Saturday, July 7, 2012

Prehospital Abdominal Assessment Part 3

In Prehospital Abdominal Assessment Part 3 we are going to take a good look at the lower left quadrant.  The two conditions we are going to look at in the lower left quadrant are worlds apart from each other, kidney stones and an abdominal aortic aneurysm.

Kidney stones can obviously occur on either the right or the left side as we have two kidneys, but we are going to discuss them here because we spent our time in the lower right quadrant focusing on appendicitis. Kidney stones are not life threatening but have been described as the most painful medical experience, including childbirth, one will ever encounter. One minute you are fine and the next minute it feels like you are being stabbed in the back or the groin.  Most kidney stones pass on their own but the ones that don't may require some sort of urological intervention that can range from supplemental medications to surgery.  Kidney stones do not cause symptoms until they try to pass through the urinary system.  Symptoms are extreme pain in the back or side that will not go away, nausea and vomiting, blood in the urine, and fever/chills.  The best prehosptital indicator that the pain your patient is experiencing is a kidney stone is a good history.  A history that predisposes a patient to kidney stones are, male gender, previous stones, family history of stones, diet heavy in animal protein and eggs.  There is no magic physical assessment tool  here that will point towards a kidney stone in the field.  The pain can be anywhere from the back to the groin, depending on where the stone has decided to get hung up, or radiating down to the groin.  The best prehospital treatment for a kidney stone is good pain management.  Pain medications are classically under dosed in the prehospital setting.  Give an initial dose of medication and continue to give additional doses as long as their pain is greater than a 5/10.  Your goal should be 0/10 pain management, but that is rarely possible with a kidney stone.  Left untreated a kidney stone can lead to infection and sepsis.  

The next emergency you should rule out is a big one and can definitely kill your patient faster then you can transport them to the nearest operating room.   An abdominal aortic aneurysm is a permanent localized dilation of the abdominal aorta greater than 3 cm and  is  one condition every near syncope and every syncope patient needs to be scrutinized for.  Symptoms can range from back pain to lower abdominal pain. it has been described as tearing, stabbing, or ripping pain.  A pulsitile mass can be an ominous sign and if you feel one then you need to be very gentle with the patient and very carefully transport to the nearest hospital with an operating room staffed and ready to go.   

Attached is a good YouTube video explaining the anatomy and the process of the surgical repair.