You are working as part of a double Paramedic crew on an Ambulance when you have a call for a 27-year-old female who is complaining of abdominal pain and a reduced level of consciousness. The call is 15 minutes away and you start blue lighting to scene.
On arrival you are met by the patients’ partner who is very concerned. He advises that his partner has been in pain for the last 12-hours but she wouldn’t go to be seen. She’s now collapsed on the kitchen floor and is crying. As you walk into the kitchen, the patient is sat up on the floor. They look visibly in a lot of pain, have a pale and clammy complexion, and are sobbing to themselves. They are complaining of severe, sharp pain in the hypogastric and pelvic region.
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You start assessing the patient while getting a history of the events. Working through the primary survey, you clear catastrophic haemorrhage, airway, and breathing. On circulation, you note a fast and thready radial pulse, with an obvious paleness and clamminess to the skin. You get the patient to lay down and raise their legs. You colleague completes a blood pressure and it comes back as 82/40. Your colleague cannulates the patient and looks to give a Sodium Chloride bolus to help with the circulation. What initial bolus is indicated for a general medical condition without haemorrhage
As your colleague sets up fluids, you do a quick ECG review but apart from tachycardia at a rate of 109 bpm, there are no other deficits. You quickly review disabilities, and other than her being in an anxious and distressed state, there are no other abnormalities. Through questioning, the history you have is; 12-hours ago, the patient developed a stabbing like pain in the hypogastric and pelvic area, the pain has continued to get worse, where she could no longer take it and collapsed in the kitchen. There was no loss of consciousness, no other past medical history, no allergies, and is not taking any medications. Your colleague has completed some observations and they are as follows; RR 24, HR 111, SPO2 95% on air, Temp 36.9°C, BP 84/41, 15 GCS, Pupils PERRLA. What NEWS score does this give the patient
The patient is visibly in a lot of pain, in this scenario and with the information gained so far, what pain management can you consider
Your colleague begins to manage pain relief as you ask the patient for consent to examine her abdomen, which she consents. You expose the abdomen and quickly examine. Which four examinations are commonly done for an abdominal examination
On assessing the abdomen; inspection shows tensing of the abdominal muscles with pain, auscultation shows normal bowel sounds, palpation causes an increase in pain in the hypogastric/pelvic area, percussion sounds normal. You note on palpation the patient also complained it was causing a pain in her shoulder tip. What can shoulder tip pain indicate when associated with abdominal pain
You further question the patient for more details on her health and history. For a female patient of child bearing age, what specifically should you further consider
You discuss with the patient whether she may be pregnant and if she has had any further health issues. She explains they have been trying for a baby recently and that she could be pregnant. She missed her last period 2 weeks ago and was talking to her partner about doing a pregnancy test soon. Given all of the information from this scenario, what is the likely cause of the pain and symptoms
You explain to the patient what you think is happening and that you will be transporting her quickly to hospital. Your colleague goes to get the stretcher while you do repeat observations. The patient is still in a lot of pain and struggling to get up off the floor, the fluids have not really affected the blood pressure with it still reading 83/41. Given your suspected diagnosis, can Entonox be given for the abdominal pain in this case
You give the patient some Entonox and this helps take a further edge off the pain. Your colleague brings in the stretcher and you assist the patient on. You get the patient onto the ambulance where the first 250 ml of Sodium Chloride has finished. You note that she seems paler than in the house and do another rapid primary survey and observations. The blood pressure has dropped to 78/39, she still is remaining conscious on the stretcher, although says she feels tired and dizzy. Can further 250 ml boluses be given
You start a second bolus of fluids and start to make your way to hospital. Given the complaint, condition, and state of the patient, you will