain
– Classic signs of shock
Treatment
– Follow general treatment guidelines.
– Fluid volume replacement.
– Consider administration of antiemetics.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Gastroenteritis
Similar to acute gastroenteritis
– Long-term mucosal changes or
permanent damage
Primarily due to microbial infection
More frequent in developing countries
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Peptic Ulcers (1 of 2)
Pathophysiology
– Erosions caused by
gastric acid
– Terminology based
on the portion of
tract affected
– Causes:
NSAID use
Alcohol/tobacco use
H. pylori
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Peptic Ulcers (2 of 2)
Signs and symptoms
– Abdominal pain
– Observe for signs of hemorrhagic
rupture.
Acute pain, hematemesis, melena
Treatment
– Follow general treatment guidelines.
– Consider administration of histamine
blockers and antacids.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Lower Gastrointestinal
Bleeding (1 of 2)
Pathophysiology
– Bleeding distal to the ligament of Treitz
– Causes
Diverticulosis
Colon lesions
Rectal lesions
Inflammatory bowel disorder
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Lower Gastrointestinal
Bleeding (2 of 2)
Signs and symptoms
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Determine acute vs. chronic.
Quantity/color of blood in stool
Abdominal pain
Signs of shock
Treatment
– Follow general treatment guidelines.
Establish IV access with large-bore
catheter(s).
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ulcerative Colitis
Pathophysiology
– Causes unknown
Signs and symptoms
– Abdominal cramping
– Nausea, vomiting,
diarrhea
– Fever or weight loss
Treatment
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Crohn’s Disease (1 of 2)
Pathophysiology
– Causes unknown
– Can affect the
entire GI tract
– Pathologic
inflammation:
Damages mucosa
Hypertrophy and fibrosis of underlying muscle
Fissures and fistulas
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Crohn’s Disease (2 of 2)
Signs and symptoms
– Difficult to differentiate
Clinical presentations vary drastically.
– GI bleeding, nausea, vomiting, diarrhea
– Abdominal pain/cramping, fever, weight
loss
Treatment
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diverticulitis
Pathophysiology
– Inflammation of
small outpockets
in the mucosal
lining of the
intestinal tract
– Common in the
elderly
– Diverticulosis
Signs and symptoms
– Abdominal pain/tenderness
– Fever, nausea, vomiting
– Signs of lower GI bleeding
Treatment
– General treatment guidelines
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hemorrhoids
Pathophysiology
– Mass of swollen veins
in anus or rectum
– Idiopathic
Signs and symptoms
– Limited bright red
bleeding and painful
stools
– Consider lower GI
bleeding
Treatment
– General treatment
guidelines
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (1 of 5)
Pathophysiology
– Blockage of the
hollow space of
the small or
large intestines
– Hernias
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (2 of 5)
Pathophysiology
– Intussusception
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (3 of 5)
Pathophysiology
– Volvulus
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (4 of 5)
Pathophysiology
– Adhesions
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (5 of 5)
Pathophysiology
– Other causes
Foreign bodies, gallstones, tumors, bowel
infarction
Signs and symptoms
– Decreased appetite, fever, malaise
– Nausea and vomiting
– Diffuse visceral pain, abdominal
distention
– Signs and symptoms of shock
Treatment
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Accessory Organ Diseases
GI accessory organs
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Liver
Gallbladder
Pancreas
Vermiform appendix
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Appendicitis (1 of 2)
Pathophysiology
– Inflammation of the vermiform appendix.
– Frequently affects older children and
young adults.
– Lack of treatment can cause rupture and
subsequent peritonitis.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Appendicitis (2 of 2)
Signs and symptoms
– Nausea, vomiting, and low-grade fever.
– Pain localizes to RLQ (McBurney’s point).
Treatment
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Cholecystitis (1 of 2)
Pathophysiology
– Inflammation of the
gallbladder
– Cholelithiasis
– Chronic cholecystitis
Bacterial infection
– Acalculus
cholecystitis
Burns, sepsis,
diabetes
Multiple organ failure
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Cholecystitis (2 of 2)
Signs and symptoms
– URQ abdominal pain
Murphy’s sign
– Nausea, vomiting
– History of cholecystitis
Treatment
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pancreatitis (1 of 2)
Pathophysiology
– Inflammation of the pancreas
Classified as metabolic, mechanical,
vascular, or infectious based on cause.
Common causes include alcohol abuse,
gallstones, elevated serum lipids, or drugs.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pancreatitis (2 of 2)
Signs and symptoms
– Mild pancreatitis
Epigastric pain, abdominal distention,
nausea/vomiting
Elevated amylase and lipase levels
– Severe pancreatitis
Refractory hypotensive shock and blood loss
Respiratory failure
Treatment
– Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis (1 of 2)
Pathophysiology
– Injury to liver cells
Typically due to inflammation or infection
– Types of hepatitis
Viral hepatitis (A, B, C, D, and E)
Alcoholic hepatitis
Trauma and other causes
– Risk factors
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis (2 of 2)
Signs and symptoms
– URQ abdominal tenderness
– Loss of appetite, weight loss, malaise
– Clay-colored stool, jaundice, scleral
icterus
– Photophobia, nausea/vomiting
Treatment
– Follow general treatment guidelines.
Use PPE and follow BSI precautions.
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
General Pathophysiology,
Assessment, and Management
Specific Illnesses
Bledsoe et al., Essentials of Paramedic Care: Division 1V
© 2006 by Pearson Education, Inc. Upper Saddle River, NJ