Abdominal Pain scenario

[VentMonkey]

Yup.

 

[VentMonkey]

 

[NysEms2117]

Ouch that looks painful.

 

[NYBLS]

How much do you weigh? Height? Figure out my dosing from there...

 

[StCEMT]

Yup.

I probably shouldn't say what my first thought to this was....

 

[ERDoc]

I probably shouldn't say what my first thought to this was....

If your first thought was maglite, then you are correct.

 

[IanW]

EMT here. NJ though so I can't do IV's. This is a BLS call so honestly we can put you on the cot in your comfortable position and secure x3. Transport as comfortably as we can .. this isn't really a medics situation for us, but they pay be interested in doing pain management ...otherwise they'll just release.

*edit*-- would probably need medics for pain management -- missed the 20 min transport time, my l1 trauma center is 5 minutes away.

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[ERDoc]

EMT here. NJ though so I can't do IV's. This is a BLS call so honestly we can put you on the cot in your comfortable position and secure x3. Transport as comfortably as we can .. this isn't really a medics situation for us, but they pay be interested in doing pain management ...otherwise they'll just release.

*edit*-- would probably need medics for pain management -- missed the 20 min transport time, my l1 trauma center is 5 minutes away.

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Before we jump to treatment, what other things do you want to know? What is on your differential?

 

[NysEms2117]

How much do you weigh? Height? Figure out my dosing from there...

5'11-6' 180-185

 

[StCEMT]

If your first thought was maglite, then you are correct.

Not quite. It was they took the saying "anything is a dildo if you are brave enough" as a challenge.

 

[ERDoc]

Not quite. It was they took the saying "anything is a dildo if you are brave enough" as a challenge.

Good point but in this case it was "I was mad at my wife so I did it to show her how mad I was."
"Sir, was there alcohol involved?"
"Yup."

 

[Handsome Robb]

5'11-6' 180-185

No lights or sirens for you.

IV, 150 mcg of fentanyl q 10 PRN. 4-8 mg of zofran PRN. 25mg of da ketaminez if the fentanyl doesn't make you stop squirming and whining so I can chart in peace

Pylo, ischemic bowel and obstruction are high on my list.


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[NysEms2117]

No lights or sirens for you.

IV, 150 mcg of fentanyl q 10 PRN. 4-8 mg of zofran PRN. 25mg of da ketaminez if the fentanyl doesn't make you stop squirming and whining so I can chart in peace

Pylo, ischemic bowel and obstruction are high on my list.


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ahh.. close, but no cigar, And thank you for catering to my needs lol

 

[StCEMT]

Good point but in this case it was "I was mad at my wife so I did it to show her how mad I was."
"Sir, was there alcohol involved?"
"Yup."

Because that always solves marital conflict. He must have been pretty mad....and well practiced lol

 

[IanW]

Before we jump to treatment, what other things do you want to know? What is on your differential?

Normal sample history,what exactly the PT had before hand and when exactly the pain started and in what way.much of which was answered already but I can't do pain management IV's or anything. We do have is have abdominal pain, previously treated, id check for any masses but if I did find something it isn't any immediate relief to the pt. Just more info for the nurse. So transport is the best bet. No lights.

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[EpiEMS]

You are called to the residence of a 26 year old male, who is having debilitating abdominal pain.

This kind of call can go three ways: taxi ride, ALS intercept (ideally to the scene if it's hard to move the patient), or rapid transport to the nearest facility depending on the acuity of the patient and distance to the facility.

Background on the patient: seems to be physically in shape, is currently on the floor in the living area of the house curled into a ball. Patient states that he has been having moderate to severe pain for 2 days, on the left side of his abdomen, radiating to the lower left back.

Differentials...appendicitis, pyelonephritis, pancreatitis, urolithiasis, peritonitis, bowel obstruction...

+ CVA tenderness? Is the abdomen rigid, supple? Rebound tenderness? Nausea? Vomiting? Normal ins/outs (eating/drinking and urination/defecation)? Any trauma? Has this happened before? I'd like to get a quick social history, too - ETOH, namely.

