# Abdominal Pain Scenario!!!!!!!



## Topher38

EMT 22 You are dispatched to a 16 year old male complaining of Abdominal/back pain. 

You arrive on scene at a brown house with lights on and door open.


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## KEVD18

this is going to take for ever if that all the info your going to give. it means we have to ask for everything, and wait for you to respond.

but i'll start:

sample, opqrst, v/s, physical exam findings, ekg, d-stick.

that should get thing moving.


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## lcbjr3000

Is the scene safe? That seems a little odd to me for the door to be wide open. Could be robbery gone bad and thats where the pain comes from


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## disassociative

SAMPLE, OPQRST, yadda yadda.

Any previous hx? surgeries? Is the abdomen rigid upon palpation? What is the BP in the left arm? What is the BP in the right arm? Pulse? EKg findings?

Is this pt a frequent flyer? Is the chopper available for stand-by?

Any recent hospital stays? 


Give me some vitals. (BP x2 arm, Resp, Sp02, Ekg, pulse)


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## Topher38

Considering this is in the BLS section. No ALS available. Only You (EMT-B) and your partner (EMT-B)

Age 16
male


Skin pink,warm (normal)
B/p 112/76 (virtually the same on both arms)
Pulse 61
Pupils are Equal and reactive PEARL
Breathing 11 (patent airway, Says hurts to breath in once in awhile)
Sp02 98%

He says the pain has been radiating from his back, then side, then inner thigh/abdomin area for 2 weeks or so. 

No vomiting or nasuea
No allergies
Takes vitamins every day, fish oil. No meds
No pertinent past history
Ate a tuna grinder earlier that day with some red bull 
The pain has just been generally getting worse for the past 2 weeks
He thought he pulled a muscle during wrestling


Last time patient was in hospital it was for a siezure caused by a serious concusion (football)

Patient has been to hospital for broken ribs, broken left leg, Hernia. 

You palpate the abdomin and find no distention, no rigidity.
You find a scratch hear and there but nothing major (dcap-btls)

You search the posterior
You find nothing on the lower back

Onset started about 2 weeks ago when he was just laying in bed
He says nothing really makes it feel better or worse
Pain feels like a shooting, stabbing pain, Severe
Pain radiates from back to side to abdomin area, (not always in that order, Random pain in those areas)
8 out of 10 (10 being the worst pain hes ever had)


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## Topher38

Also on the posterior you find some small scars here and there. Some circular, some straight.


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## KEVD18

press hard, three copies, you'll be fine.


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## KEVD18

press hard, three copies, you'll be fine.

if they request transport. transfer to stretcher, secure and transport non emergent. physical exam is unremarable for an acute abdomen. v/s are on the low side, but within normal limits. 

at the als level: iv, monitor, titrate morphine.


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## disassociative

Kidney stones, by chance?


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## JPINFV

> You search the posterior
> You find nothing on the lower back
> 
> Onset started about 2 weeks ago when he was just laying in bed
> He says nothing really makes it feel better or worse


Just to be clear, no tenderness on palpation? 

Any changes in urine or stool color [inlcuding, but not limited to, blood], consistance, smell, or amount? 

Any changes in eating habits before the pain started?


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## KEVD18

disassociative said:


> Kidney stones, by chance?



presenting as pain times 2wks? i suppose it possible, but its been my experience that kidney stones present very acutely. from fine to doubled over in pain puking in minutes. watched my dad go down that road three times. never had a twinge up until <1hr.


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## disassociative

No, no. I am talking about history.

History of kidney stones?


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## TKO

I've seen kidney stones that presented over a period of time longer than a week.  Come and go and generally more of an irritation until the big day, but yah.

Any fever with this pt?

How old were those scars?  Any history on those?

Any pain on palpation?  Which side of the abdomen is there pain?  And Lower quadrant, right?


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## certguy

*Scenerio*

How's his urinary output ? What color is it ? Can he pass urine w/o effort or pain ? Has he been drinking enough water , or does he have the typical teenage addiction to soda and milk ? What caused the scars ? Has he been in a fight or hit in the flank in football recently ? Did he get cleated ? The description of the scars sounds suspisciously like football cleats . Could be a bruised kidney .


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## certguy

Been there , done that , got the t - shirt as far as kidney stones go and mine did present gradually . Right now , I'm thinking more about flank trauma damaging the kidneys .


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## rgnoon

My diagnosis is that the kid is most definitely suffering from growing up in new england....the tuna grinder is symptomatic of said condition. In fact I'm relatively certain that "tuna grinder" is almost universally included in the differential for chronic noreasterosis.

:-D


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## Topher38

No tenderness on palpation of abdomin, when you palpate the lower posterior over/around the scars he screams in pain.

