GIT - Net
GIT - Net
Medical Emergencies
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 32 Gastroenterology
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
General Pathophysiology, Assessment, and Management Specific Illnesses
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Pathophysiology
General risk factors
Excessive alcohol consumption Excessive smoking Increased stress Ingestion of caustic substances Poor bowel habits
Emergencies
Acute emergencies usually arise from chronic underlying problems.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Abdominal Pain
Types
Visceral Somatic Referred
Causes
Inflammation Distention Ischemia
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment (1 of 2)
Scene size-up and initial assessment
Scene clues Identify and treat life-threatening conditions.
Focused history
Obtain SAMPLE history. Obtain OPQRST history.
Associated symptoms Pertinent negatives
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Assessment (2 of 2)
Physical exam
General assessment and vital signs Abdominal assessment
Inspection, auscultation, and palpation Cullens sign Grey-Turners sign
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
General Treatment
Maintain the airway. Support breathing.
High-flow, high-concentration oxygen or assisted ventilations
Maintain circulation. Monitor vital signs and cardiac rhythm. Establish IV access. Transport in position of comfort.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Specific Illnesses
The Gastrointestinal System
Upper gastrointestinal tract Lower gastrointestinal tract Liver Gallbladder Pancreas Appendix
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Treatment
Follow general treatment guidelines.
Begin volume replacement using 2 large-bore IVs.
Esophageal Varices (1 of 2)
Cause
Portal hypertension
Chronic alcohol abuse and liver cirrhosis Ingestion of caustic substances
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Esophageal Varices (2 of 2)
Signs and symptoms
Hematemesis, dysphagia Painless bleeding Hemodynamic instability Classic signs of shock
Treatment
Follow general treatment guidelines.
Aggressive airway management Aggressive fluid resuscitation
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Acute Gastroenteritis (1 of 2)
Cause
Damage to mucosal GI surfaces
Pathologic inflammation causes hemorrhage and erosion of the mucosal and submucosal layers of the GI tract.
Risk factors
Alcohol and tobacco use Chemical ingestion (NSAIDs, chemotherapeutics) Systemic infections
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Acute Gastroenteritis (2 of 2)
Signs and symptoms
Rapid onset of severe vomiting and diarrhea Hematemesis, hematochezia, melena Diffuse abdominal pain Classic signs of shock
Treatment
Follow general treatment guidelines. Fluid volume replacement. Consider administration of antiemetics.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Gastroenteritis
Similar to acute gastroenteritis
Long-term mucosal changes or permanent damage
Primarily due to microbial infection More frequent in developing countries
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Peptic Ulcers (1 of 2)
Pathophysiology
Erosions caused by gastric acid Terminology based on the portion of tract affected Causes:
NSAID use Alcohol/tobacco use H. pylori
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Peptic Ulcers (2 of 2)
Signs and symptoms
Abdominal pain Observe for signs of hemorrhagic rupture.
Acute pain, hematemesis, melena
Treatment
Follow general treatment guidelines. Consider administration of histamine blockers and antacids.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Treatment
Follow general treatment guidelines.
Establish IV access with large-bore catheter(s).
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Ulcerative Colitis
Pathophysiology
Causes unknown
Crohns Disease (1 of 2)
Pathophysiology
Causes unknown Can affect the entire GI tract Pathologic inflammation:
Damages mucosa Hypertrophy and fibrosis of underlying muscle Fissures and fistulas
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Crohns Disease (2 of 2)
Signs and symptoms
Difficult to differentiate
Clinical presentations vary drastically.
Treatment
Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Diverticulitis
Pathophysiology
Inflammation of small outpockets in the mucosal lining of the intestinal tract Common in the elderly Diverticulosis
Treatment
General treatment guidelines
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hemorrhoids
Pathophysiology
Mass of swollen veins in anus or rectum Idiopathic
Treatment
General treatment guidelines
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (1 of 5)
Pathophysiology
Blockage of the hollow space of the small or large intestines Hernias
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (2 of 5)
Pathophysiology
Intussusception
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (3 of 5)
Pathophysiology
Volvulus
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (4 of 5)
Pathophysiology
Adhesions
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bowel Obstruction (5 of 5)
Pathophysiology
Other causes
Foreign bodies, gallstones, tumors, bowel infarction
Treatment
Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Appendicitis (1 of 2)
Pathophysiology
Inflammation of the vermiform appendix. Frequently affects older children and young adults. Lack of treatment can cause rupture and subsequent peritonitis.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Appendicitis (2 of 2)
Signs and symptoms
Nausea, vomiting, and low-grade fever. Pain localizes to RLQ (McBurneys point).
Treatment
Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Cholecystitis (1 of 2)
Pathophysiology
Inflammation of the gallbladder Cholelithiasis Chronic cholecystitis
Bacterial infection
Acalculus cholecystitis
Burns, sepsis, diabetes Multiple organ failure
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Cholecystitis (2 of 2)
Signs and symptoms
URQ abdominal pain
Murphys sign
Treatment
Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pancreatitis (1 of 2)
Pathophysiology
Inflammation of the pancreas
Classified as metabolic, mechanical, vascular, or infectious based on cause. Common causes include alcohol abuse, gallstones, elevated serum lipids, or drugs.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Pancreatitis (2 of 2)
Signs and symptoms
Mild pancreatitis
Epigastric pain, abdominal distention, nausea/vomiting Elevated amylase and lipase levels
Severe pancreatitis
Refractory hypotensive shock and blood loss Respiratory failure
Treatment
Follow general treatment guidelines.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis (1 of 2)
Pathophysiology
Injury to liver cells
Typically due to inflammation or infection
Types of hepatitis
Viral hepatitis (A, B, C, D, and E) Alcoholic hepatitis Trauma and other causes
Risk factors
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Hepatitis (2 of 2)
Signs and symptoms
URQ abdominal tenderness Loss of appetite, weight loss, malaise Clay-colored stool, jaundice, scleral icterus Photophobia, nausea/vomiting
Treatment
Follow general treatment guidelines.
Use PPE and follow BSI precautions.
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
General Pathophysiology, Assessment, and Management Specific Illnesses
Bledsoe et al., Essentials of Paramedic Care: Division 1V 2006 by Pearson Education, Inc. Upper Saddle River, NJ