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145 Cards in this Set
- Front
- Back
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Blunt/Penetrating ABD Trauma
S/Sx |
- Associated injuries
- Hypotensive shock syndrome - Peritonitis Syndrome - Penetrating wound - Shock - Rigidity and gaurding(viseral injury) |
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Blunt/Penetrating ABD Trauma
Tx |
-O2, NG Tube w/ suction, NPO, IV (ns), Monitor I&O, IV Antibiotics, Pain Meds, PROPAQ Monitor
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Blunt/Penetrating ABD Trauma
Complications |
- Organ injury: Liver, Spleen, Kidney, Pancreas, Diaphragm
- Major Vessel Injury - Injury to penetrating areas |
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Blunt/Penetrating ABD Trauma
Dispo |
- Retain if minor.
- (BOTH) Medevac if evidence of peritonitis, unstable vital signs, questionable Dx. |
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Appendicitis
S/Sx |
- Vague Onset. Pain to RLQ w/in 12 hrs
- N/DA/Constipated/F/Pain w/ Cough/ + Psoas, Rebound, Gaurding -Decrease to absent bowel sounds - Rectal tenderness |
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Appendicitis
Tx |
ABD protocol
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Appendicitis
Complications |
- Perforation
- Peritonitis - abscess - sepsis - death |
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Appendicitis
Dispo |
Medevac
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Appendicitis
D/Dx |
-VGE/Constipation/Bowel Obstruction/GYN Disorders
- Pyelonephritis, Renal colic, Crohn's, Diver, Chole |
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Peritonitis
S/Sx |
- ABD Pain, N/V/DA/D/Constipation/F/C/tachycardia/ Sweating/ Shock
-ABD Rigid/Gaurding/ Rebound/ Decreased to Absent BS/ Distenion |
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Peritonitis
Tx |
ABD Protocol
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Peritonitis
Complications |
- Sepsis
- Death |
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Peritonitis
d/dx |
- Intestinal obstruction
- Appendicitis, Chole, Pancreatitis - Lower Lobe Pneumonia - GI Hemorrhage - GYN Disorders |
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Peritonitis
Dispo |
Medevac
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Gastroenteritis
S/Sx |
- Sudden Onset
- N/V/DA/D/M/Fatigue - Crampy ABD Pain - Distention - Increase BS - Afebrile - Diffuse ABD Tenderness |
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Gastroenteritis
Tx |
- Supportive
- BRAT/Clear Fluids - IV/I&O - NO AntiD unless over 48hrs |
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Gastroenteritis
Complications |
- Dehydrate
- Salmonella,Cholera |
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Gastroenteritis
D/Dx |
- Appendicitis
- Food Bourne illness |
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Gastroenteritis
Dispo |
- Retain (SIQ)
- No food handle - Resolves in 72 |
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Diverticulitis
S/Sx |
- Mild - Severe
- Abrupt onset LLQ - Constipation or loose stool - N/V/F/C - LLQ Tenderness/ Palpable Mass, Occult blood positive |
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Diverticulitis
Tx |
ABD Protocol
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Diverticulitis
Comp |
- Fistula, Peritonitis, Colon Strictures, Obstruction, Hemorrage, Avoid Moriphine
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Diverticulitis
D/Dx |
- Cancer
- Crohns - Colitis - Obstructions - Appendicitis - GYN disorders |
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Diverticulits
Dispo |
Medevac
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Pilonidal Cyst
S/Sx |
- Pain/Swelling Sacrococcygeal
- Palpable Mass/Abscess - TTP, Erythema, Tracts |
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Pilonidal Cyst
Tx |
- I&D
- Pack (Iodiform) - Antibiotics - Pain Meds |
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Pilonidal Cyst
Comp |
- Cellulitis
- Sepsis - Recurrent Problem |
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Pilonidal Cyst
D/Dx |
- Anorectal Abscess/Fistula
- Carbuncle/Furuncle - Hidradenitis Suppurativa |
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Pilonidal Cyst
Dispo |
- Retain on board
- Refer to surgeon if recurrent |
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Anorectal Abcess
S/Sx |
Superficial
