I
Detailed Lesson Plan
Chapter 23
Abdominal, Gynecologic, Genitourinary, and
Renal Emergencies
120–150 minutes
|Chapter 23 objectives can be found in an accompanying folder. |
|These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. |
|Minutes |Content Outline |Master Teaching Notes |
| |Introduction |Case Study Discussion |
|5 |During this lesson, students will learn about assessment and emergency medical care for abdominal, gynecologic, |What are some possible causes for Parker’s fever and abdominal|
| |genitourinary, and renal emergiences. |pain? |
| |Case Study |What questions will give you important information about |
| |Present The Dispatch and Upon Arrival information from the chapter. |Parker’s condition? |
| |Discuss with students how they would proceed. | |
| |Acute Abdomen—Abdominal Structures and Functions | |
|5 |Acute abdomen or acute abdominal stress is a common condition. | |
| |Abdominal cavity is located below the diaphragm and extends to the top of the pelvis. | |
| |The abdominal cavity is lined with the peritoneum | |
| |Visceral peritoneum is the innermost layer and is in contact with the abdominal organs. | |
| |Parietal peritoneum is the outer layer. | |
| |Organs enclosed by the visceral peritoneum (stomach, spleen, liver, gallbladder, pancreas, small intestine, and | |
| |part of the large intestine) are termed intraperitoneal. | |
| |Organs located behind the peritoneal space (kidneys, ureters, pancreas, and abdominal aorta are located in the | |
| |retroperitoneal space. | |
| |Abdominal quadrants and regions | |
| |Abdominal quadrants—Use the umbilicus to divide the abdomen into quarters. | |
| |Left upper quadrant (LUQ) | |
| |Right upper quadrant (RUQ) | |
| |Right lower quadrant (RLQ) | |
| |Left lower quadrant (LLQ) | |
| |Nine regions | |
| |Right hypochondriac | |
| |Epigastric | |
| |Left hypochondriac |Teaching Tip |
| |Right lumbar |Draw the nine abdominal regions on the white board. Have |
| |Umbilical |students come up and write the names of the organs in their |
| |Left lumbar |respective regions. |
| |Right iliac | |
| |Hypogastric | |
| |Left iliac |Discussion Questions |
| |Types of abdominal structures |In what quadrant or region of the abdomen is the appendix |
| |Hollow organs contain some type of substance that may leak out into the abdominal cavity if the organ is perforated|located? |
| |or injured. |What is the location of the kidneys? |
| |Solid organs are very vascular, and a rupture or injury to a solid organ could lead to bleeding or severe shock. |What are examples of solid organs in the abdominal cavity? |
| |Vascular structures are the large blood vessels found in the abdominal cavity, and rupture could lead to major | |
| |bleeding, rapid blood loss, and death. | |
| |Acute Abdomen—Abdominal Pain |Weblink |
|5 |Pathophysiology of abdominal pain—Results from mechanical forces (stretching), inflammation, or ischemia (organ and|Go to |
| |tissue hypoxia) |and click on the mykit link for Prehospital Emergency Care, |
| |If organ is torn, pain results from blood irritating the peritoneum. |9th edition to access a web resource on information about |
| |Rapid distention of an organ causes pain. |abdominal pain. |
| |Stretching of the peritoneum causes pain. | |
| |Pain from stretching a solid organ is usually a steady pain. | |
| |Inflammation may cause a crampy type of pain. |Discussion Question |
| |Pain associated with ischemia worsens as the organ becomes more hypoxic. |How is visceral abdominal pain different from somatic pain? |
| |Types of abdominal pain | |
| |Visceral pain occurs when the organ itself is involved; pain is usually less severe, poorly localized, dull or |Critical Thinking Discussion |
| |aching, and constant or intermittent. |How could a problem elsewhere in the body, such as pneumonia, |
| |Parietal pain (somatic pain) is associated with irritation of the peritoneal lining; pain is more severe, |cause abdominal pain? |
| |localized, and typically constant. | |
| |Referred pain is actually visceral pain that is felt elsewhere in the body; pain is usually poorly localized but is| |
| |felt consistently in the part of the body to which it is referred. | |
| |Acute Abdomen—Conditions That May Cause Acute Abdominal Pain | |
|25 |Peritonitis | |
| |Irritation and inflammation of the peritoneum | |
| |Occurs when blood, pus, bacteria, or chemical substances leak into the peritoneal cavity | |
| |Common signs and symptoms | |
| |Abdominal pain or tenderness | |
| |Nausea, vomiting, or diarrhea | |
| |Fever and chills | |
