Als dispatch for possible Appendicitis

njemtbvol

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We had a discussion today down at the squad building about whether Als should be sent out for a possible appendicitis. The pt. chief was complaint was a stabbing pain the lower left quadrant. 10/10 no radiation
Als dispatch?
 

adamjh3

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Yes, for pain management.

However, wouldn't appendicitis be lower right quadrant?
 
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JPINFV

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Yes, for pain management.

However, wouldn't appendicitis be lower right quadrant?

Almost always, but it can (extremely rarely) present LLQ (situs inversus). Regardless, there are other things besides appendicitis that can cause LLQ pain.
 

the_negro_puppy

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We had a discussion today down at the squad building about whether Als should be sent out for a possible appendicitis. The pt. chief was complaint was a stabbing pain the lower left quadrant. 10/10 no radiation
Als dispatch?

As others have said ALS for pain relief.
 

LondonMedic

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Appendicitis is a diagnosis made on imaging or direct vision. Until that point it is an acute abdomen. Pre-hospital intervention is usually limited to analgesia but the patient may require resuscitating if they are shocked. If you need ALS to do that then, yes, it is an ALS job, if not then it's BLS.
 

medicsb

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We had a discussion today down at the squad building about whether Als should be sent out for a possible appendicitis. The pt. chief was complaint was a stabbing pain the lower left quadrant. 10/10 no radiation
Als dispatch?

How well are they tolerating the pain? We all know that some patients will state 10/10 and then pick up their phone to call someone and giggle over some youtube video of a duck eating pizza.
 

Katy

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Yes, you would dispatch for ALS. As already stated, for pain management and just a tip it is more likely for pain to be expressed in the RLQ for Appendicitis.
 

MasterIntubator

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+1 here for pain management.

Rebound pain..... referred pain.... common points in appendicitis
 

firecoins

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How long is your response time to the patient?
How long will it take for ALS to arrive?
How far is the pt's location from the hospital?
 

DrParasite

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We had a discussion today down at the squad building about whether Als should be sent out for a possible appendicitis. The pt. chief was complaint was a stabbing pain the lower left quadrant. 10/10 no radiation
Als dispatch?
first off, appendicitis isn't a possible dispatch criteria, because it's a diagnosis, not a complaint. now for abdominal pain, based on the criteria set forth by NJ Depart of Health/NJ Office of Emergency Telecommunications Services (found here: http://www.state.nj.us/911/home/highlights/2009EMDGuidecards.pdf) the answer is no, they should not be sent out for a possible appendicitis on the initial dispatch.

Being familiar with NJ's ALS protocols, as well as paramedics from all over north and central NJ, with no other complaints, they probably won't give pain meds prehospitally. Not that it won't happen, but they probably won't treat just pain, especially given the proximity to a hospital to most area.

But if you want to call, ALS, than by all means call them. a request cannot be denied, regardless of the reason (assuming a regional ALS unit is available). whether or not they will treat the patient is a different story
 

JPINFV

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Being familiar with NJ's ALS protocols, as well as paramedics from all over north and central NJ, with no other complaints, they probably won't give pain meds prehospitally. Not that it won't happen, but they probably won't treat just pain, especially given the proximity to a hospital to most area.

Whether paramedics should be dispatched to acute abdominal pain and whether the protocol calls for it or not are two separate issues.
 

Flight-LP

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first off, appendicitis isn't a possible dispatch criteria, because it's a diagnosis, not a complaint. now for abdominal pain, based on the criteria set forth by NJ Depart of Health/NJ Office of Emergency Telecommunications Services (found here: http://www.state.nj.us/911/home/highlights/2009EMDGuidecards.pdf) the answer is no, they should not be sent out for a possible appendicitis on the initial dispatch.

Being familiar with NJ's ALS protocols, as well as paramedics from all over north and central NJ, with no other complaints, they probably won't give pain meds prehospitally. Not that it won't happen, but they probably won't treat just pain, especially given the proximity to a hospital to most area.

But if you want to call, ALS, than by all means call them. a request cannot be denied, regardless of the reason (assuming a regional ALS unit is available). whether or not they will treat the patient is a different story

Yet another example of why NJ has the stellar reputation they do (*note heavy sarcasm*).

Should it be an ALS response? Yes.

Should the patient in pain have their pain needs addressed? Yes.

Should a medic that withholds analgesia on the basis of location or sheer laziness be fired and turned into the state for investigation? Yes.

Sorry, but this age old "pre-hospital analgesia isn't appropriate for abdominal pain" and the "I'm close enough to the hospital, so let our patient suffer" crap is just that; crap. Folks need to get with the times and start appropriately treating their patients.
 

Medic87

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ALS for sure.If the appendix raptures it will cause a spread of infection and next thing you know you have a peritonitis on your hand,and there is possibility of pt going into a shock as well..... OOO and I forgot , if you ever had an appendix removed you probably know in what kinda pain the pt might be in , so pain therapy is indicated .
 

