Class 22 (Abdominal Pain and OB/GYN) Ch14 & Ch20

1. Class 22 (Abdominal Pain and OB/GYN)Ch14 & Ch20

2. Abdominal Pain • Common complaint • Cause is often difficult to identify; not necessary to determine cause • Need to recognize life-threatening problems and act swiftly

3. Physiology of the Abdomen (1 of 2) • Peritonitis • Irritation of the peritoneum • Peritoneum • Thin membrane lining the entire abdomen • Acute abdomen • Sudden onset of abdominal pain • Can be fatal

4. Physiology of the Abdomen (2 of 2) • Pain usually interpreted as colic; a severe, intermittent cramping pain. • Referred pain • Perceived pain at a distant point of the body caused by irritation of the visceral peritoneum

5. Causes of Acute Abdomen (1 of 2) • Nearly every kind of abdominal problem can cause an acute abdomen. • Substances lying in or adjacent to the abdominal cavity

6. Causes of Acute Abdomen (2 of 2) • Perforation of an ulcer • Gallstones that lead to inflammation (cholecystitis) • Inflammation of the pancreas (pancreatitis) • Inflammation or infection of appendix • Inflammation of pouches in large intestine (diverticulitis)

7. Urinary System • Kidneys can be affected by stones that form from materials normally passed in the urine. • Kidney infections can cause severe pain. • Patients are often quite ill, with a high fever. • Bladder infection (cystitis) more common, especially in women. • Patients usually have lower abdominal pain.

8. Uterus and Ovaries • Always consider a gynecologic problem with women having abdominal pain. • Causes of pain • Menstrual cycle • Pelvic inflammatory disease • Ectopic pregnancy

9. Other Organ Systems • Aneurysm • Weakness in aorta • Pneumonia • May cause ileus and abdominal pain • Hernia • Protrusion through a hole in the body wall

10. Ileus Paralysis of muscular contractions in the intestine Causes abdominal distention Nothing can pass normally out of stomach or bowel. Stomach can only empty through vomiting. Almost always associated with nausea and vomiting Signs and Symptoms of Acute Abdomen(1 of 2)

11. Signs and Symptoms of Acute Abdomen (2 of 2) • Distention • Anorexia • Loss of body fluid into peritoneal cavity • Fever may or may not be present. • Tenseness of abdominal muscles over irritated area

12. Emergency Medical Care • Take steps to provide comfort and lessen effects of shock; reassure patient. • Position patients who are vomiting to maintain airway. • Be sure to use BSI. • Clean ambulance and equipment once patient is delivered.

13. 20: Obstetric and Gynecologic Emergencies

14. Female Reproductive System

15. Three Stages of Labor • First stage • Dilation of the cervix • Second stage • Expulsion of the infant • Third stage • Delivery of the placenta

16. Predelivery Emergencies • Preeclampsia • Headache, vision disturbance, edema, anxiety, high blood pressure • Eclampsia • Convulsions resulting from hypertension • Supine hypotensive syndrome • Low blood pressure from lying supine

17. Hemorrhage • Vaginal bleeding that occurs before labor begins • If present in early pregnancy, it may be a spontaneous abortion or ectopic pregnancy.

18. Ectopic Pregnancy • Pregnancy outside of the uterus • Should be considered for any woman of childbearing age with unilateral lower abdominal pain and missed menstrual period • History of PID, tubal ligation, or previous ectopic pregnancy

19. Placenta abruptio Premature separation of the placenta Placenta previa Development of placenta over the cervix Placenta Problems

20. Gestational Diabetes • Develops only during pregnancy. • Treat as regular patient with diabetes.

21. When to Consider Field Delivery • Delivery can be expected within a few minutes • A natural disaster or other catastrophe makes it impossible to reach a hospital • No transportation is available

22. Preparing for Delivery • Use proper BSI precautions. • Be calm and reassuring while protecting the mother’s modesty. • Contact medical control for a decision to deliver on scene or transport. • Prepare OB kit.

23. Positioning for Delivery

24. Delivering the Baby • Support the head as it emerges. • Once the head emerges, the shoulders will be visible. • Support the head and upper body as the shoulders deliver. • Handle the infant firmly but gently as the body delivers. • Clamp the cord and cut it.

25. Complications With Normal Vaginal Delivery • Unruptured amniotic sac • Puncture the sac and push it away from the baby. • Umbilical cord around the neck • Gently slip the cord over the infant’s head. • It may have to be cut.

26. Postdelivery Care • Immediately wrap the infant in a towel with the head lower than the body. • Suction the mouth and nose again. • Clamp and cut the cord. • Ensure the infant is pink and breathing well.