| |Lack of appetite | |
| |Positive Markle test | |
| |Markle “Heel Drop” or “Heel Jar” test |Discussion Question |
| |Instruct patient to stand on his feet with his knees straight. |What is a positive Markle sign? |
| |Upon request, the patient should raise himself onto his toes and drop suddenly down on his heels with enough force | |
| |to produce an audible thump. | |
| |The EMT can modify the Markle test by lifting each of the ankles of the supine patient and knocking the heels | |
| |together or by making a fist and striking the bottom of the heel (“heel jar” test). | |
| |Be sure to watch the patient’s face for a grimace or listen for sounds indicating pain. | |
| |Appendicitis | |
| |Inflammation of the appendix usually caused by a blockage in the intestines | |
| |Common signs and symptoms | |
| |Abdominal pain or cramping | |
| |Nausea and vomiting | |
| |Low-grade fever and chills | |
| |Lack of appetite | |
| |Abdominal guarding | |
| |Positive Markle (“heel drop” or “heel jar”) test | |
| |Pancreatitis | |
| |Inflammation of the pancreas that causes severe pain in the middle of the upper quadrants of the abdomen |Discussion Question |
| |May be caused by ingestion of alcohol, gallstones, or infection |What are some typical complaints associated with pancreatitis?|
| |Common signs and symptoms | |
| |Abdominal pain (can be severe and radiate from the umbilicus to the back and shoulders) | |
| |Nausea and vomiting | |
| |Abdominal tenderness and distention | |
| |Mild jaundice (depending on cause) | |
| |Fever, rapid pulse, signs of shock (extreme cases) | |
| |Cholecystitis | |
| |Inflammation of the gallbladder and commonly associated with gallstones | |
| |More common in women and frequently occurs between the ages of 30 and 50 | |
| |Common signs and symptoms | |
| |Sudden onset of abdominal pain located from the middle of upper quadrants to RUQ areas | |
| |Tenderness upon palpation of the RUQ | |
| |Belching or heartburn | |
| |Nausea and vomiting (contents may be greenish) | |
| |Gastrointestinal bleeding | |
| |Bleeding that can occur anywhere within the gastrointestinal tract and can be attributed to numerous causes | |
| |Usually classified as upper or lower |Discussion Question |
| |Common signs and symptoms |What are causes of gastrointestinal bleeding? |
| |Abdominal pain or tenderness | |
| |Hematemesis | |
| |Hematochezia |Critical Thinking Discussion |
| |Melena |What are some reasons gastrointestinal bleeding may not be |
| |Altered, mental status, weakness, or syncope |diagnosed and treated promptly? |
| |Tachycardia | |
| |Signs of shock | |
| |Esophageal varices | |
| |Bulging, engorgement, or weakening of the blood vessel in the lining of the lower part of the esophagus | |
| |Common to heavy alcohol drinkers or patients with liver disease | |
| |Caused by increased pressure in the venous blood supply system of the liver, stomach, and esophagus | |
| |Common signs and symptoms | |
| |Large amounts of bright red hematemesis | |
| |Absence of pain or tenderness in abdomen | |
| |Rapid pulse | |
| |Breathing difficulty | |
| |Pale, cool, clammy skin | |
| |Other signs and symptoms of shock | |
| |Jaundice | |
| |Gastroenteritis |Weblink |
| |Inflammation of the stomach and small intestines and commonly associated with abdominopelvic pain |Go to |
| |Condition can be chronic or acute |and click on the mykit link for Prehospital Emergency Care, |
| |Common signs and symptoms |9th edition to access a web resource on gastroenteritis and |
| |Abdominal pain or cramping |dehydration. |
| |Nausea, vomiting, and diarrhea | |
| |Abdominal tenderness | |
| |Fever and dehydration | |
| |Signs and symptoms of shock and hemorrhage (severe cases) | |
| |Ulcers | |
| |Open wounds or sore within the digestive tract | |
| |Breakdown of the lining that normally protects the intestine from the digestive fluids contained in the tract. | |
| |Signs and symptoms | |
| |Sudden onset of abdominal pain normally in the LUQ and epigastric area | |
| |Nausea and vomiting | |
| |Hematemesis, hematochezia, or melena or coffee-ground emesis in some cases | |
| |Signs or symptoms of shock (in cases of massive bleeding) | |
| |Peritonitis | |
| |Intestinal obstruction | |
| |Blockage that interrupts the normal flow the of intestinal contents | |
| |Can occur in both the small and large intestines and be either partial or complete | |
| |Common signs and symptoms | |
| |Abdominal pain, moderate to severe, depending on location of obstruction (crampy or colicky) | |
| |Nausea and vomiting | |
