EMT - OBGYN, Trauma, EMS Op

• Cullen sign: bruising around umbilicus

  • indicates intraperitoneal hemorrhage
• The right lower quadrant of abdomen contains the large and small intestines
• The right upper quadrant contains the liver, gallbladder, duodenum of the small intestine, and a portion of the pancreas.
• The left upper quadrant contains the stomach, spleen, and a portion of the pancreas.
• Grey Turner sign: bruising along sides of the abdomen (also called flank echhymosis)

  • indicates retroperitoneal hemorrhage
• Murphy’s sign:

  -pain at right subcostal area with palpation

  • indicates inflamed gallbladder, also called cholecystitis
• Kehr’s sign:

  -pain in tip of shoulder due to blood/irritants in peritoneal cavity when person is lying down

  -in left shoulder = ruptured spleen
• GI Internal Bleeding

  -dark tarry stools (melena)

  -coffee ground (emesis)

  -bloody vomit (hematesis)
• Upper GI Bleeding

  -Mallory-Weiss syndrome: partial tearing of esophagus

  -Boerhaave syndrome: complete rupture of esophagus (result of vomiting)
• Lower GI bleeding:

  Ulcerative colitis: inflammation of the colon
• Gallstones: aka cholelithiasis; right upper quadrant pain, may radiate to right upper back, shoulder, flank
• Cholecystitis: inflammation of gallbladder; vomiting, right upper quadrant pain, referred pain to right shoulder, nausea, vomiting, fever, jaundice, light loose bowel
• Appendicitis: lower right quadrant pain, nausea, vomiting, fever, chills, rebound tenderness
• Pancreatitis: upper L and R pain, radiates to back and worsens after eating; nausea, vomiting, abdominal distension, tenderness (can be caused by gallstones)
• Hepatitis: right upper quadrant pain, jaundice
• Internal bleeding lacerated liver: referred pain to right shoulder
• Pneumonia: cough, fever, dyspnea, occasionally pain that radiates to upper abdomen
• Kidney: hematuria, flank pain, costovertebral angle tenderness/guarding
• Renal calculi: flank or lower back pain
• Respiratory alkalosis:

  -hyperventilation, fever, aspirin overdose
• Opiates/Narcotics (morphine, heroin, methadone, oxy, fentanyl)

  -pinpoint pupils, hypoventilation/respiratory arrest, hypotension, sedation, coma, unconscious, bradypnea, cyanosis, pinpoint pupils 🡪 respiratory and cardiac arrest, respiratory acidosis

  -Naloxone: IV, IM, or INasally
• Sympathomimetics (cocaine, meth, epi, albuterol MDMA, PCP)

  -stimulants that mimic SNS, hypertension, tachycardia, dilated pupils, agitation, seizures, hyperthermia
• Anticholinergic (diphenhydramine, atropine, chlorphenoramine, doxylamine)

  -tachycardia, hypertension, hyperthermia, dilated pupils, dry skin/mucous membranes, decreased bowel sounds, and sedation/coma, hyperthermia, warm red skin
• Cholinergic poisoning

  -diarrhea, excessive tears, drooling, mucus secretion, abnormal heart rate
• Sedative-hypnotic (diazepam, secobarbital, flunitrazepam, midazolam, Xanax, valium, ket) 

  -hypoventilation, hypotension, slurred speech, and sedation/coma

  -sedative-hypnotics generally do not affect pupil diameter.
• Beta Blockers: treat hypertension, interfere with SNS

  -bradycardia, hypotension, possibly coma

  -hypoglycemia with pediatric 
• Bee Sting:

  -gently scrape skin with stiff rigid object (credit card)
• Heat stroke: flushed skin, hot dry skin, elevated body temperature (106)
• Preeclampsia: possible complication during 2nd half of pregnancy, severe hypertension, headaches, visual abnormalities, edema, anxiety (typically affects primigravida patients)

  -protein in urine, swelling hands and feet, blurred vision

  -placed on bed rest to prevent eclampsia
• Eclampsia: onset of seizures due to hypertension
• Postictal state: lethargy, drowsiness, confusion, nausea, hypertension, headache, disoriented

  -lactic acidosis, breathing fast and deep to reduce CO2 lvls

  -altered mental, muscles relax/floppy
• Febrile seizures: children under 6 years, occur with sudden spike in body temperature, tonic clonic seizure
• Placenta Previa: placenta develops over the cervical opening, bleeding but no pain
• Any patient in the third trimester of pregnancy should be positioned on the left side during transport due to Supine Hypotensive Syndrome:

  -pregnant patient lies supine and the pregnant uterus compresses the inferior vena cava

  -blood return to the heart is decreased, resulting in subsequent hypotension
• First stage labor (12-18 hrs): uterine contractions, cervix dilation, cervix fully dilated
• Second Stage labor: baby enters birth canal, baby delivered

  -after baby head delivered it rotates to side

  -guide head down to help upper shoulder deliver

  -support head and upper body as shoulders deliver

  -upward guidance of head to deliver lower shoulder
• Third Stage of labor: delivery of placenta

  -massage uterus in firm circular kneading motion to slow bleeding after placenta delivery
• prior to cutting cord, assess baby for resp distress; clamp 2-3 inches apart and cut between; placental delivery follows in 30 min
• baby should breathe spontaneously in 15-30 seconds after birth
• Prolapsed cord procedure:

  • do not attempt to push cord back
  • place patient in supine with foot of cot raised 6-12 inches higher than head, hips elevated on pillow OR knew chest position kneeling and bent forward while face down (keep weight off fetus and cord), wrap cord in sterile towel moistened with saline