Post on 26-Dec-2015
Illinois EMSC 1
Abdominal and Genitourinary Objectives
Upon completion of this lecture, you will be better able to:
Describe specific parameters for assessing abdominal or GU complaints in students
Describe necessary interventions for selected abdominal or GU problems
Accurately triage students presenting with abdominal or GU complaints
Describe the procedure for emergency childbirth at school and interventions for potential complications affecting the mother and infant
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ABDOMINAL ANDGENITOURINARY
EMERGENCIES
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SPECIAL CONSIDERATIONS
Very common complaintMust take all complaints of
abdominal pain seriouslyHistory, assessment and cooperation
neededPrivacy is essentialWatch facial expression during exam
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TYPES OF ABDOMINAL PAIN
Visceral intermittent cramping
Somatic severe, sharp
Referred felt away from
source
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PQRST - HISTORY
P= Problem (Provoke or palliative)Q= QualityR= RadiateS= Severity (Signs and symptoms)T= Timing
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FOCUSED ASSESSMENT
Inspection Skin color Contour/Symmetry
Auscultation Bowel sounds
PercussionPalpation
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Abdominal Assessment
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TESTS FOR INFLAMMATION
IliopsoasObturatorHeel dropRebound
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TRIAGE EMERGENT
Trauma, rigid abdomen, distention Absent bowel sounds
URGENT Abdominal pain less than 24 hours Tenderness on palpation, guarding
NON-URGENT Gastroenteritis (without signs or symptoms of
hypovolemic shock), constipation, RAP (recurrent abdominal pain)
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SELECTED EMERGENCIES
AppendicitisAcute GastroenteritisConstipationRecurrent abdominal pain (RAP)Trauma
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SELECTED EMERGENCIES
Urinary Tract Infection (UTI)Vaginal BleedingOvarian CystEctopic PregnancyTesticular painPelvic Inflammatory Disease (PID)Sexually transmitted diseases
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Out of Hospital Delivery
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PREGNANCY HISTORY
AgePrior pregnancies and
deliveriesExpected due datePrenatal carePotential for multiple births
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Stages of Labor
There are 3 stages of labor:First stage – begins when contractions become
regular and ends when cervix is fully dilatedSecond stage – begins when cervix is fully dilated
and ends when the infant is fully deliveredThird stage – begins when the infant is fully
delivered and ends with delivery of the placenta
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DETERMINATION OF LABOR PROGRESSION
Presence of mucus plug or bloody show
Rupture of membranesTime between contractionsFeeling of bowel movement
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PREPARATION FOR DELIVERY
Contact EMS and follow school plan for childbirth
Follow universal body substance precautions
Place mother on hard surfaceRemove essential clothingExamine for crowningObtain supplies
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DELIVERYSupport the infant’s headRupture the sac (if not
already broken)Observe for meconium
stainingObserve for the umbilical
cordSuction the infant’s
nose and mouth (mouth before nose)
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DELIVERY
Deliver the shoulders
Cut the umbilical cord once pulsations stop
Deliver placenta
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POSTNATAL CARE OF INFANT
Keep infant warmKeep airway clearAssure adequate responseAuscultate respiratory and heart rateObtain APGAR score at 1 minute and
5 minutes
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APGAR ScoreT A B L E 1 0 – 5 . A P G A R E V A L U A T I O N O F T H E N E O N A T E
S I G N 0 1 2
Appearance (color)
Cyanotic or pallid
Centrally pink, extremities cyanotic
Completely pink
Pulse rate Absent <100 bpm >100 bpm
Grimace (reflex irritability)*
No response Grimace Cough/cry/sneeze
Activity (muscle tone)
Limp Some flexion (extremities)
Active movement
Respiratory effort
Absent Slow/irregular Good; cries
*In response to nasal or oral stimulation
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Resuscitation MeasuresIn most deliveries, the infant will need no other care
beyond maintenance of warmth, airway suctioning and mild stimulation.
Positive-pressure ventilation is indicated if any of the following conditions are present:
Apnea or gasping respirations Heart rate slower than 100 beats/minute Persistent central cyanosis despite 100% oxygen
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POSTNATAL CARE OF THE MOTHER
Position of comfortUterine massageKeep warmFacilitate mother-infant bonding
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SPECIAL SITUATIONSPremature birthMultiple birthsStillbirthBreech birthProlapsed umbilical
cordPregnancy induced
hypertension
Hemorrhage Abruptio placentae Placenta previa Spontaneous abortion
Trauma in PregnancyEpistaxisDrug use during
pregnancy
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PREVENTIONEarly recognition of emergent and urgent
conditions is fundamental to ensure appropriate management of the student with abdominal pain
Educate students about physical changes associated with puberty and encourage adoption of good hygiene and nutritional habits
Encourage safe-sex strategies to reduce the risk of pregnancy and sexually transmitted disease
When pregnancy does occur, students need to understand the importance of prenatal care and anticipate their post-partum needs
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SUMMARYIdentifying the location, intensity and quality of
abdominal pain can assist in determining the most likely underlying condition, which will facilitate accurate triage and appropriate interventions.
If there are pregnant students or staff in your school, be prepared to manage an out-of-hospital delivery. Stock sterile, prepackaged obstetric kits and additional supplies as appropriate. Review delivery procedures so that you will know how to assist the mother if the need should arise.
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ANY QUESTIONS??