| |Constipation | |
| |Abdominal distension and tenderness | |
| |Abnormally prominent, high-pitched bowel sounds with auscultation in early stages | |
| |Hernia | |
| |Protrusion or thrusting forward of a portion of the intestine through an opening or weakness in the abdominal wall | |
| |Associated with increased pressure in the abdominal cavity during heaving lifting or straining | |
| |Common signs and symptoms | |
| |Sudden onset of abdominal pain (usually after heavy lifting or straining | |
| |Fever | |
| |Rapid pulse | |
| |Tender mass at point of hernia | |
| |Others similar to intestinal obstruction | |
| |Abdominal aortic aneurysm | |
| |Weakened, ballooned, and enlarged area of the wall of the abdominal aorta | |
| |May eventually rupture and is one of the most lethal causes of abdominal pain | |
| |Common signs and symptoms | |
| |Gradual onset of lower lumbar, groin, and abdominal pain | |
| |Rupture associated with sudden onset of severe, constant abdominal pain | |
| |Testicular pain in the male patient | |
| |Possible nausea and vomiting | |
| |Mottled or spotty abdominal skin | |
| |Pale, cool, clammy, and possibly cyanotic skin in legs | |
| |Absent or decreased femoral or pedal pulses | |
| |Pulsating abdominal mass (felt if abdomen is soft) or rigid and tender abdomen (if aneurysm has burst) | |
| |Cyanotic, cold, or mottled skin below waistline (if aortic aneurysm is starting to rupture) | |
| |Vomiting/diarrhea/constipation | |
| |Symptoms of many of the conditions previously discussed | |
| |EMT should be concerned if condition has persisted for hours (vomiting) or days (diarrhea), and the patient has | |
| |become dehydrated. | |
| |Acute Abdomen—Assessment-Based Approach: Acute Abdomen | |
|25 |It is not important that you try to isolate the exact cause of abdominal pain or distress in the prehospital | |
| |setting, but rather that you simply correctly assess and identify that the patient is suffering abdominal pain and | |
| |provide suitable emergency care based on the symptom. | |
| |Scene size-up | |
| |Check for scene safety and take Standard Precautions. | |
| |Look for mechanism of injury | |
| |Use all of your senses to size-up the scene. | |
| |Primary assessment | |
| |Stabilize spine injury if suspected. |Discussion Question |
| |Person with an acute abdomen generally appears very ill and assumes a guarded position with his knees drawn up and |What are the management priorities for patients with acute |
| |his hands clenched over his abdomen. |abdominal pain? |
| |Ensure the patient has a patent airway with adequate breathing. | |
| |Apply high-flow, high-concentration oxygen therapy and assist the patient’s ventilations if they are inadequate. | |
| |Assess circulation. | |
| |Look for signs of shock. | |
| |Consider the patient a priority for transport if he meets any of the following criteria. | |
| |Poor, general appearance | |
| |Unresponsive | |
| |Responsive, not following commands | |
| |Shock | |
| |Severe pain | |
| |Secondary assessment | |
| |If patient is responsive, conduct history before the physical exam; if patient is unresponsive, conduct history | |
| |after physical exam and vitals, gathering information from family or bystanders. | |
| |Important questions to ask during the history | |
| |Ask the OPQRST questions to get the full description of the pain. | |
| |Does the patient have any known allergies to medications, food, or other substances? |Class Activities |
| |Is the patient currently taking any medications? |Divide students into small groups. Provide individual students|
| |Does the patient have any pertinent past medical history? |in each group with an index card listing a cause of |
| |When was the last time the patient had anything to eat or drink? |abdominopelvic pain. Instruct students not to share the |
| |Has the patient’s appetite changed? |information on the cards with their classmates. Ideally, each |
| |Has the patient been nauseated? |student will have a card, but at least one student in each |
| |Did the patient vomit, and if so, what was the color and appearance? |group must have a card. Students will spend time researching |
| |What was the color of the patient’s last stools? |the presentation of their condition and will develop a |
| |Has the patient had difficulty urinating? |complaint and history to be elicited by the other students in |
| |Was the patient doing anything prior to the onset that led to the abdominal pain or distress? |their group. The other students must obtain a history to |