- Very Painful - Swelling, Erythema, TTP, Induration - May see discharge Deep Abcess - Local Pain - Systemic Sepsis - no external evidence - DRE Tenderness - Lower ABD Pain |
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Anorectal Abcess
Tx |
- Local Anesthesia
- I&D - Antibiotics - Hot Soaks/Sitz bath - Pain Meds |
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Anorectal Abcess
Comp |
- Recurrent
- Fistula - Spread of infection |
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Anorectal Abcess
D/Dx |
- Hidradentitis Suppuritiva
- Anorectal Fistula - Crohn's |
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Anorectal Abcess
Dispo |
- Retain is responsive
- Medevac Deep Abcess or systemic involvement - Refer to surgery |
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Anorectal Fistula
S/Sx |
- Recuurent Abcess
- Local Itching, TTP, Pain on BM - 1 or more openings - Cord like tract can be palpated |
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Anorectal Fistula
Tx |
- PO/IV Antibiotics
- Hot Soaks/Sitz baths - Pain meds - Surgery is definitive Tx |
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Anorectal Fistula
Comp |
- Sepsis
- Recurrent - Carcinoma |
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Anorectal Fistula
D/Dx |
- Hidradenitis Suppurativa
- Pilonidal Sinus - Crohn's - Cancer |
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Anorectal Fistula
Dispo |
- Retain
- Medevac Systemic - Refer to surgery - Eval to r/o Inflammatory bowel disease or cancer |
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Anal Fissure
S/Sx |
- Painful BM
- Blood on tissue - Constipation - Sentinel Pile (External tag) - TTP on DRE |
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Anal Fissure
Tx |
- Regulate BM
- Topical ointment - Warm Sitz baths after BM - Pain Meds - Refer to Surgery |
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Anal Fissure
Comp |
- Chronic Condition
- Infection - Constipation |
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Anal Fissure
D/Dx |
- Carcinoma
- Primary Syphillis Lesions - TB - Crohn's |
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Anal Fissure
Dispo |
- Retain on Board
- Refer to Surgery if chronic |
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Hemorrhoids
S/Sx |
Internal
- Bleed/no pain/Muccoid drainage/non vis unless prolapsed/ nontender and non palpable on DRE External - Blood/ pain/Burning/ itching/visible on inspection |
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Hemorrhoids
Tx |
- Topical Anesthetics
- Stool Softner - Proctofoam HC - Good Hygiene - Warm Sitz baths - Increase fiber/fluid - Pain meds - Gentle reductions - May I&D |
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Hemorrhoids
Comp |
- Hemorrhage
- Infection - Constipation |
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Hemorrhoids
D/Dx |
- Colorectal cancer
- Ulcerative Colitis - Crohn's - Diverticulitis |
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Hemorrhiods
Dispo |
- Retain
- Refer if chronic |
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Cholecystitis
S/Sx |
- Sudden onset of severe pain RUQ post large fatty meal
- Pain subsides over 12-18 hrs - N/V/F - RUQ Tenderness w/ gaurding and rebound - Radiate to right - Murphy's Sign |
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Cholecystitis
Tx |
ABD Protocol
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Cholecystitis
Comp |
- Gangrene of the gallbladder
- Cholangitis - Peritonitis - Sepsis |
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Cholecystitis
D/Dx |
- Perforated peptic ulcer
- pancreatitis - hepatitis - perf bowel - pneumonia |
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Cholecystitis
Dispo |
MEDEVAC
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Pancreatitis
S/Sx |
- Sudden onset radiates to back and r/l sides
- Pain while walk/lying - pain better when sitting fwd - N/V/W/F/HTN/TACHY/ - Cool skin/ BS decreased - Tender Upper ABD w/o Gaurding, rebound, rigidity - Upper ABD Mass maybe |
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Pancreatitis
Tx |
- ABD Protocol
- Decrease fatty foods |
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Pancreatitis
Comp |
- Shock
- Renal Failure - pancreatic Abscess or pseudocyst - Chronic Pancreatitis - ARDS |
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Pancreatitis
D/Dx |
- Doudenal ulcer perf
