EMS Gastrointestinal Emergencies - Patient Assessment

EMS Providers should be prepared to recognize and respond to gastrointestinal (GI) emergencies, as they are relatively common and can range from mild to life-threatening. Here are some key points and examples of gastrointestinal emergencies that EMTs need to be aware of:

1. Signs and Symptoms: Be familiar with the common signs and symptoms of gastrointestinal emergencies, which may include abdominal pain, nausea, vomiting, diarrhea, constipation, blood in vomit or stool, and abdominal distension.

2. Dehydration: Many GI conditions can lead to dehydration due to fluid loss from vomiting or diarrhea. EMTs should be skilled in assessing a patient's hydration status by checking vital signs (e.g., blood pressure, pulse, skin condition) and mucous membrane moisture.

3. Abdominal Pain Assessment: Learn how to perform a thorough abdominal pain assessment, which includes identifying the location, intensity, and radiation of pain, as well as any aggravating or alleviating factors.

    -  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.

4. Gastrointestinal Bleeding: Understand the signs of gastrointestinal bleeding, such as hematemesis (vomiting blood), melena (black, tarry stools), and hematochezia (bright red blood in stool). Be prepared to manage bleeding and provide appropriate interventions.

5. Infection Control: Gastrointestinal emergencies can often be related to infectious causes. EMTs should practice strict infection control measures to prevent the spread of infection, including wearing appropriate personal protective equipment (PPE).

6. Medication Allergies: Ask about medication allergies or intolerances, as patients with gastrointestinal conditions may be taking medications or have allergies to specific drugs.

7. Abdominal Trauma: Consider the possibility of trauma, especially in cases of severe abdominal pain. Assess for signs of external trauma and be prepared to manage accordingly.

8. Patient History: Obtain a detailed patient history, including any pre-existing gastrointestinal conditions, previous surgeries, and current medications.

9. Vital Signs: Monitor vital signs regularly, paying close attention to changes in blood pressure, heart rate, and respiratory rate. These can indicate the severity of the condition.

10. Transport and Communication: Determine the need for transport to a medical facility based on the severity of the condition. Communicate effectively with higher-level medical providers to provide a smooth transition of care.

11. Patient Comfort: Help alleviate discomfort and anxiety in patients with gastrointestinal emergencies. Position the patient comfortably and provide reassurance.

12. Documentation: Maintain accurate patient care documentation, including the patient's history, assessment findings, interventions performed, and the patient's response to treatment.

EMS Providers should perform a thorough patient assessment, obtain a medical history, and note any pre-existing gastrointestinal conditions. 

In cases of GI bleeding or severe abdominal pain, initiate prompt transport to a healthcare facility. Monitoring vital signs, assessing for signs of shock, and providing appropriate interventions such as intravenous fluids can be life-saving.

EMS Mnemonics - SAMPLE

The SAMPLE mnemonic is a useful tool for EMS Providers to gather important information during the initial assessment of a patient.

It helps ensure a systematic and thorough evaluation of the patient's condition.

Here's what EMS Providers need to know about the SAMPLE mnemonic:

Signs and Symptoms: This refers to the physical signs and symptoms the patient is experiencing. EMS providers should assess the patient's complaints, such as pain, shortness of breath, or dizziness. It's essential to listen carefully to the patient's description of their symptoms and note any obvious signs of distress.

Allergies: Determine if the patient has any known allergies, especially to medications or substances. Allergies are crucial to know because administering a medication or treatment that a patient is allergic to can have serious consequences.

Medications: Find out what medications the patient is currently taking. This includes prescription medications, over-the-counter drugs, and any herbal or dietary supplements. Knowing the patient's medications can help avoid potential drug interactions and guide treatment decisions.

Past Medical History: Ask about the patient's past medical history, including chronic conditions, surgeries, and significant illnesses. Understanding the patient's medical history can provide insights into their current condition and help in decision-making.

Last Oral Intake: Determine when the patient last ate or drank anything. This information is crucial if the patient requires surgery or sedation because it helps prevent complications related to anesthesia. It's also relevant for patients with certain medical conditions.

Events Leading Up to the Present Illness or Injury: Ask the patient or any available witnesses about the events leading up to the current illness or injury. This can help in understanding the mechanism of injury and identifying any potential contributing factors.

By following the SAMPLE mnemonic, EMS providers can collect vital information that assists in the assessment and management of the patient.

This information is essential for making informed decisions regarding treatment, transport, and communication with medical facilities. Additionally, it contributes to better patient care and safety.

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EMS Peculiar Patient Presentations - Angioedema

Angioedema is a condition characterized by localized swelling, typically involving the face, lips, tongue, throat, or extremities. It occurs due to the rapid swelling of the deeper layers of the skin and underlying tissues. In some cases, it can be accompanied by hives or itching.

In the prehospital setting, EMS Providers should be aware of the following key points regarding angioedema:

1. Airway Management: Angioedema can cause swelling of the airway, potentially leading to respiratory distress or obstruction. EMS providers should closely monitor the patient's airway and be prepared to intervene with advanced airway management techniques if necessary.

2. Assessment: A thorough assessment should be conducted to determine the severity of angioedema and any associated symptoms. This includes evaluating the patient's breathing, vital signs, and level of distress.

3. Allergies and Medical History: It is important to gather information about the patient's medical history, including any known allergies or previous episodes of angioedema. This information can help in identifying potential triggers and guiding treatment decisions.

4. Treatment: The primary goal of treatment is to maintain a patent airway and alleviate symptoms. Depending on the severity and underlying cause, interventions may include administering oxygen, providing nebulized bronchodilators, administering epinephrine, or initiating intravenous access for medications such as antihistamines or corticosteroids.

5. Transport: Patients with angioedema should be transported to a medical facility for further evaluation and management. Ongoing monitoring of the patient's airway and vital signs during transport is crucial.

Remember, angioedema can have various causes, including allergic reactions, medications, hereditary factors, or other underlying medical conditions. Prompt recognition and appropriate management by EMS providers can help ensure the best possible outcome for the patient.

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