| |Focus on the abdomen during the physical exam but still asses the rest of the body for signs and symptoms. |determine their classmate’s condition. Students will then |
| |General guidelines for the physical exam |discuss how well the complaints and history matched the |
| |Determine if the patient is restless or quiet and whether pain is increased upon movement. |condition. |
| |Inspect the abdomen to determine if it if distended. Ask the patient whether that is normal or not. |Provide ample opportunity for students to practice skills. |
| |Gently palpate the abdomen using the quadrants as landmarks. Remember to start with the least painful area first. | |
| |Assess if the abdomen feels soft or rigid (involuntary guarding/rigidity versus voluntary guarding). | |
| |Assess if the abdomen is tender or nontender when touched. | |
| |When palpating the abdomen, note any masses that may be present and if they are pulsating. | |
| |Ask the patient if he has any pain on other body areas. | |
| |Document the quadrant in which any pain is located. | |
| |Obtain and document the patient’s baseline vital signs. | |
| |Signs and symptoms | |
| |Pain or tenderness | |
| |Anxiety and fear | |
| |Guarded position or other comfortable position | |
| |Rapid and shallow breathing | |
| |Rapid pulse | |
| |Blood pressure changes | |
| |Nausea, vomiting, and/or diarrhea | |
| |Rigid abdomen or guarding | |
| |Distended abdomen | |
| |Fever or chills | |
| |Belching or flatulence | |
| |Changes in bowel habits or urination | |
| |Other signs and symptoms associated with shock | |
| |Signs of internal bleeding | |
| |Do not waste time with extensive exams or palpation prior to initiating transport. Excessive palpation can worsen | |
| |the pain and aggravate the cause. | |
| |Emergency medical care | |
| |Keep the airway patent. | |
| |Place the patient in the position of comfort. | |
| |If breathing is adequate, administer oxygen based on the SpO2 reading and patient signs and symptoms. | |
| |Never give anything by mouth. | |
| |Calm and reassure the patient. | |
| |If signs and symptoms of hypoperfusion are present, treat for shock. |Knowledge Application |
| |Initiate a quick and efficient transport. |Given a series of scenarios of patients complaining of |
| |Reassessment |abdominal pain, students should be able to develop an index of|
| |Reassess during transport. |suspicion for the cause and provide appropriate management for|
| |Document and record vital signs and communicate to receiving facility. |the patient. |
| |Gynecologic Emergencies—Female Reproductive Structures and Function | |
|5 |Gynecology is the branch of medicine that studies health of the female patient and her reproductive system. | |
| |External genitalia (vulva) | |
| |Consists of vascular tissues called the perineum, mons pubis, labia, and the clitoris | |
| |Provides accessory functions to the internal organs that are used primarily for reproduction | |
| |Internal organs | |
| |Includes the vagina, uterus, ovaries, and fallopian tubes | |
| |Vagina functions as the birth canal during childbirth, receives the penis during sexual intercourse, and serves as | |
| |a passageway for menstrual flow. | |
| |Ovaries are the primary sex glands located on each side of the uterus. | |
| |Fallopian tubes extend from near each of the ovaries to the uterus. | |
| |Uterus is the pear-shaped muscular organ which provides an appropriate site for egg implantation and fetal | |
| |development during pregnancy. The endometrium lines the uterus and is sloughed off during menses. | |
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| | | |
| |Gynecologic Emergencies—Gynecological Conditions |Teaching Tip |
|15 |Sexual assault |Consider having a sexual assault nurse examiner lecture on |
| |Act of violence and a crime that is defined differently by each state (most include sexual intercourse or other |management of patients who have been sexually assaulted. |
| |sexual activities that are performed without consent) | |
| |Make sure you follow your local protocols when dealing with a sexual assault patient. | |
| |Physical effects of rape or sexual assault | |
| |Traumatic injuries from beatings, chokings, and penetrations | |
| |Swelling, bleeding, and pain around the genital or rectal area | |
| |Sexual transmitted diseases | |
| |Possible pregnancy | |
| |Psychological effects of rape or sexual assault | |
| |Severe anxiety, depression, or fear | |
| |Inappropriate feelings of guilt | |
| |Flashbacks or nightmares | |
| |Emotional withdrawal, numbness, or irritability | |
