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"Shorts" | From PreHospital Medicine Principles, Pearls & Pitfalls
What is meant by the acute Abdomen?
This is a term used by surgeons and emergency physicians to describe abdominal conditions that require surgical exploration. Most disease processes result from infection, obstruction, ischemia, or perforation. Examples of such conditions include an infected or perforated appendix, perforated gastric or duodenal ulcer, strangulated bowel, ruptured intraperitoneal abscess, ruptured spleen or liver, and ruptured ectopic pregnancy. A patient with an acute abdomen typically has a rigid-board-hard abdominal wall or rebound tenderness upon examination and prefers to lie still with minimal movement. He or she may complain about the bumps in the road during the car or ambulance ride to the hospital.
¿Qué se entiende por Abdomen agudo?
Es un término utilizado por cirujanos y médicos de urgencias para describir las afecciones abdominales que requieren exploración quirúrgica. La mayoría de los procesos patológicos son consecuencia de una infección, obstrucción, isquemia o perforación. Ejemplos de estas afecciones son el apéndice infectado o perforado, la úlcera gástrica o duodenal perforada, el intestino estrangulado, la rotura de un absceso intraperitoneal, la rotura del bazo o el hígado y la rotura de un embarazo ectópico. Un paciente con un abdomen agudo suele presentar una pared abdominal rígida o dura o sensibilidad de rebote a la exploración y prefiere permanecer inmóvil con un movimiento mínimo. Es posible que se queje de los baches de la carretera durante el trayecto en coche o en ambulancia hasta el hospital.
ما المقصود بالبطن الحاد؟
هذا مصطلح يستخدمه الجراحون وأطباء الطوارئ لوصف حالات البطن التي تتطلب استكشافا جراحيا. تنتج معظم عمليات المرض عن العدوى أو الانسداد أو نقص التروية أو الانثقاب. ومن الأمثلة على هذه الحالات الزائدة الدودية المصابة أو المثقوبة ، وقرحة المعدة أو الاثني عشر المثقوبة ، والأمعاء المختنقة ، وتمزق الخراج داخل الصفاق ، وتمزق الطحال أو الكبد ، وتمزق الحمل خارج الرحم. عادة ما يكون لدى المريض المصاب ببطن حاد جدار بطن صلب أو حنان ارتدادي عند الفحص ويفضل الاستلقاء بأقل قدر من الحركة. قد يشتكي من المطبات في الطريق أثناء ركوب السيارة أو سيارة الإسعاف إلى المستشفى.
What does colicky pain mean, and what causes it?
Patients with obstructing gallstones or renal stones may present with colicky pain, meaning that the pain comes and goes and increases and decreases in intensity. They have an acute onset of abdominal pain in the upper quadrants and flanks. Patients tend to writhe about, appearing restless in their attempts to find comfortable positions.
O que significa dor em cólica e o que a causa?
Os pacientes com cálculos biliares obstrutivos ou cálculos renais podem apresentar dor em cólica, o que significa que a dor vai e vem e aumenta e diminui de intensidade. Eles têm um início agudo de dor abdominal nos quadrantes superiores e nos flancos. Os pacientes tendem a se contorcer, parecendo inquietos em suas tentativas de encontrar posições confortáveis.
What is meant by Peritoneal Signs?
Peritoneal signs or signs of peritoneal inflammation are valuable findings during the physical exam. They are caused by a primary insult inside the abdomen, causing the inner peritoneal lining to become inflamed and provide a consistent constellation of signs that can be used to evaluate and triage a sick patient on presentation. These signs include rebound tenderness (pain that is severe with releasing pressure from the patient’s abdomen), abdominal wall rigidity when palpated, pain with coughing, movement of the patient’s stretcher or tapping the patient’s heel, pain with flexion and extension of the hip or changes in a sitting position. Peritoneal signs and peritonitis usually require urgent surgical evaluation and operative exploration.
Articles | IPHMI Literature Review
Ketamine vs. Morphine for Prehospital Pain Management in Trauma
Objective: Assess the efficacy and safety of ketamine compared to morphine for out-of-hospital pain management in trauma patients.