- Intestinal Obstruction - Cholecystitis - Hepatitis - Renal Colic - Dissection aortic aneurysm |
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Pancreatitis
Dispo |
MEDEVAC
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Esophagitis
S/Sx |
- Heartburn
- Diff. Swallow - Regurg - Relief w/ Antiacid |
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Esophagitis
Tx |
- Lifestyle modifications
- Rantidine - Mylanta |
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Esophagitis
Comp |
- Upper GI Bleed
- Esophageal Stricture - Barrett's Esophagus |
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Esophagitis
D/Dx |
- Angina Pectoris
- MI - PUD |
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Esophagitis
Dispo |
- Retain unless evidence of GI Bleed
- Refer to UMO |
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Crohn's (Regional Enteritis)
Tx |
- Diet
- Avoid Dairy, Raq fruits/vegi, popcorn, nuts - Tx dehydrations - Antibiotics - Prednisone - Surgery |
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Crohn's
D/Dx |
IBS/APPY/DIVER/CANCER/Ulcerative Colitis
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Crohn's
Dispo |
- MEDEVAC
- Waiver |
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Ulcerative Colitis
S/sx Mild |
Mild
- less than 4bm/day - Normal HCT/Weight/Temp - LLQ cramps relieved by poop - no ABD Pain/TTP -Tenesmus |
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Ulcerative Colitis
S/Sx Moderate |
- Bm per day
- hct 30-40 - 1-10 lbs weight loss - temp 99-100 - Freq bleeding - Mild ABD Pain/TTP |
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Ulcerative Colitis
S/Sx Severe |
- more than 6 bm/day
- hct 30 or less - weight loss 10lb or more - temp 100 or more - Hypovolemia - Impaired nutrition - Moderate ABD pain/TTP - Toxemia |
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Ulcerative Colitis
Tx |
Mild- Moderate
- Diet/Fiber supp's/Prednisone Severe - NPO/IV/I&O/Avoid Opiates - Freq vitals/abd exams - solumedral - antibiotics - surgery |
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Ulcerative Colitis
Comp |
Stricture of rectum or colon
- Anemia - Dehydration - toxemia - increased risk of colon cancer - Multiple systemic manifestations |
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Ulcerative Colitis
D/Dx |
- Cancer
- Crohn's - Diver |
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Ulcerative Colitis
Dispo |
MEDEVAC
SUB DISQUAL |
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Small Bowel Obstruction
S/Sx |
- ABD Pain (occurs in waves)
- V/Constipation/Obstruction - Mild ABD Pain - ABD Distention - Decreased/Absent BS - May detect hernia - VS Normal - Low grade fever - Normal DRE |
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Small Bowel Obstruction
Tx |
ABD Protocol
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Small Bowel Obstruction
Comp |
- Bowel Strangulation
- Bowel Perf - Peritonitis - Sepsis |
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Small Bowel Obstruction
D/Dx |
- Adynamic Ileus
- Pancreatitis/APPY/ Gastro - Peritonitis/ Renal Colic |
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Small Bowel Obstruction
Dispo |
Medevac
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Adynamic Ileus
S/Sx |
- Mild/Diffuse ABD Pain
- N/V/ Cont/ Obstruction - Hx of precipitating factor - mild ABD TTP - BS Decreased - General ABD Distention - Dehydration |
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Adynamic Ilieus
Tx |
- Treat precipitating factors
- NPO - IV until return of bowel func - Foley - Severe = NG Tube - Surgery - PROPAQ - ABD PROTOCOL |
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Adynamic Ilieus
Comp |
- Dehydration
- Electrolyte imbalance - Bowel Obstruction |
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Adynamic Ileus
D/Dx |
- Mech Obstruction
- APPY/Pancreatitis/GASTRO |
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Adynamic Ileus
Dispo |
- Retain uncomplicated
- MEDEVAC - UMO Inport |
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Gastric Carcinoma
S/Sx |
- Asymptomatic
- Epigastric Pain/Early Satiety - Heart Burn/N/V/ DA/ post meal vomit - unexplained weight loss w/ decline in health - hematemesis - Melena - palpable abd mass - Metastasis |
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Gastric Carcinoma
Tx |
- Symptoms
- Surgery |
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Gastric Carcinoma