He says he has had a loss of appetite for a week or so.
Mom says he just hasnt been himself and has been complaining about the pain for awhile

Urine is normal in color, him being an athlete he doesnt drink really anything else but water, clear and non-painful. Hes been urinating normaly in normal amounts. 

Hes not sure about the scars, he think they might be from his cat but hes not totally sure, he has no idea where the small circular ones came from.

Pain is on left lower back-left lower quadrant-and runs through his left side in between the two.

No history of kidney stones or kidney problems, none in the family either.


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## Topher38

rgnoon said:


> My diagnosis is that the kid is most definitely suffering from growing up in new england....the tuna grinder is symptomatic of said condition. In fact I'm relatively certain that "tuna grinder" is almost universally included in the differential for chronic noreasterosis.
> 
> :-D





Sorry not the food. Keep trying!


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## rgnoon

Didn't say it was the food.


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## KEVD18

i stand by my tx


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## Topher38

What is post-herpetic neuralgia? 
Roughly 20 percent of those diagnosed with shingles go on to suffer long-lasting pain from post-herpetic neuralgia or PHN, a condition that can be more painful than shingles. Although most people suffer with shingles for about a month, the pain and skin sensitivity can continue for months or even years in some patients with PHN. 
PHN pain persists long after the shingles rash heals. Although invisible, the virus of herpes zoster can cause damage to the nerves, resulting in mild to severe pain. This pain of PHN may be sharp, piercing, throbbing or stabbing and may result in intolerable skin sensitivity to even the lightest touch. PHN occurs more often in older people and can last for months and even years. 

However, the good news is that for most people who develop PHN, the pain will gradually resolve with time. And today there are multiple treatment options that do result in pain relief for those suffering from PHN. 

What is the source of post-herpetic neuralgia? 
The pain results from damage to the nerve fibers during the shingles infection. The pain of PHN is in the same area as the pain and rash of shingles. Some PHN patients feel pain in the exact same location as the rash, others have PHN pain in smaller areas within the rash region, and others feel the PHN pain in an area larger than the original rash site. 

Pain from nerve damage is among the worst types of pain. Consider a mild pain related to nerve injury: the sensation when banging the "funny bone," the area in the elbow where a major nerve crosses. Patients who have had a spinal tap, in which a needle pierces the nerve-rich area of the back, describe this as one of the most painful procedures they have ever had. 

Patients have described the pain of PHN as "deep and aching," "fire under the skin," "like electric shocks," and "unbearable shooting pain." For some PHN patients, even a light touch, like the pressure of a shirt, a gust of wind, or brushing the hair, can bring tears to the eyes. In other PHN sufferers, the painful area is sensitive to slight changes in temperature. 

Because the pain can be so awful, it can interfere with a person's life. For some PHN sufferers, all normal activity comes to a halt for months. Depression is common in people with PHN because of the severe pain and social isolation that can occur.



The patient was me. I had shingles and I didnt even know. I had circular scabs down my lower back and abdomin. The pain was horrible. I didnt know and niether did my mom. The shingles cleared up and PHN kicked in. Although it is harder to get for younger people it happens. PHN as you read above is worse or the same as shingles its just you cant see the scabs/soars on the body. So thats what happened here. 

After getting a ride to the hospital the docters put me on a lidocaine patch and its been about 2 months and the pain is slowly dieing down.

My dad had the same thing when he was 18.


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## Flight-LP

Just out of curiousity, did it ever dawn on you or your mother to seek treatment from your PMD prior to going to the hospital by ambulance. Shingles is pretty easy to diagnose, as is PHN if identified early immediately after the Shingles stage. You might have saved a few pennies vs. getting an ambulance and ER bill. So why the wait?


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## Topher38

I wrestle. I get mat burn alot. So i didnt think anything of it. Just thought it was mat burn and i pulled a muscle in my side because its happened before. Just didnt go to the doc. It was a simple mistake.


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## TKO

Well, that was enlightening.  But not a common scenario for emergency care providers, so we learned something new.  Nice.


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## YouthCorps1

IS THIS PT IN THE HOUSE>? lol...once you make contact, ask for a sample history. is this gas and you just have to use the toilet lol? back pain,,,any neck pain? backboard and fully immiblize this pt .. on a scale of 1-10 what the pain in your stomach...palpate your quadrants. start pt on 2-lpm o2


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## KEVD18

this is getting out of control.

it wouldnt be so bad if you were adding anything useful to these threads, but you arent!!!!1


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## EMTinNEPA

KEVD18 said:


> this is getting out of control.
> 
> it wouldnt be so bad if you were adding anything useful to these threads, but you arent!!!!1



:nosoupfortroll:


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