EMS Particular Patient Presentations - Crohn's Disease

EMS Providers should have an understanding of Crohn's Disease and its potential implications for prehospital care. 

Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract, from the mouth to the anus. It is characterized by inflammation, ulceration, and thickening of the intestinal wall, leading to a variety of symptoms and complications.

In terms of prehospital care, EMS providers should be aware of the signs and symptoms of Crohn's disease, which may include:

Abdominal Pain: Patients with Crohn's disease often experience abdominal pain, cramping, and discomfort, which may be intermittent or persistent and can vary in severity.

Diarrhea: Chronic diarrhea is a common symptom of Crohn's disease, which may be accompanied by urgency, frequency, and passage of bloody or mucus-containing stools.

Weight Loss: Patients with Crohn's disease may experience weight loss due to malabsorption of nutrients, reduced appetite, or increased metabolic demands associated with chronic inflammation.

Fatigue: Chronic inflammation and malnutrition associated with Crohn's disease can lead to fatigue, weakness, and decreased energy levels.

Extraintestinal Manifestations: Crohn's disease can affect other organs and systems outside the gastrointestinal tract, leading to extraintestinal manifestations such as arthritis, skin rashes, eye inflammation, and liver involvement.

In terms of potential issues for prehospital care, EMS providers should consider the following:

Dehydration & Electrolyte Imbalances: Chronic diarrhea and fluid loss can lead to dehydration, electrolyte imbalances, and metabolic disturbances. EMS providers should be prepared to assess and manage dehydration, including fluid resuscitation and electrolyte replacement as needed.

Pain Management: Abdominal pain and discomfort associated with Crohn's disease can be severe and debilitating. EMS providers should be equipped to provide appropriate pain management interventions, such as analgesics or non-pharmacological techniques, to alleviate patient discomfort.

Inflammatory Flare-Ups: Patients with Crohn's disease may experience periods of disease exacerbation or flare-ups characterized by worsening symptoms and complications. EMS providers should be prepared to assess and manage acute exacerbations of Crohn's disease, including supportive care and prompt transport to a medical facility for further evaluation and treatment.

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The discovery of Crohn's disease is credited to Dr. Burrill B. Crohn, an American gastroenterologist, along with his colleagues Dr. Leon Ginzburg and Dr. Gordon D. Oppenheimer. 

In 1932, they published a landmark paper titled "Regional Ileitis: A Pathologic and Clinical Entity" in the Journal of the American Medical Association, describing a distinct inflammatory bowel disorder affecting the terminal ileum and other parts of the gastrointestinal tract. 

This condition, later named Crohn's disease in honor of Dr. Crohn, represented a significant contribution to the understanding of inflammatory bowel diseases and revolutionized their diagnosis and management.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice Volume 1 (6th Ed) Pearson.  

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Patient Assessment - Abdominal Pain

Visceral and parietal pain are two types of pain that originate from distinct structures in the body and are perceived differently by a patient.

Visceral Pain: Visceral pain arises from the internal organs, such as the heart, lungs, liver, intestines, and bladder. It is often described as a deep, dull, aching, or cramping sensation.

Visceral pain results from the stimulation of pain receptors within the internal organs themselves. These pain receptors are not as sensitive as those found in the skin and muscles, so visceral pain tends to be less localized and can be challenging to pinpoint. It is often described as a vague, diffuse discomfort and may be difficult to locate precisely.

Visceral pain is typically caused by conditions like inflammation, stretching, or ischemia (lack of blood flow) in the internal organs.

Parietal Pain: Parietal pain, on the other hand, originates from the parietal peritoneum, which is the membrane that lines the abdominal cavity and covers the abdominal wall. It is a thin, sensitive membrane with a high density of pain receptors.

Parietal pain is usually sharp, well-localized, and easier to pinpoint compared to visceral pain. It occurs when the parietal peritoneum is irritated, inflamed, or damaged due to conditions like peritonitis (inflammation of the peritoneum), trauma, or surgery. The pain is often described as more intense and precise than visceral pain.

The key differences between visceral and parietal pain are their origins and the way they are perceived:

• Visceral pain originates from internal organs and is often described as a diffuse, deep, and aching sensation.

• Parietal pain originates from the parietal peritoneum and is typically sharp, well-localized, and easier to identify.

Understanding the distinction between these two types of pain is important for medical professionals when diagnosing and treating various medical conditions, as the quality and location of pain can provide important clues to the underlying issue.

#PreHospitalCare #PatientAssessment #Visceral #Parietal #PainManagement 

#EMS #EMR #EMT #AEMT #Paramedics