27. Delivery of Placenta • Placenta is attached to the end of the umbilical cord. • It should deliver within 30 minutes. • Once the placenta delivers, wrap it and take to the hospital so it can be examined. • If the mother continues to bleed, transport promptly to the hospital.

28. APGAR Scoring AAppearance PPulse GGrimace AActivity RRespirations

29. Neonatal Resuscitation

30. Giving Chest Compressionsto an Infant (1 of 2) • Find the proper position • Just below the nipple line • Middle third of the sternum • Wrap your hands around the body, with your thumbs resting at that position. • Press your thumbs gently against the sternum, compressing 1/2˝ to 3/4˝ deep.

31. Giving Chest Compressionsto an Infant (2 of 2) • Ventilate with a BVM device after every third compression. • 100 compressions to 20 ventilations per minute • Continue CPR during transport.

32. Breech Delivery • Presenting part is the buttocks or legs. • Breech delivery is usually slow, giving you time to get to the hospital. • Support the infant as it comes out. • Make a “V” with your gloved fingers then place them in the vagina to prevent it from compressing infant’s airway.

33. Rare Presentations (1 of 2) • Limb presentation • This is a very rare occurrence. • This is a true emergency that requires immediate transport.

34. Rare Presentations (2 of 2) • Prolapsed cord • Transport immediately. • Place fingers into the mother’s vagina and push the cord away from the infant’s face.

35. Excessive Bleeding • Bleeding always occurs with delivery but should not exceed 500 mL. • Massage the mother’s uterus to slow bleeding. • Treat for shock. • Place pad over vaginal opening. • Transport to hospital.

36. Spina Bifida • Defect in which the portion of the spinal cord or meninges may protrude outside the vertebrae or body. • Cover area with moist, sterile compresses to prevent infection. • Maintain body temperature by holding baby against an adult for warmth.

37. Abortion (Miscarriage) • Delivery of the fetus or placenta before the 20th week • Infection and bleeding are the most important complications. • Treat the mother for shock. • Transport to the hospital. • Bring tissue that has passed through the vagina to the hospital.

38. Twins • Twins are usually smaller than single infants. • Delivery procedures are the same as that for single infants. • There may be one or two placentas to deliver.

39. Delivering an Infantof an Addicted Mother • Ensure proper BSI precautions • Deliver as normal. • Watch out for severe respiratory depression and low birth weight. • Infant may require immediate care.

40. Premature Infants and Procedures • Delivery before 8 months or weight less than 5 lb at birth. • Keep the infant warm. • Keep the mouth and nose clear of mucus. • Give oxygen. • Do not infect the infant. • Notify the hospital.

41. Fetal Demise • An infant that has died in the uterus before labor • This is a very emotional situation for family and providers. • The infant may be born with skin blisters, skin sloughing, and dark discoloration. • Do not attempt to resuscitate an obviously dead infant.

42. Delivery Without Sterile Supplies • You should always have goggles and sterile gloves with you. • Use clean sheets and towels. • Do not cut or clamp umbilical cord. • Keep placenta and infant at same level.

43. Gynecologic Emergencies • Do not examine genitalia unless there is obvious bleeding. • Leave any foreign bodies in place, after packing with bandages • Treat as any other patient with blood loss.

44. On The Scene: OB The following slides walk the studentthrough an OB call

45. You are the Provider • You and your partner are dispatched to the A&E Bank for a woman in active labor. • En route, you discuss previous experiences assisting in a delivery and how you can prepare yourselves. • What equipment should accompany you and your partner inside the bank?

46. You are the Provider (continued) • You find a woman in her mid 30s lying on the couch, holding her abdomen and moaning. • Between labored breaths she tells you that her name is Jane and that she is a teller. • She is conscious, alert, and oriented. Breathing in rapid panting breaths. Pulse is strong and bounding. Skin is pale and clammy. • What questions might you consider asking to assess how far along her labor is?

47. Scene Size-up • Woman’s balance is altered. Be aware for falls and the need for spinal stabilization. • Use BSI. • Usual threats to your safety still exist. • Be calm. Protect the mother and the child.

48. Initial Assessment • Is the mother in active labor? • Evaluate trauma or medical problems first. • Treat ABCs in line with local protocols.

49. Transport Decision • If delivery is imminent, prepare for delivery in warm, private location. • If delivery is not imminent, transport on left side if in last two trimesters of pregnancy. • If the patient was subject to spinal injury, stabilize and prop backboard with towel roll on right side.

50. You are the Provider (continued) • The woman is one week past her due date. She has been having contractions for the past hour. • Her water broke just before your arrival. This is her fourth pregnancy, and she has three children. • She feels like she has to go to the restroom. • Your partner applies high-flow oxygen via a nonrebreathing mask and begins timing her contractions. • What does the patient’s request to go to the restroom indicate?