| |Guidelines for when sexual assault has occurred | |
| |Address both the physical and emotional needs of the patient. |Discussion Question |
| |Always maintain patient confidentiality. |What are some special considerations in management of the |
| |Do not allow the patient to change clothes, bathe, comb, or clean any part of the body. If the clothing was |patient who has been sexually assaulted? |
| |changed, collect it, bag it separately, and take it with you. | |
| |Do not cut through any holes or tears in the patient’s clothing. Handle the clothing as little as possible. | |
| |Do not touch or change anything at the crime scene unless it impedes emergency medical care. | |
| |Do not clean wounds, if possible. Treat wounds as you would other soft-tissue injuries. | |
| |Do not examine the genital area unless there is a life-threatening hemorrhage. Minor bleeding can be absorbed by a | |
| |pad. Make sure all bloody articles are collected and transported with the patient. | |
| |Document all findings objectively and accurately. | |
| |Vaginal bleeding (nontraumatic) | |
| |May be caused by cancerous lesions, pelvic inflammatory disease, hormonal imbalances, spontaneous abortion, or | |
| |labor. | |
| |EMT should not assume bleeding is occurring from menses; however, for girls about the age of ten, menses could be | |
| |the cause of bleeding. | |
| |Common signs and symptoms of a spontaneous abortion |Discussion Question |
| |Lower abdominal or pelvic pain |What are some gynecological conditions that can lead to life |
| |Abdominal tenderness |threatening emergencies? |
| |Vaginal bleeding | |
| |Rapid pulse | |
| |Signs and symptoms of shock |Video Clip |
| |Menstrual pain |Go to |
| |Dysmennorhea is strong uterine cramps that cause severe pain during menstruation and could be caused by hormonal |and click on the mykit link for Prehospital Emergency Care, |
| |imbalances. |9th edition to access a video on premenstrual syndrome. |
| |Mittelschmerz is abdominopelvic pain in the middle of the menstrual cycle and occurs when the small amount of | |
| |bleeding associated with the release of a mature ovum irritates the peritoneum. |Weblink |
| |Ovarian cyst |Go to |
| |Fluid-filled sac that forms inside or on an ovary |and click on the mykit link for Prehospital Emergency Care, |
| |Common signs and symptoms of an ovarian cyst |9th edition to access a web resource on menstruation and |
| |Unilateral abdominopelvic pain that may radiate to the back |menstrual problems. |
| |Abdominal tenderness | |
| |Vaginal bleeding that may be irregular or abnormal | |
| |Pain during sexual intercourse or bowel movements | |
| |Endometritis | |
| |Inflammation of the endometrium | |
| |Caused by infection | |
| |Common signs and symptoms of endometritis | |
| |Abdominopelvic pain or tenderness | |
| |Fever | |
| |Abdominal distention | |
| |Vaginal bleeding or discharge | |
| |Discomfort during a bowel movement | |
| |Endometriosis | |
| |Condition in which endometrial tissue grow outside the uterus | |
| |Common signs and symptoms of endometriosis | |
| |Abdominopelvic pain or tenderness that may be dull or cramping | |
| |Dysmenorrhea | |
| |Vaginal bleeding | |
| |Pain during sexual intercourse or a bowel movement | |
| |Pelvic inflammatory disease | |
| |Infection of the female reproductive tract caused by bacteria, fungi, or viruses | |
| |Common signs and symptoms of pelvic inflammatory disease | |
| |Abdominopelvic pain or tenderness | |
| |Vaginal discharge with an abnormal color, consistency, or odor | |
| |Fever and chills | |
| |Anorexia | |
| |Nausea or vomiting | |
| |Irregular vaginal bleeding or cramping | |
| |Pain during sexual intercourse | |
| |Sexually transmitted disease | |
| |Infectious diseases transmitted through sexual contact and caused by bacteria, viruses, parasites or fungi. |Weblink |
| |Common signs and symptoms of sexually transmitted diseases |Go to |
| |Abdominopelvic pain or tenderness |and click on the mykit link for Prehospital Emergency Care, |
| |Vaginal discharge with an abnormal color, consistency, or odor |9th edition to access a web resource on STDs. |
| |Fever and chills | |
| |Nausea or vomiting |Video Clip |
| |Irregular vaginal bleeding or cramping |Go to |
| |Pain during sexual intercourse or urination |and click on the mykit link for Prehospital Emergency Care, |
| |Genital itching, redness, or swelling |9th edition to access a video on gonorrhea. |
| |Lesions or ulcers | |
| | Gynecologic Emergencies—Assessment-Based Approach: Gynecological Emergencies | |