Comp |
- Metastasis
- Hemorrhage - Death |
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Gastric Carcinoma
D/Dx |
- Benign Gastric Ulcer
- Crohn's - Ulcerative Colitis |
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Gastric Carcinoma
Dispo |
MEDEVAC
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Colorectal Carcinoma
S/Sx |
- Insidious Onset
- Change in BM - Vague/Clicky ABD Pain - Weak/Fatigue/ Unexplained weight loss - Tenesmus/Hematochezia - Exam Normal - Metastasis - Positive guaiac |
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Colorectal Carcinoma
Tx |
- symtoms
- surgical |
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Colorectal Carcinoma
Comp |
- Hemorrhage
- Obstructions - Metastasis - Death |
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Colorectal Carcinoma
D/Dx |
- IBS/DIVER
- Inflamatory Bowel Disease |
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Colorectal Carcinoma
Dispo |
MEDEVAC
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Portal HTN
S/Sx |
- Hematemesis
- GI Hemorrhage - W/Fatigue/Weight loss - DA/ABD Pain, Vitamin Deficiencies - Jaundice - Hepatomegaly - Ascites - Varices - spider viens |
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Portal HTN
TX |
- Symptoms
- DC ETOH - Control GI Hemorrhage - Viramins - No tylenol |
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Portal HTN
Comp |
- GI Bleed
- Hepatic Encephalopathy - Liver Failure - Death |
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Portal HTN
D/Dx |
- Cirrhosis
- Hepatitis - Esophageal Varices - CHF |
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Portal HTN
DISPO |
- MEDEVAC
- Refer to ETOH tx |
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Alcoholic Hep
S/Sx |
- Period of heavy drinking
- N/DA/F - ABD Pain/TTP - Hepatomegaly - Splenomegaly - Juandice - Ascities - Encephalopathy - Delirium tremens |
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Alcoholic Hep
Tx |
- DC ETOH
- High Carb/ Calorie Diet - Increase Fluids - Vitamins - Avoid Tylenol |
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Alcoholic Hep
Comp |
- Liver Failure
- GI Bleed - Delirium Tremens - Hepatic Encephalopathy - Portal Hypertension |
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Alcoholic Hep
D/Dx |
- Cholecystitis
- Pancreatitis |
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Alcoholic Hep
Dispo |
- MEDEVAC
- ETOH Counseling/TX |
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Cirrhosis
S/Sx |
- Weakness/Fatigue/Weight loss
- DA/N/V/F - ABD PAIN - Impotence, Painful enlarged breast - Pruritus , Hepatomegaly, Hematemesis, Jaundice, Ascities, Splenomegaly, Hepatic Encephalopathy - GI Bleed, Esophageal/ Rectal Varices, Muscle wasting, Testicular atrophy |
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Cirrhosis
Tx |
- D/C ETOH
- High Calorie Nutritious Diet - Vitamins - Symptoms |
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Cirrhosis
Comp |
- Portal HTN
- GI Hemorrhage - Hepatic Encephalopathy - Liver Failure - Death |
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Cirrhosis
D/Dx |
- Hepatitis
- CHF - Cancer - Portal HTN |
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Cirrhosis
Dispo |
- MEDEVAC
- SUB DISQUAL |
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PUD
s/sx |
-Gnawing, dull, aching, hunger like pain
- Pain fluctuates throughout day/night - periods lasting several weeks/months/years - NOCTERNAL Pain - Relief w/ Antacids - N/DA - Hematemesis - Normal exam - Mild epegastric tenderness - TILT Positive |
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PUD
Tx |
- D/C Aggravating substances
- Pepto Bismol - Ranitidine - AD PROTOCOL |
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PUD
COMP |
- GI Hemorrhage
- Ulcer Perf - Ulcer Pen - Gastric outlet obstruction - Resistant to cure |
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PUD
D/Dx |
- Angina Pectoris
- MI - GERD - Pancreatitis - Cholecystitis |
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PUD
Dispo |
- Retain onboard
- Refer to UMO/6000 |
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Esophageal Varices
S/Sx |
- Spontaneous Vomit of BRB/Coffee ground material
- Hematochezia/Melena - W/Fatigue - Hypovolemia - Hepato/Splenomegaly - Jaundice - Ascities |
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Esophageal Varices
Tx |
- Stop Bleed
