Sunday, February 25, 2024

EMS Patient Assessment - Referred Pain (1)

EMS Providers should have a comprehensive understanding of referred pain to effectively assess and manage patients in the field. 

Here are key points they should know:

Definition and Mechanism: A phenomenon where pain is felt in an area of the body that is different from the actual source of the pain. It occurs due to the convergence of nerve pathways, where signals from one area of the body are interpreted as originating from another area that shares nerve connections.

Common Examples: EMS providers should be familiar with common examples of referred pain, such as cardiac referred pain (e.g., chest pain radiating to the left arm or jaw during a heart attack), gallbladder referred pain (e.g., pain in the right shoulder or between the shoulder blades with gallstones or cholecystitis), and spleen referred pain (e.g., left shoulder pain with spleen-related issues).

Recognition: Recognizing patterns of referred pain can aid EMS providers in diagnosing the underlying cause of a patient's symptoms. Understanding the characteristic locations of referred pain associated with specific conditions can help differentiate between different potential diagnoses.

Clinical Signs: Some conditions have specific clinical signs associated with referred pain, such as Levine's Sign for cardiac referred pain (clutching of the chest) or Murphy's Sign for gallbladder-related pain (increased pain during palpation beneath the ribcage on the right side).

Diagnostic Considerations: Referred pain can complicate the diagnostic process by masking the true source of the pain. EMS Providers should be aware of this possibility and consider a broad range of differential diagnoses when assessing patients presenting with symptoms of referred pain.

Treatment Implications: Understanding referred pain can influence the treatment approach for patients. EMS Providers should consider the underlying cause of the pain when administering interventions and be prepared to manage the primary condition contributing to the referred pain.

Communication: Effective communication with receiving facilities is crucial when transferring patients with suspected referred pain. Providing a clear and accurate description of the patient's symptoms, including any associated referred pain, can help guide further evaluation and treatment at the receiving facility.

By being knowledgeable about referred pain and its clinical implications, EMS Providers can enhance their ability to assess, manage, and provide appropriate care for patients experiencing this phenomenon in the prehospital setting.

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