Das Fachmagazin für den Rettungsdienst
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Bauchschmerzen klingen banal, sind für den Rettungsdienst aber alles andere als einfach. Häufig gelingt es nur, eine Verdachtsdiagnose zu stellen. Entscheidend ist, die Transportpriorität festzulegen und die richtige Zielklinik auszuwählen.
„Where has Thomas gone on holiday then?“ Anton Moser, an older, experienced colleague, asks Claudia Gerold. „He's paragliding in South Tyrol. Totally nuts if you ask me, but he seems to like it.“ While they are talking about Thomas's hobby, they get the next emergency call. „Lupinenweg 8, Family Steinhoff, 32-year-old female patient with abdominal pain.“
Situation at the scene
The Steinhoff family live in a new housing estate on the outskirts of the town. The husband is already waiting on the street as they arrive. He explains that his wife has been complaining of abdominal pain since yesterday. The pain got worse throughout the day, and although it improved for a short time, it has now become unbearable. Claudia calms the husband down and hurries to the patient with Anton.
Relieving posture and hard abdomen
As soon as they enter the bedroom, they notice the relieving posture of the young woman. She is pale and is moaning with pain. While Claudia checks over her vital signs, Anton prepares some oxygen and an IV infusion. Mrs Steinhoff's pulse is palpable, but at 140 beats per minute is tachycardic. The patient is breathing quickly, but deeply enough. Even before they take the patient's history, Claudia asks her colleague to call for the emergency doctor.
Claudia quickly takes the patient's history. For orientation she uses the SAMPLER+S mnemonic. Although the questions about allergies, medication and previous conditions don't reveal anything, Claudia's ears prick up at the last point: „Mrs Steinhoff, is it possible that you could be pregnant?“ The patient replies that she takes the pill, but that her period is 5 weeks overdue. Because of the stress of moving into their new house, she just hadn't thought about it. Meanwhile the team have put in a large-bore IV line, and are administering the infusion quickly. The patient's blood pressure is a little low at 100/70 mmHg, but not unusual for a slim woman. „Anton, can you get everything ready for an urgent transfer to the hospital, please?“ asks Claudia, who looks very serious.
To better understand the symptoms, Claudia uses the OPQRST system. She asks specifically when the pain began (Onset), if anything makes the pain worse or better (Provocation / Palliation), what kind of pain it is – is it dull, stabbing or throbbing (Quality), if it moves (Radiation), how strong it is (Severity), and finally how the pain has developed over time (Time). The patient explains that the pain started in her lower abdomen, on the left. At the beginning it was more of a pulling pain, but then the pain suddenly increased and radiated to the back and upper abdomen. Just before the ambulance arrived the pain was devastating. Now it is more bearable but still very strong. On a scale from 1–10, the patient rates her pain at 7.
Suspected diagnosis and transfer to the hospital
Anton returns with the roll-in stretcher. „I think we are dealing with an ectopic pregnancy with a tubal rupture. Let's not waste any time, and let's get her transferred to the hospital quickly,“ says Claudia. Although everything goes very quickly, she still finds time to explain the suspected diagnosis in basic terms to the couple, and tries to reassure them. As they are loading the roll-in stretcher to the ambulance the emergency doctor arrives. Claudia describes the case. The doctor nods and during the journey to the hospital the patient is given sufficient pain relief. Additionally, Anton has informed the central clinic that they will be arriving at the intensive care unit soon.
Lesen Sie hier den gesamten Beitrag: Unklare Schmerzen im Bauch – Non-specific abdominal pain
Aus der Zeitschrift retten! 4/2015