JPINFV

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To be fair, if rapture occurs, a little appendicitis is the least of our concerns.

/funny typos are funny.
 

medicsb

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Yet another example of why NJ has the stellar reputation they do (*note heavy sarcasm*).

Should it be an ALS response? Yes.

Should the patient in pain have their pain needs addressed? Yes.

Should a medic that withholds analgesia on the basis of location or sheer laziness be fired and turned into the state for investigation? Yes.

Sorry, but this age old "pre-hospital analgesia isn't appropriate for abdominal pain" and the "I'm close enough to the hospital, so let our patient suffer" crap is just that; crap. Folks need to get with the times and start appropriately treating their patients.

ALS units are a very limited resource in NJ, therefore they are not and should not be sent/requested/dispatched to every patient with a complaint of pain (abdominal or otherwise). Many patients in pain tolerate it pretty well. Not all pain requires narcotic analgesia. And unfortunately, in NJ, as is the case in most other places, it's all or nothing when it comes to pain management.

If the pain is tolerable, then, um, yes, I don't see how it would be inappropriate for a medic to turf to BLS (or not be called at all)... even if appendicitis is in the differential. If the appendix has ruptured or is close to rupturing, there will be more than just pain to worry about and it would be more evident than a subjective 10/10 rating by the patient. The OP has not provided any other info about the patient's pain other than it didn't radiate and the pt. rated it 10/10. The rating means nothing without some other indicator of pain.

So, to be sure... pain may be a reason for ALS dispatch and treatment, but most patients with some sort of pain do not require IV narcotics and for them there is no point of a medic sticking around on some far-out "what if" scenario.
 

Flight-LP

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ALS units are a very limited resource in NJ, therefore they are not and should not be sent/requested/dispatched to every patient with a complaint of pain (abdominal or otherwise). Many patients in pain tolerate it pretty well. Not all pain requires narcotic analgesia. And unfortunately, in NJ, as is the case in most other places, it's all or nothing when it comes to pain management.

If the pain is tolerable, then, um, yes, I don't see how it would be inappropriate for a medic to turf to BLS (or not be called at all)... even if appendicitis is in the differential. If the appendix has ruptured or is close to rupturing, there will be more than just pain to worry about and it would be more evident than a subjective 10/10 rating by the patient. The OP has not provided any other info about the patient's pain other than it didn't radiate and the pt. rated it 10/10. The rating means nothing without some other indicator of pain.

So, to be sure... pain may be a reason for ALS dispatch and treatment, but most patients with some sort of pain do not require IV narcotics and for them there is no point of a medic sticking around on some far-out "what if" scenario.

Then maybe the system as a whole should be overhauled, the have the 1st aid council eliminated, and then you could potentially have the resources your communities deserve.

Pain is subjective. That is a fact. Pain is exactly what your patient tells you it is. It is completely inappropriate for a Paramedic to try to quantify another individual's pain. It also completely innappropriate for a Paramedic to pretend he / she is a CT scanner. You don't know if it is or will soon be ruptured. If they hurt, you should advocate for your patient and provide them analgesia.

Can you stand up before a jury of your peers and make the factual statement that your patient "didn't require IV narcotics"?
 

medicsb

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Then maybe the system as a whole should be overhauled, the have the 1st aid council eliminated, and then you could potentially have the resources your communities deserve.

Pain is subjective. That is a fact. Pain is exactly what your patient tells you it is. It is completely inappropriate for a Paramedic to try to quantify another individual's pain. It also completely innappropriate for a Paramedic to pretend he / she is a CT scanner. You don't know if it is or will soon be ruptured. If they hurt, you should advocate for your patient and provide them analgesia.

Can you stand up before a jury of your peers and make the factual statement that your patient "didn't require IV narcotics"?

Do you seriously believe that every patient that rates their pain 10/10 should get IV narcotics? If you do, then... :rofl: I agree pain is subjective, but it is not purely so. Many physical signs indicate the presence of pain.

A decent assessment can determine whether IV narcs are appropriate. And there is no pretending that one has X-ray vision here. There is also no pretending that there is anything for a medic to do other than stare at the patient when only modest pain is present. Pain in and of itself does not indicate appendicitis specifically, it is just one of many many other pathologies in the differential. Again, a good assessment will reveal if the patient needs IV narcotics, an anti-emetic, or fluid resuscitation for sepsis, dehydration, or hemorrhage. The presence of pain, in and of itself, is not necessarily an indicator of the need of a paramedic.

I'm pretty confident with my assessment skills, so I'll take my chances with the jury, thanks. :cool:
 

usafmedic45

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Almost always, but it can (extremely rarely) present LLQ (situs inversus). Regardless, there are other things besides appendicitis that can cause LLQ pain.

Also, but it can also start out with midline pain and in pregnant women will tend to present with RUQ pain.
 
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