|10 |Scene size-up | |
| |Ensure the scene is safe, and take Standard Precautions. | |
| |Determine if the patient has been injured or is suffering a medical illness. | |
| |Call the proper authorities if the call appears to be a crime scene. | |
| |Primary assessment | |
| |Form a general impression of the patient. | |
| |Stabilize the spine, if necessary. | |
| |Ensure your patient has a patent airway. | |
| |Assess breathing and either administer oxygen or provide bag-valve-mask ventilations with supplemental oxygen as | |
| |appropriate. | |
| |Assess circulation and look for signs of shock. | |
| |If major bleeding is coming from the vagina, attempt to control bleeding by placing a pad over the external | |
| |genitalia to absorb the blood flow. | |
| |Consider the patient a priority for transport if she meets any of the following criteria. | |
| |Poor general appearance | |
| |Unresponsive | |
| |Responsive, not following commands | |
| |Severe pain | |
| |Shock (hypoperfusion) | |
| |Secondary assessment | |
| |Protect the patient’s privacy and modesty. | |
| |Be patient, compassionate, and professional when asking the following questions. | |
| |What are the signs and symptoms the patient is complaining of? |Discussion Question |
| |Did the signs and symptoms seem to get progressively worse or better? |What are key questions to ask when obtaining the history of a |
| |How long has the patient been sick or suffering from these signs and symptoms? |patient with a gynecological complaint? |
| |Was the onset of signs and symptoms gradual or sudden? | |
| |What was the patient doing prior to the onset of the complaint? | |
| |Does the patient have any known allergies to medications, food, or other substances? | |
| |When did the patient last have something to eat or drink? What did she eat or drink? | |
| |What medications is the patient taking? Is she taking birth control pills or other contraceptives? |Critical Thinking Discussion |
| |What is the patient’s past medical history? When was the last time she has seen a doctor for her medical condition?|How can you lessen the embarrassment or self-consciousness of |
| |When was the patient’s last menstrual period? Is her cycle regular? |a patient with a gynecological complaint? |
| |Does the patient have any vaginal bleeding? |How can you increase your own comfort level in dealing with |
| |Is there a possibility that she is pregnant? Has she been pregnant before? |patients with gynecological complaints? |
| |Does she have any vaginal discharge? | |
| |Has the patient had any nausea or vomiting? | |
| |Does the patient have any pain associated with urination, defecation, or sexual intercourse? | |
| |Common signs and symptoms of gynecological emergency |Knowledge Application |
| |Abdominopelvic pain or tenderness |Given several different scenarios, students should be able to |
| |Irregular vaginal bleeding or cramping |obtain a relevant history from the patient with a |
| |Vaginal discharge with an abnormal color, consistency, or odor |gynecological complaint. |
| |Nausea and vomiting | |
| |Fever or chills | |
| |Syncope | |
| |Vaginal pain | |
| |Genital itching, redness, or swelling | |
| |Signs of shock | |
| |Physical exam | |
| |Still assess the rest of the body for signs and symptoms | |
| |Perform the physical examination of the abdomen carefully and gently. | |
| |Palpate the least painful quadrant first and the most painful quadrant last. | |
| |Document the number of pads a patient saturates if she is bleeding, and record the baseline vital signs. | |
| |Emergency medical care | |
| |Do not try to isolate the exact cause of abdominopelvic pain or vaginal bleeding in the prehospital setting. | |
| |Provide suitable emergency medical care based on the signs and symptoms. | |
| |Maintain manual spine stabilization. | |
| |Keep the airway patent. | |
| |If breathing is adequate, administer oxygen based on the SpO2 reading and patient signs and symptoms. | |
| |Control any major vaginal bleeding if present. | |
| |Place the patient in a potion of comfort if no trauma is suspected. | |
| |Calm and reassure the patient. | |
| |Initiate a quick and efficient transport. | |
| |Reassessment | |
| |Reassess the patient and record vital signs every five minutes. | |
| |Report your findings to the receiving facility. | |
| |Genitourinary/Renal Emergencies—Genitourinary/Renal Structures and Functions |Video Clip |
|5 |Urology is the branch of medicine that studies the urinary system in females and the genitourinary system in males.|Go to |
