Abdominal Pain scenario

NysEms2117

ex-Parole officer/EMT
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To start off i'm going to say that I am the patient in this real case that happened. Now that i know the answer i will provide the case. I was taken 2 separate times for just about the same "case", and got 2 separate styles of treatment (both were fine with me).

You are called to the residence of a 26 year old male, who is having debilitating abdominal pain. Background on the patient: seems to be physically in shape, is currently on the floor in the living area of the house curled into a ball. Patient states that he has been having moderate to severe pain for 2 days, on the left side of his abdomen, radiating to the lower left back. Pain on scale: 11/10. Pain described as: stabbing, stomach turning inside out, and burning. Last oral intake: about 4 hours ago/ few slices of bread, patient states he could not eat due to pain increasing upon intake.
FFW: patient is now in the ambulance, 20 minute transport time to a level 1 hospital has any capability (closest and obviously best choice). V/S BP:150/90 RR: 20 Sat:98% HR:96 SR
Patient also states he is not allergic to any medications to his knowledge.

curious as to: 1. How do you transport this patient(LS or non emergent) 2. Pain control? 3. General impressions? 4. what other information would you try to gather?

this is my first scenario so am probably forgetting things, lmk what you would need.
 
ABD distended? Rigid? How has urine output and color been?

1. No lights or sirens
2. I'd have to call for orders but I would try to get orders for 50mcg Fent every 5 minutes as needed for pain control.
3. The first thing that came in my head is possible kidney stone.
 
ABD distended? Rigid? How has urine output and color been?
urine output normal, no pain upon urination no blood, blood in stool, painful upon stool production.
Abd not distended, but slightly rigid.
 
My diagnosis is "buggered if I know" which is not uncommon for abdominal problems. If I have to pick I would say pyelonephritis but the blood in stool and painful stool makes me think of maybe a GI bleed or a bowel obstruction.

Analgesia: I would start with methoxyflurane if there was going to be a delay in getting IV access. No entonox cos I can't rule out a bowel obstruction. I'd give him some IV morphine; big strapping bloke in severe pain I'd give him 5 mg to start and after his pain settled oral paracetamol, iburpofen and tramadol in combination. Top up 2 mg IV aliquots of morphine as required. With this combination he'll be well analgesed for a while so the hospital shouldn't have to worry about it immediately which is better for him.
 
Rectal foreign body. Next. And the pt fails the intelligence portion of the exam for 11/10 pain.:p
Nono that's too easy :P this makes you think ;)!. I never seem to pass intelligence tests for some reason, i can't quite figure it out either :oops:o_O
 
Nono that's too easy :p this makes you think ;)!. I never seem to pass intelligence tests for some reason, i can't quite figure it out either :oops:o_O
Well, you are an LEO so that explains a lot.:D
 
Well, you are an LEO so that explains a lot.:D
well ya know what they say... "we all can't be doctors" or something like that....probably not. At least you summarized me into the right category :cool: guess you really are smart ;)
 
well ya know what they say... "we all can't be doctors" or something like that....probably not. At least you summarized me into the right category :cool: guess you really are smart ;)
If I get a ticket tomorrow, I'm blaming you so call off your friends.
 
Rectal foreign body. Next. And the pt fails the intelligence portion of the exam for 11/10 pain.:p
First off: well played, sir.
TV/S BP:150/90 RR: 20 Sat:98% HR:96 SR...Patient also states he is not allergic to any medications to his knowledge...curious as to: 1. How do you transport this patient(LS or non emergent)
Code 2 (non-emergent). 2. Pain control? Yes, and antiemetics titrated to comfort and tolerability (hemodynamically). 3. General impressions? The patient is in a great deal pain. Pylo is pretty high on my differential as well, but could be a slew of other diagnoses. 4. what other information would you try to gather? Febrile? Honestly, there isn't much more digging on my end. As others have mentioned in this thread and another, abdominal complaints can yield many diagnoses. It's almost always supportive care in the prehospital setting, which at the ALS-level is typically antiemetics, analgesics, and IV(F) until they're transported to definitive care for lab work, and CT and/ or U/S.
 
If I get a ticket tomorrow, I'm blaming you so call off your friends.
i dont control Michigan... especially after that loss, drive cautious friend :P. Tell them you know a NYS parole officer maybe they'll give ya a break.
 
Or a ticket based on this statement alone??...:confused:
Do what EMS does pretty dam good :p. risk reward analysis?
If i actually was to send a PBA card it'd be a different story :)
 
i dont control Michigan... especially after that loss, drive cautious friend :p. Tell them you know a NYS parole officer maybe they'll give ya a break.

Maybe I'll mention I have an uncle who was a town police chief in Sullivan County also. That should get me off the hook.
 
Maybe I'll mention I have an uncle who was a town police chief in Sullivan County also. That should get me off the hook.
Eh NY PBA cards go a long way. Never needed to use one. But i suppose that could work. although broome and Delaware county sheriffs aren't the easiest folks in the world to deal with >.<
 
Eh NY PBA cards go a long way. Never needed to use one. But i suppose that could work. although broome and Delaware county sheriffs aren't the easiest folks in the world to deal with >.<

Gotta be better than troopers. Hey wasn't there a scenario or something going on here?
 
Gotta be better than troopers. Hey wasn't there a scenario or something going on here?
yeah, you sticking with your original diagnosis :P?
 
If this is in fact pylo, then IVF is actually a highly recommended modality, IMO. Prime that (kidney) pump...
 
Yup.

IMG_0362_zpsosjuxiw0.jpg
 
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