Methods: Prospective, multicenter, randomized, single-blind trial conducted in 11 French emergency medical services (EMS) centers. Adult patients (n=251) with acute traumatic pain (verbal numeric rating scale ≥5) were randomized to ketamine (20 mg initial dose, followed by 10 mg increments) or morphine (2-3 mg every 5 minutes). The primary outcome was pain score change at 30 minutes.
Results: Both ketamine and morphine were non-inferior in pain reduction at 30 minutes. Adverse events occurred in 41% and 17% of patients receiving ketamine and morphine, respectively. Emergence phenomena were most common in the ketamine group, while nausea was most frequent in the morphine group.
Limitations: Physician presence on EMS teams, small initial morphine doses, single-blind design, limited follow-up, and inability to assess superiority for secondary endpoints.
Conclusion: Ketamine demonstrates similar pain relief to morphine in out-of-hospital trauma management, with a higher rate of minor adverse events. Ketamine may be a viable option for opioid-sparing pain control in this setting.
Ketamina frente a morfina para el tratamiento prehospitalario del dolor en traumatismos
Objetivo: Evaluar la eficacia y seguridad de la ketamina comparada con la morfina para el tratamiento del dolor extrahospitalario en pacientes traumatizados.
Métodos: Ensayo prospectivo, multicéntrico, aleatorizado, simple ciego realizado en 11 centros franceses de servicios médicos de urgencias (SEM). Pacientes adultos (n=251) con dolor traumático agudo (escala de valoración numérica verbal ≥5) fueron aleatorizados a ketamina (dosis inicial de 20 mg, seguida de incrementos de 10 mg) o morfina (2-3 mg cada 5 minutos). El resultado primario fue el cambio en la puntuación del dolor a los 30 minutos.
Resultados: Tanto la ketamina como la morfina fueron no inferiores en la reducción del dolor a los 30 minutos. Se produjeron efectos adversos en el 41% y el 17% de los pacientes que recibieron ketamina y morfina, respectivamente. Los fenómenos emergentes fueron más frecuentes en el grupo de ketamina, mientras que las náuseas lo fueron en el grupo de morfina.
Limitaciones: Presencia de médicos en los equipos de SEM, pequeñas dosis iniciales de morfina, diseño simple ciego, seguimiento limitado e incapacidad para evaluar la superioridad de los criterios de valoración secundarios.
Conclusiones: La ketamina demuestra un alivio del dolor similar al de la morfina en el tratamiento del traumatismo extrahospitalario, con una mayor tasa de eventos adversos menores. La ketamina puede ser una opción viable para el control del dolor con ahorro de opiáceos en este contexto.</voice>
Abdominal Pain, here are some Pearls and Pitfalls to keep in mind.
- Acute onset of abdominal and back pain in association with hypotension in a patient over the age of 50 years is a ruptured aortic aneurysm until proven otherwise.
- Acute onset of abdominal pain and hypotension in a female of child-bearing age is a ruptured ectopic pregnancy until proven otherwise.
- Epigastric pain can result from abdominal or cardiac causes.
- Withholding analgesics until a surgeon evaluates the patient is an outdated concept.
- ln a patient who appears stable and not critically injured or actively succumbing to their illness, take an extra few seconds to gather a history about their pain.
Defibrillation Strategies for Refractory Ventricular Fibrillation
A recent study evaluated the effectiveness of double sequential external defibrillation (DSED) and vector-change (VC) defibrillation compared to standard defibrillation in treating refractory ventricular fibrillation (VF) during out-of-hospital cardiac arrest.
The study found that both DSED and VC significantly improved survival rates and neurological outcomes compared to standard defibrillation. While DSED demonstrated slightly better results, the need for two defibrillators might limit its widespread adoption. VC defibrillation, requiring only one defibrillator, could be a more practical alternative.
However, the study was limited by early termination due to the COVID-19 pandemic and a relatively small sample size. Further research is needed to confirm these findings and explore the optimal implementation of these techniques in EMS systems.
Listen to the 4-minute discussion above.