| |Organs of the female reproductive system are separate from those in the urinary system; however, in males, some of |and click on the mykit link for Prehospital Emergency Care, |
| |the structures are shared (genitourinary system). |9th edition to access a video on erectile dysfunction. |
| |The urinary system is composed of the kidney’s ureters, urinary bladder, and urethra. The system produces, stores, | |
| |and eliminates urine from the body. | |
| |The organs of the male reproductive system include the testes, epididymis, vas deferens, prostrate gland, and | |
| |penis. | |
| | |Discussion Question |
| | |What are the functions of the kidneys? |
| |Genitourinary/Renal Emergencies—Genitourinary/Renal Conditions |Weblink |
|15 |Urinary tract infection |Go to |
| |Affect the urethra, bladder, ureters, kidneys, and prostate (in men) |and click on the mykit link for Prehospital Emergency Care, |
| |Most frequently caused by bacteria entering the urethra |9th edition to access a web resource on genitourinary |
| |Common signs and symptoms of urinary tract infections |problems. |
| |Abdominopelvic pain or tenderness | |
| |Blood in the urine (hematuria) | |
| |Urine with cloudiness or a foul or strong odor | |
| |Pain or burning with urination or sexual intercourse |Discussion Questions |
| |Frequent or urgent need to urinate |What are the signs and symptoms of a urinary tract infection? |
| |Genital or flank pain |What are some risk factors for kidney stones? |
| |Fever or chills | |
| |Nausea or vomiting |Weblink |
| |Altered mental status |Go to |
| |Kidney stones (renal calculi) |and click on the mykit link for Prehospital Emergency Care, |
| |Crystals of substances like calcium, uric acid, struvite, and crystine that are formed from metabolic abnormalities|9th edition to access a web resource on the urinary tract and |
| |Common signs and symptoms of kidney stones |kidney stones. |
| |Abdominopelvic pain or tenderness | |
| |Flank or back pain that is colicky and severe |Video Clips |
| |Groin pain |Go to |
| |Abnormal urine color |and click on the mykit link for Prehospital Emergency Care, |
| |Pain with urination |9th edition to access videos on different types of kidney |
| |Frequent or urgent need to urinate |stones and renal failure. |
| |Nausea or vomiting | |
| |Kidney failure (renal failure) | |
| |Occurs when the kidneys fail to function adequately and are not able to filter the wastes and maintain homeostasis |Discussion Question |
| |Acute renal failure (ARF) normally occurs over a period of days and often results from a significant decrease in |How are acute and chronic renal failure different? |
| |urine elimination (cardiac failure, surgery, shock, sepsis, urinary tract infection). | |
| |Chronic renal failure (CRF) occurs over a period of years, and the symptoms range from mild at first to severe | |
| |kidney failure (diabetes, hypertension). This condition is permanent and life threatening. | |
| |Complications fro kidney failure | |
| |Pulmonary edema | |
| |Cardiac tamponade or pericarditis | |
| |Electryolyte and other metabolic abnormalities | |
| |Cardiac dysrhythmias | |
| |Congestive heart failure | |
| |Hypertension | |
| |Infections | |
| |Hemorrhage | |
| |Liver failure | |
| |Altered mental status | |
| |Seizures | |
| |Uremia | |
| |Common signs and symptoms of kidney failure | |
| |Abdominopelvic or flank pain | |
| |Blood in the urine | |
| |Altered mental status | |
| |Edema of the feet, ankles, and legs | |
| |Decreased urine output or cessation of urination | |
| |Blood in the urine or stools | |
| |Hypertension | |
| |Swelling or easy bruising | |
| |Anorexia | |
| |Hypertension | |
| |Swelling | |
| |Tachycardia |Weblink |
| |Dialysis |Go to |
| |Artificial process used to remove water and waste substances from the blood when the kidneys fail to function |and click on the mykit link for Prehospital Emergency Care, |
| |properly |9th edition to access a web resource on dialysis from the |
| |Blood containing waste products passes on one side of the membrane while a dialysate passes on the other side. |National Kidney Foundation. |
| |Water and waste products travel into the dialysate. | |
| |Hemodialysis involves a dialysis machine that contains the dialysate and is connected to an access site on the | |
| |patient. |Discussion Question |
| |Peritoneal dialysis involves a dialysate that is run through a tube into the patient’s abdomen, and the peritoneal |What are some complications of dialysis? |
| |membrane functions as the semipermeable membrane. | |