Not that these really change *my* management, honestly, it's more for my own education.

Pain on scale: 11/10. Pain described as: stabbing, stomach turning inside out, and burning. Last oral intake: about 4 hours ago/ few slices of bread, patient states he could not eat due to pain increasing upon intake.

Ideally, I'd get V/S in the house. Can the patient walk? Do we need to assist him to a standing position? Or do we have to lift him to the stretcher? If need be, I'd rather get ALS on scene for pain control prior to moving him. If this is too time consuming, it's easy enough to move this patient (not particularly heavy).

FFW: patient is now in the ambulance, 20 minute transport time to a level 1 hospital has any capability (closest and obviously best choice). V/S BP:150/90 RR: 20 Sat:98% HR:96 SR
Patient also states he is not allergic to any medications to his knowledge.

curious as to: 1. How do you transport this patient(LS or non emergent) 2. Pain control? 3. General impressions? 4. what other information would you try to gather?

Transport for this patient will be non-emergent. If traffic picks up and I don't have any pain control on board, I would consider an exceptionally easy L/S transport.

Pain control would totally be indicated, as far as I can tell. If I could, I'd get ALS on scene. They may not be happy with me, but they'll give this guy some sort of opioid, and probably Zofran for good measure.

With certainty, I can say that this call warrants ALS assistance (or, even better, BLS provision of some sort of effective pain control and an antiemetic) if the patient is really this uncomfortable.

 

[NysEms2117]

Differentials...appendicitis, pyelonephritis, pancreatitis, urolithiasis, peritonitis, bowel obstruction...

+ CVA tenderness? Is the abdomen rigid, supple? Rebound tenderness? Nausea? Vomiting? Normal ins/outs (eating/drinking and urination/defecation)? Any trauma? Has this happened before? I'd like to get a quick social history, too - ETOH, namely.

Appendix is on the right side of the abdomen (i was taught to do rebound pain test on LRQ to test for appendicitis), if im not mistaken (i probably am..), abdomen is rigid to an extent, not rock solid, but not "normal" no nausea, no vomiting. Urination normal, stool present but bloody. no trauma, only the past day- to 2 days.

Ideally, I'd get V/S in the house. Can the patient walk? Do we need to assist him to a standing position? Or do we have to lift him to the stretcher? If need be, I'd rather get ALS on scene for pain control prior to moving him. If this is too time consuming, it's easy enough to move this patient (not particularly heavy).

Patient cannot move, cannot stand, can roll over, but causes agonizing pain.

What everything actually was will be put up later today.

 

[EpiEMS]

Appendix is on the right side of the abdomen (i was taught to do rebound pain test on LRQ to test for appendicitis), if im not mistaken (i probably am..), abdomen is rigid to an extent, not rock solid, but not "normal" no nausea, no vomiting. Urination normal, stool present but bloody. no trauma, only the past day- to 2 days.

Patient cannot move, cannot stand, can roll over, but causes agonizing pain.

What everything actually was will be put up later today.

Appendix is LRQ, yeah, I was just putting it on the list as a "thing that I can't definitively rule out, but doesn't seem likely" (assuming the patient doesn't suffer from situs inversus totalis ).

Pain control prior to movement would definitely be preferable, if it doesn't cause too much delay and as long as the patient is relatively stable (as he seems to be at this point).

 

[NysEms2117]

Solution: EMS could not solve the problem. My particular issue needed definitive care. This was an Infected Ulcer in the Descending colon(left side). Definitive care has shown, Ulcerative Colitis. This was compounded by a broken rib that was still in the process of healing. (left side as well), compounded further by moderate- severe electrolyte imbalance, which was producing severe cramps.

My 2 ambulance trips produced severely different treatment routes. One group of medics gave pain control, until i was tolerable, but didn't snow me with analgesics. the other group did not give pain control, did just about nothing, and refused to transport my girlfriend with me for some reason.

Maybe this helped? if not sorry for taking up your time .

 

[DesertMedic66]

refused to transport my girlfriend with me for some reason.

I very rarely transport anyone other than the patient. If your girlfriend is able to drive herself to the ED that is overall going to be the better option