GI/GU
Scenario:
You arrive for a 22-year-old patient complaining of abdominal pain. She points to the right lower quadrant and says the pain started near her belly button several hours ago before moving to its current location. She has nausea and a low-grade fever.
Question:
What condition should you consider?
What is appendicitis?
Scenario:
You find a diabetic patient who is shaky, sweaty, hungry, and confused. His wife says he took his insulin but hasn't eaten since breakfast.
Question:
What condition should you suspect?
What is hypoglycemia?
Scenario:
A 17-year-old develops an itchy rash and hives after eating something new. She is breathing normally, has no facial swelling, and has normal vital signs.
Question:
What type of reaction does this presentation suggest?
What is an allergic reaction?
Scenario:
A patient with severe anemia complains of weakness, fatigue, and shortness of breath with exertion.
Question:
Which blood component is primarily responsible for transporting oxygen?
What are red blood cells?
Scenario:
A 58-year-old patient reports vomiting several times. You notice approximately 500 mL of dark, coffee-ground material in the emesis basin. The patient is pale and weak.
Question:
What should this finding make you suspect?
What is an upper GI bleed?
EMT Priority:
Assess for shock, protect the airway, provide appropriate supportive care, and prioritize transport.
Scenario:
A 19-year-old diabetic is confused and sweating heavily. He is able to follow simple commands and can swallow normally. His blood glucose is 48 mg/dL.
Question:
What treatment may be appropriate for an EMT?
What is oral glucose, assuming local protocol permits it and the patient can safely swallow?
Critical consideration:
What must you determine before giving oral glucose?
Answer:
Whether the patient can protect their airway and swallow safely.
Scenario:
A patient was stung by a bee 10 minutes ago. Initially, he developed hives. Now he reports:
Question:
What condition should you now suspect?
What is anaphylaxis?
Scenario:
A 46-year-old patient complains of severe epigastric abdominal pain that began several hours ago. The pain radiates toward the back. The patient is nauseated and has vomited several times.
Question:
Which condition should be included in your differential?
What is pancreatitis?
Scenario:
You respond to a 28-year-old patient with diabetes. The patient has:
Question:
What condition should you suspect?
What is diabetic ketoacidosis (DKA)?
Scenario:
A patient develops severe respiratory distress and hypotension after eating peanuts. The patient has an epinephrine auto-injector prescribed for previous allergic reactions.
Question:
What medication should be considered first-line treatment for life-threatening anaphylaxis?
What is epinephrine?
Scenario:
A 24-year-old patient with sickle cell disease complains of severe pain in his back, chest, and extremities. He says this feels similar to previous pain crises.
Question:
What condition should you consider, and what is an important EMT treatment priority?
What is a sickle cell pain crisis, with appropriate supportive care, assessment for complications, and transport?
Scenario:
You are called for a 72-year-old patient with abdominal pain and vomiting. His abdomen is visibly distended. He reports that he has not had a bowel movement or passed gas for two days.
He is becoming increasingly weak and tachycardic.
Question:
What condition should you suspect, and what complication are you particularly concerned about?
What is a bowel obstruction, with concern for dehydration/shock and possible deterioration?
Scenario:
You are called to two patients.
Patient A:
Patient B:
Question:
Which patient is more consistent with hypoglycemia?
What is Patient A?
Scenario:
You arrive at a restaurant for a 35-year-old patient who ate shrimp approximately 15 minutes ago.
You find:
Question:
What is your highest treatment priority?
What is administering epinephrine according to protocol while managing the airway and breathing?
Scenario:
You arrive at a home and find a 63-year-old patient sitting on the bathroom floor. His wife reports that he vomited a large amount of bright-red blood.
Assessment reveals:
Question:
What is your highest priority?
What is recognizing hemorrhagic shock, managing airway/breathing as needed, providing supportive care, and initiating rapid transport?
NREMT Teaching Point:
Don't get stuck trying to determine the exact GI diagnosis. Shock is the immediate life threat.
Scenario:
You arrive to find a diabetic patient lying unconscious on the couch. His family tells you, "His sugar must be low. Give him some juice!"
The patient does not respond to verbal commands and has an inadequate airway-protection response.
Question:
Should you give the patient oral glucose or juice?
What is no?
Why?
Scenario:
A patient develops sudden severe respiratory distress and hypotension shortly after receiving a medication. The patient has no hives or visible skin changes.
A student says, "It can't be anaphylaxis because there aren't any hives."
Question:
Is the student correct?
What is no?
Why?
Scenario:
A patient with sickle cell disease initially complains of severe pain. During your assessment, he develops:
Question:
Why should this patient's condition immediately concern you?
What is possible acute chest syndrome/serious respiratory compromise?
Scenario:
You respond to a 31-year-old patient at a picnic.
The patient's friend states that approximately 10 minutes ago, the patient ate a cookie containing peanuts.
Your assessment:
The patient says:
"I can't breathe."
❓ Question:
What is the most appropriate immediate intervention?
What is epinephrine administered IM according to protocol, while simultaneously addressing airway and breathing and arranging rapid transport?