FL_Medic Posted July 26, 2006 Share Posted July 26, 2006 Ok since this section is titled scenarios I am going to make one and you have to ask questions to get answers. You get dispatched to a 23 y/o female complaining of CP/ABD pain. Dispatch advises that the mother called. Link to comment Share on other sites More sharing options...
rocket Posted July 26, 2006 Share Posted July 26, 2006 Let's start at the beginning and play it step by step. EMS Dispatch: F&B Unit 3854 arriving. 3854 arriving 13:40. Where are we arriving? private residence? Is the scene safe to enter? What do we see upon arrival? -Trevor Link to comment Share on other sites More sharing options...
Ridryder 911 Posted July 26, 2006 Share Posted July 26, 2006 23 y.o. get a good H & P with pin point assessment of abd pain. Is it @ Mcburney's point.. last menses, ectopic pregnancy, PID, associated N & V (if so how many, description (food/blood/fecal) last time) last meal (what?) , last B.M. (normal), change in weight >10 lbs if so how much and how long, description of pain - cramping, dull, sharp, intermittent... ? PMHX- surgeries, birth control (if so type, adhere. missed, IUD, past pregnancies, abortions) anyone else ill lately? Examination- where and location of pain, have patient point with one finger specific area. Examine abdominal wall, (obese, flat, distended, bruising)?, listen for bowel sounds (RLQ usually hear loudest) all quads, palpate usin pads of fingers, opposite corner where c/c location, checking for grimacing, enlargement of organs, rigidity. That's it for starters, R/r911 Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 Let's start at the beginning and play it step by step. EMS Dispatch: F&B Unit 3854 arriving. 3854 arriving 13:40. Where are we arriving? private residence? Is the scene safe to enter? What do we see upon arrival? -Trevor scene is safe Private residence, pt. is lying on couch diaphoretic holding ABD. Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 23 y.o. get a good H & P with pin point assessment of abd pain. Is it @ Mcburney's point.. last menses, ectopic pregnancy, PID, associated N & V (if so how many, description (food/blood/fecal) last time) last meal (what?) , last B.M. (normal), change in weight >10 lbs if so how much and how long, description of pain - cramping, dull, sharp, intermittent... ? PMHX- surgeries, birth control (if so type, adhere. missed, IUD, past pregnancies, abortions) anyone else ill lately? Examination- where and location of pain, have patient point with one finger specific area. Examine abdominal wall, (obese, flat, distended, bruising)?, listen for bowel sounds (RLQ usually hear loudest) all quads, palpate usin pads of fingers, opposite corner where c/c location, checking for grimacing, enlargement of organs, rigidity. That's it for starters, R/r911 You are greeted by the mother at the residence and she shows you her daughter on the couch. Pt. denies all possibility of being pregnant, and says she is not sexually active. Pain is in both R quadrants, last meal was chicken at lunch time, no previous pregnancies, pt. states that she has no Hx. diffuse pain. No one else has been ill in the household or in her friend circle. on palpation you feel some rigidity in the RU quadrant, very tender upon palpation. Link to comment Share on other sites More sharing options...
rocket Posted July 26, 2006 Share Posted July 26, 2006 Thank you sir! No unusual aspects to the residence? excessive heat? odors? evidence of domestic "issues"? Per dispatch Mom called this in? is Mom on scene as well? She might be a helpful (or harmful :wink: ) historian... Are the patient's legs drawn up as well or is she just holding her belly? Presuming the patient is A and O I'd like to get down to her level (bend on a knee), get a quick feel for her pulse (assess te & quality) and observe her breathing while asking her why we were called here today. What is the character of her pulses and respirations and What is she complaining of? -Trevor Link to comment Share on other sites More sharing options...
rocket Posted July 26, 2006 Share Posted July 26, 2006 D'oh! typed those questions while you were giving some answers! I'm still curious about the character or pulse and resps though. -Trevor Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 D'oh! typed those questions while you were giving some answers! I'm still curious about the character or pulse and resps though. -Trevor resp a little shallow at 24/min, pulse is weak, thready and rapid at radial Link to comment Share on other sites More sharing options...
rocket Posted July 26, 2006 Share Posted July 26, 2006 OK. Let's start O2 therapy as a precautionary measure and ask a few more questions. She's a little young for Biliary Colic but the physical location and some of the complaints somewhat fit the bill so maybe we can get some more info to help rule it in or out. How long ago was lunch? Was the chicken fried? what else did you eat with it? And N/V? How long ago did this pain start? You said the pain is diffuse; does it come in waves or is it constant? Did the pain increase in intensity or start at the level it is now? This call was dispatched as CP and ABD pain; do you hurt anywhere other than your stomach? -Trevor Link to comment Share on other sites More sharing options...
FL_Medic Posted July 26, 2006 Author Share Posted July 26, 2006 OK. Let's start O2 therapy as a precautionary measure and ask a few more questions. She's a little young for Biliary Colic but the physical location and some of the complaints somewhat fit the bill so maybe we can get some more info to help rule it in or out. How long ago was lunch? Was the chicken fried? what else did you eat with it? And N/V? How long ago did this pain start? You said the pain is diffuse; does it come in waves or is it constant? Did the pain increase in intensity or start at the level it is now? This call was dispatched as CP and ABD pain; do you hurt anywhere other than your stomach? -Trevor lunch was about two hours ago, grilled chicken denies n/v/d pain has been in the ABD since this morning and the CP started around noon, a couple hours ago constant pain that worsens in waves the ABD Yes pt. is complaining of palpitations Link to comment Share on other sites More sharing options...
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