Study Notes for Chapter 23: Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies

Chapter 23: Abdominal, Hematologic, Gynecologic, Genitourinary, and Renal Emergencies

Learning Readiness

• EMS Education Standards: Refer to page 822 of the text for specific standards.

• Chapter Objectives: Found on page 822 of the text to outline key learning goals.

• Key Terms: Pages 822-823 list important terminology to understand throughout the chapter.

• Purpose of Lecture Presentation vs. Textbook Reading Assignments: Clarifies how lecture presentations supplement reading material.

Setting the Stage

• Overview of Lesson Topics:

  • Acute Abdomen

  • Hematologic Emergencies

  • Gynecologic Emergencies

  • Genitourinary/Renal Emergencies

Case Study Introduction

• Patient Profile: 67-year-old Mary Hill

  • Symptoms: Intermittent abdominal pain and cramping

  • Pain has intensified, localized to the right lower quadrant

  • Associated symptoms: Nausea and possible fever

Case Study Analysis (1 of 4)

• Concern Assessment: Evaluate the severity of the chief complaint.

• Questioning: Determine key questions to ask Mrs. Hill.

• Physical Examination Steps: Outline steps for a thorough examination.

Introduction to Abdominal Emergencies

• Abdominopelvic Pain Causes: Numerous causes potentially linked to serious conditions.

• Management: Includes handling life threats, ensuring patient comfort, and planning transport.

• Hematologic Disorders: Focus on disorders related to blood components.

Hematologic Emergencies Overview

• Gynecologic Emergencies: Can present with abdominal pain and vaginal bleeding, some are life-threatening.

• Renal Diseases: Common encounters with patients under dialysis.

Acute Abdomen

Abdominal Structures and Functions

• Cavity Anatomy:

  • Extends from diaphragm to pelvis.

  • Lining:

  • Parietal peritoneum: Lining of the abdominal cavity.

  • Visceral peritoneum: Covers the organs.

• Abdominal Quadrants and Regions:

  • Division into four quadrants for localization: Right Upper Quadrant (RUQ), Left Upper Quadrant (LUQ), Right Lower Quadrant (RLQ), Left Lower Quadrant (LLQ).

  • Involves the retroperitoneal or intraperitoneal spaces.

Types of Abdominal Structures

• Hollow Organs:

  • Stomach

  • Gallbladder

  • Intestines

  • Urinary Bladder

• Solid Organs:

  • Liver

  • Spleen

  • Pancreas

  • Kidneys

• Vascular Structures:

  • Abdominal Aorta

  • Inferior Vena Cava

Pathophysiology of Abdominal Pain

• Mechanisms:

  • Stretching

  • Inflammation

  • Ischemia

• Type of Pain:

  • Visceral Pain:

  • Origin: Internal organs.

  • Characteristics: Dull, generalized, less severe.

  • Can be constant or intermittent.

  • Parietal Pain:

  • Origin: Peritoneum.

  • Characteristics: Sharp, localized, more severe, constant.

  • Referred Pain:

  • Pain felt away from the organ affected, often due to shared nerve pathways.

Conditions causing Acute Abdominal Pain

• Common Causes: Includes but not limited to:

  • Peritonitis

  • Appendicitis

  • Pancreatitis

  • Cholecystitis

  • Gastrointestinal bleeding

  • Gastroenteritis

  • Peptic ulcer disease

  • Intestinal obstruction

  • Hernia

  • Abdominal aortic aneurysm (AAA)

Specific Conditions and Symptoms

• Peritonitis:

  • Signs: Abdominal pain, nausea, vomiting, fever, chills.

• Appendicitis:

  • Symptoms: Periumbilical pain shifting to RLQ, fever, chills, guarding.

• Pancreatitis:

  • Symptoms: Flank pain radiating to the back, distention, fever, shock.

• Cholecystitis:

  • Associated with gallstones. Symptoms include RUQ tenderness, belching, nausea.

• Gastrointestinal Bleeding:

  • Signs: Hematemesis, altered mental status, signs of shock.

  • Assess for major symptoms: Abdominal pain, pale skin, rapid pulse.

• Esophageal Varices:

  • Caused by weakened veins, common in liver disease patients, can lead to copious bleeding.

• Gastroenteritis:

  • Presence of pain, cramping, dehydration.

• Ulcers:

  • Features include left upper quadrant pain, hematemesis, signs of shock.

• Intestinal Obstruction:

  • Abdominal pain, distention, obstipation.

• Hernia:

  • Protrusion may cause pain and can lead to obstruction.

• AAA:

  • Tearing pain in back, significant risk of rupture.

Special Patient Considerations

• Pediatric Patients: Risk of misdiagnosis.

• Geriatric Patients: Often present with atypical symptoms, may delay seeking care, immunocompromised responses.

Assessment-Based Approach to Acute Abdomen

• Scene Size-Up:

  • Standard precautions, identify mechanism of injury, and signs of bleeding.

• Primary Assessment:

  • General impression, airway, breathing, circulation.

• High-Priority Classification:

  • Unresponsiveness, severe pain, shock symptoms.

• Secondary Assessment:

  • Questions regarding OPQRST, past medical history.

• Abdomen Examination:

  • Palpation, assessment for tenderness, rigidity, masses.

• Vital Signs check: Key indicators of shock.

Emergency Medical Care Protocol for Abdominal Pain

• Ensure Open Airway: Insert airway if unresponsive.

• Monitoring: Continuous reassessment every 5 minutes.

• Positioning: Comfort positioning or lateral recumbent for vomiting patients.

• Oxygen Administration: Goal to maintain saturation above 94%.

Case Study Conclusion for Mary Hill

• Care protocol included placing Mary in a comfortable transport position, allowing airway safety, and rapid transport for surgical evaluation. Diagnosis revealed bowel obstruction requiring surgical intervention.

Hematologic Emergencies

Common Disorders

• Anemia: Defined as a decrease in red blood cell volume with symptoms including fatigue, pallor.

• Sickle Cell Disease: A genetic condition leading to various crisis types:

  • Vaso-occlusive crisis

  • Aplastic crisis

  • Hemolytic crisis

• Signs and Symptoms of crisis: Pain in joints, fever, jaundice, and tachycardia found common.

• Hemophilia: Impaired clotting leads to emergency scenarios from minor bleeding episodes.

• Thrombophilia: Condition leading to thrombosis; noted symptoms include swelling, pain in limbs.

Gynecologic Emergencies

Female Anatomy Overview

• Structures: Vagina, ovaries, fallopian tubes, uterus, etc.

• Common Symptoms: Abdominal pain, bleeding, abnormal discharge.

Conditions Leading to Abdominopelvic Pain

• Embodied in sexual assault, dysmenorrhea, ovarian cysts, endometriosis, PID, and STDs.

Treatment Considerations for Sexual Assault

• Importance of following protocol and preserving the crime scene, and offers psychological support.

Urinary and Renal Emergencies

Conditions Overview

• Common Disorders: UTIs, kidney stones, renal failure with evident symptoms.

Presentation of Symptoms

• UTI: Painful urination, cloudy urine.

• Kidney Stones: Severe back pain, colicky.

• Renal Failure: Edema, hypertension, nausea, and altered mental status.

Dialysis Specifics

• Types: Hemodialysis and peritoneal dialysis, with known complications and emergency management required.