Gastrointestinal Emergencies Lower Gastrointestinal Tract Bleeding

1 EMT-Basic Gastrointestinal Emergencies | Lower Gastrointestinal Tract Bleeding

■■ Gastrointestinal Emergencies

Lower Gastrointestinal Tract Bleeding Scenario: You are called to a local assisted-living facility for a woman with abdominal pain. Upon arrival you find an elderly woman lying in a fetal position on the couch.

Prearrival Question 1. What are common causes of lower gastrointestinal (GI) tract bleeding?

Scene safe Yes Body substance isolation Gloves, eyewear Nature of illness Unknown at this time Number of patients One Additional help Dispatched—ALS C-spine stabilization No General impression 73-year-old woman lying on the couch in distress

Assessment Questions 2. What are important pertinent negatives to ask a patient experiencing abdominal pain? 3. What is melena? 4. What is hematochezia?

Level of consciousness Responsive, will answer questions Chief complaint Severe abdominal pain Airway Open Breathing 18 breaths/min Symmetrical rise and fall of the chest Circulation Radial pulses strong and equal Skin color, temperature, and condition Pink, warm, and dry Control of major bleeding None Transport decision High priority Initial interventions Oxygen via nonrebreathing mask at 10–15 L/min Baseline vital signs Blood pressure—128/66 mm Hg Pulse—114 beats/min Respirations—18 breaths/min SaO2—93% on room air SAMPLE history S—Severe abdominal pain in the left lower quadrant; general weakness; light-headedness; black, tarry stools A—Cipro, Novocain M—Aleve P—Arthritis L—Chicken soup last evening for dinner approximate- ly 12 hours ago E—Feeling bad for a few days, with increasing abdominal pain

OPQRST O—2 days ago with increasing severity P—Movement makes the pain worse Q—Dull, achy, cramping pain R—None S—8 on a scale of 1–10 with 10 being the worst T—2 days ago

Management Questions 5. Why is it important not to allow a patient experiencing abdominal pain to have anything to eat or drink? 6. Can a person with a GI bleed go into shock?

Treatment Provide oxygen. Allow the patient to remain in a position of comfort. Maintain warmth, reassess vital signs, and monitor for signs of shock. Response to treatment The patient remains stable while awaiting ALS transport. Ongoing assessment Blood pressure—134/72 mm Hg Pulse—110 beats/min Respirations—18 breaths/min SaO2—98% on 15 L/min via nonrebreathing mask

Conclusion: An IV is started en route and the patient is transported without event to the local emergency de- partment, where she is admitted for further testing. A colonoscopy reveals irritation and bleeding in a portion of the large intestine.