- NPO - NG Tube - Room temp Gastric lavage until clear - IV x2 (NS) - Monitoring I&O - PROPAQ |
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Esophageal Varices
Comp |
- Severe Hemorrhage
- Rapid death |
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Esophageal Varices
D/Dx |
PUD/MWS/Erosive Gastritis/Cancer
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Esophageal Varices
Dispo |
MEDEVAC
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Gastritis
S/Sx |
- N/V/DA
- Epigastric Pain - Mild Ulcer like symptoms - Bloating and early satiety - UPPER GI BLEED - Epigastric ABD Tenderness - Hypovolemia - Occult Blood |
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Gastritis
Tx |
- Treat underlying causes
- Remove Mucosal Irritants - NPO - Force PO Fluids/IV - Pepto Bismol - NG TUBE |
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Gastritis
Comp |
- Dehydration
- GI Bleed |
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Gastritis
D/Dx |
- PUD/GERD/MWS
- Cancer/Gastroenteritis |
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Gastritis
Dispo |
- Retain if uncomplicated
- Refer to UMO |
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MWS
S/Sx |
- Hematemesis w/ or w/o Melena
- Epigastric - Hx of forcefull Vomit/Retching/Straining - Occult Blood - Hypovolemia |
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MWS
Tx |
- Symptoms
- Stop Vomit/Retching/Straining - IV/I&O/ - PROPAQ |
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MWS
Comp |
- Hemorrhage
- Hypovolemia |
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MWS
D/Dx |
- PUD
- Erosive Gastritis - Esophageal Varices |
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MWS
Dispo |
- Retain onbard
- MEDEVAC Comp - Refer to UMO |
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Fecal Impaction
S/sx |
- N/V/DA/D
- ABD Pain - Rectal pain, Straining at stool - Repeated but futile attempts to poop - Distended ABD - Palpable Masses in ABD - Firm feces upon DRE |
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Fecal Impaction
Tx |
- Warm oil retention Enema followed by fleets enema
- If unsuccessful, digital removal - Rx citrucel and increase H2O |
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Fecal Impaction
Comp |
- Partial or complete obstructions
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Fecal Impaction
D/Dx |
Bowel Obstruction
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Fecal Impaction
Dispo |
- Retain if Tx is successful.
- MEDEVAC if unable to remove |
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IBS
S/Sx |
- MUST BE PRESENT FOR 3-6 Months
- N/V/DA/CON/D - Intermittent Crampy Lower ABD pain - Recent Hx to Stress - Lower ABD TTP - Increased/Decreased BS |
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IBS
Tx |
- Diet Mod
- Increase Dietary Fiber - Avoid Dairy and aggravating foods - Adequate Sleep/Meals/Exercise - D/C / reduce ETOH/TOB - Reassurance & Education about IBS - Symptomatic Tx |
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IBS
Comp |
- Hypovolemia
- Severe Anxiety/Depression |
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IBS
D/Dx |
- Parasitic Infection
- Crohn's - Psychiatric Disorders - Cancer - Organic Bowel Disease |
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IBS
Dispo |
- retain
- Refer to UMO |
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Hiatal Hernia
S/Sx |
- Retrosternal/epigastric chest pain
- Heartburn - Regurg - Dysphagia - Normal Exam Hematemesis, melena and occult blood |
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Hiatal Hernia
Tx |
- Pepto Bismal
- Ranitidine - Evevate head off bed 6" - Decrease meal size refrain from eating 2-3hrs prior to sleep - Weight reduction and wear loose clothes - Avoid aggravating foods/drink |
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Hiatal Hernia
Comp |
- Hemorrhage
- Esophagitis - Esophageal Ulcer/stricture |
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Hiatal Hernia
D/Dx |
- Angina Pectoris
- MI - PUD - Esophagitis |
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Hiatal Hernia
Dispo |
- Retain On board
- Refer to UMO |
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ABD Protocol
|
- Hx
- Physical Exam - Lab (UA/CBC) - MedAdvice - IV Fluid - I&O - Pain (Keterolac/Hydrocodone/Morphine) - Nausea (Promethazine) - Antibiotics (U F G) - MEDEVAC/MEDADVICE - Transfer to MTF |