| |Risks and life-threatening complications of dialysis | |
| |Hypotension |Critical Thinking Discussion |
| |Muscle cramps |How would a dialysis patient be affected by missing dialysis |
| |Peritonitis |appointments? |
| |Nausea and vomiting | |
| |Hemmorhage | |
| |Infection at the access site | |
| |Irregular pulse or cardiac arrest | |
| |Difficulty breathing | |
| |Dialysis emergency management | |
| |Maintain the airway, breathing, and circulation. | |
| |Support ventilation as needed. | |
| |Provide high-flow, high-concentration oxygen. | |
| |Stop any bleeding from the shunt or access site as needed. | |
| |Position the patient. If the patient has signs of shock, place him in a supine position. If the patient has | |
| |pulmonary edema, place him upright. | |
| |Urinary catheters |Teaching Tip |
| |Foley or indwelling catheters (most common) have a balloon that is inserted into the urinary bladder via the |Pass around an example of urinary catheter kit to allow |
| |urethra and allows urine to drain from the bladder into a bag. |students to examine it. |
| |Suprapubic catheters work in a similar way, but instead of being inserted through the urethra, they are placed into| |
| |the urinary bladder directly through the patient’s abdominal wall. |Critical Thinking Discussion |
| |Urinary catheter management |Why are women and patients with a urinary catheter at |
| |Note any swelling, redness, pain, unusual odor or color, or bleeding around the site. |increased risk of UTIs? |
| |Drain the bag before moving and transporting the patient (record amount of urine). | |
| |Be sure there are no kinks in the device, transfer the patient to the cot or bed, and lower the bag so urine can | |
| |freely flow into it. | |
| |Genitourinary/Renal Emergencies—Assessment-Based Approach: Genitourinary/Renal Emergencies | |
|10 |Scene size-up | |
| |Ensure the scene is safe and take Standard Precautions. | |
| |Determine if the patient has been injured (mechanism of injury) or is suffering a medical illness. | |
| |Primary assessment | |
| |Form a general impression of the patient. | |
| |Stabilize the spine if necessary. | |
| |Ensure a patent airway. | |
| |Assess the patient’s breathing and apply oxygen or bag-valve-mask ventilations as appropriate. | |
| |Assess circulation and look for signs of shock. | |
| |Identify and control any major bleeding. | |
| |Consider the patient a priority for transport for any of the following reasons. | |
| |Poor general appearance | |
| |Unresponsive | |
| |Responsive, not following commands | |
| |Severe pain | |
| |Shock | |
| |Secondary assessment | |
| |Protect the patient’s privacy and modesty. | |
| |Be patient, compassionate, and professional when communicating and asking the following questions. | |
| |What are the signs and symptoms the patient is complaining of? | |
| |Did the signs and symptoms seem to get progressively worse or better? | |
| |How long has the patient been sick or suffering from these signs and symptoms? | |
| |Was the onset of signs and symptoms gradual or sudden? | |
| |What was the patient doing prior to the onset of the complaint? | |
| |Does the patient have any known allergies to medications, food, or other substances? | |
| |When did the patient last have something to eat or drink? What did he eat or drink? | |
| |What medications, prescription and nonprescription, is the patient taking? | |
| |What is the patient’s past medical history? When was the last time he has seen a doctor for | |
| |his medical condition? Has he had any surgeries? | |
| |When was the patient’s last menstrual period? Is her cycle regular? Does she have any vaginal bleeding or | |
| |discharge? Could she be pregnant? | |
| |Is there any genital pain or discharge? If so, what is the color, consistency, and odor | |
| |like?Is there a change in urine? If so, what is the color and odor like? | |
| |Does the patient receive dialysis? If so, when was the last treatment received? When is the next treatment due? | |
| |Does the patient have any abdominopelvic or flank pain? | |
| |Has the patient had any nausea or vomitting? If so, when and how much? | |
| |Does the patient have any pain associated with urination, defecation, or sexual intercourse? | |
| |Signs and symptoms | |
| |Urine with an abnormal color, consistency, or odor | |
| |Abdominopelvic pain or tenderness | |
| |Nausea and vomiting | |
| |Fever or chills | |
| |Syncope or altered mental status | |
| | ................
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