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.

 

[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.

 

[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

 

[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)

 

[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)

 

[Topher38]

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

 

[KEVD18]

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

 

[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.

 

[disassociative]

Kidney stones, by chance?

 

[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?

 

[KEVD18]

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.

 

[disassociative]

No, no. I am talking about history.

History of kidney stones?

 

[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?

 

[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 .

 

[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 .

 

[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

 

[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.

 

[Topher38]

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!

 

[rgnoon]

Didn't say it was the food.

 

[KEVD18]

i stand by my tx