Acute Abdomen Overview

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Questions and Answers

What is the typical duration of chest pain associated with acute coronary syndrome (ACS)?

15 minutes to 30 minutes

Usually lasts longer than 15 minutes (correct)

Less than 5 minutes

More than 1 hour

Which symptom is most commonly associated with atypical presentations of ACS in women?

Abdominal pain (correct)

Unexplained weight loss

Classic chest pain

Intense sweating

What is the appropriate oxygen saturation target for patients with known or suspected COPD during ACS treatment?

At least 90%

Exactly 92%

Between 88% and 92% (correct)

Above 94%

Which of the following is a key component of the MONA acronym in pre-hospital management of ACS?

Nitrates Signup and view all the answers

What medication provides analgesia and may help reduce myocardial oxygen demand in ACS management?

Morphine Signup and view all the answers

What is an indication for administering nitrates during ACS treatment?

If chest pain persists and blood pressure is >90 mmHg systolic Signup and view all the answers

In older patients, which symptoms are commonly misinterpreted as signs of ACS?

Confusion, weakness, or fatigue Signup and view all the answers

What should be the maximum repeated dose of morphine administered for pain relief in ACS?

20 mg Signup and view all the answers

What complication can occur due to a volvulus of the intestine?

Bowel ischaemia Signup and view all the answers

Which condition is characterized by inflammation of the peritoneum?

Peritonitis Signup and view all the answers

What symptom is commonly associated with lower lobe pneumonia?

Coughing with chest pain Signup and view all the answers

What causes pain during Mittelschmerz?

Ovulation Signup and view all the answers

Which of the following is NOT a common symptom of an acute bowel obstruction?

Severe headache Signup and view all the answers

What condition involves the ovary twisting around its supporting ligaments?

Ovarian torsion Signup and view all the answers

What urgent medical intervention may be required for ovarian torsion?

Emergency surgery Signup and view all the answers

Which condition can cause sudden severe pain due to blocked blood vessels?

Sickle cell crisis Signup and view all the answers

What is the primary function of toxicology?

To detect and treat poisons Signup and view all the answers

Which poison disrupts cellular respiration?

Cyanide Signup and view all the answers

What is a common effect of heavy metals like lead and mercury?

Liver or kidney damage Signup and view all the answers

Which of the following substances is classified as a corrosive agent?

Bleach Signup and view all the answers

What is the ABCDE approach used for in clinical examination?

Evaluating severity of poisoning Signup and view all the answers

Which demographic is most frequently seen in cases of unintentional poisoning?

Children under five Signup and view all the answers

What constitutes a body packer in the context of poisoning?

A drug smuggler hiding drugs in the body Signup and view all the answers

Which of the following is true about deliberate poisoning?

It accounts for about one-third of acute poisoning cases. Signup and view all the answers

What is a potential consequence of oesophageal intubation during a procedure?

Urgent removal or confirmation of cardiac arrest Signup and view all the answers

Which indicator suggests proper placement of an ET tube?

Normal capnogram readings Signup and view all the answers

What is a common cause of higher than expected CO₂ levels?

Increased CO₂ production Signup and view all the answers

Which condition is likely to result in reduced CO₂ excretion?

COPD Signup and view all the answers

What effect does hyperventilation have on CO₂ levels?

Excessive CO₂ removal Signup and view all the answers

What immediate action should be taken if there is a total absence of ETCO₂?

Consider equipment failure for troubleshooting Signup and view all the answers

What is the primary function of the Easi-Cap CO₂ device?

Color change in presence of CO₂ Signup and view all the answers

Which device is capable of displaying a graph for continuous CO₂ measurements?

EMMA device Signup and view all the answers

What is a primary indicator that mass poisoning may be occurring?

Two or more casualties with similar symptoms Signup and view all the answers

Which of the following is NOT a potential source of mass poisoning?

Mild allergic reactions to food Signup and view all the answers

Which symptoms are commonly associated with early signs of poisoning?

Nausea, headache, and confusion Signup and view all the answers

What should you do if you suspect a hazardous area during a potential mass poisoning incident?

Call emergency services for assistance Signup and view all the answers

Which of the following is a characteristic of organic chemical manufacturing accidents?

Often involve explosions or leaks at production sites Signup and view all the answers

What is the main purpose of Hazardous Area Response Teams (HART)?

To handle hazardous materials incidents Signup and view all the answers

What is a common misconception about symptoms of mass poisoning?

They always include severe symptoms immediately Signup and view all the answers

What response measure should be taken if an area is suspected to be contaminated?

Do not put yourself at risk and avoid entering the area Signup and view all the answers

Study Notes

Acute Abdomen

Pain out of proportion to clinical signs is common in older patients
Peritonitis is inflammation of the peritoneum, the thin layer of tissue that lines the inside of the abdomen and covers abdominal organs
Peritonitis is caused by infection, injury, or bacteria
Peritonitis can be caused by free bowel contents, acid, or blood
Acute bowel obstruction is a sudden blockage of the intestines that prevents the normal passage of food fluids and gas through the digestive tract
Symptoms of acute bowel obstruction include pain, total constipation (including flatus), vomiting, and a distended abdomen
Volvulus is when a loop of the intestine twists around itself, causing a blockage and cutting off blood supply
Volvulus can lead to bowel ischemia
Ovarian torsion is when the ovary twists around the ligaments that support it, cutting off its blood supply
Ovarian torsion symptoms include sudden severe pelvic pain, nausea, vomiting, and possible abdominal tenderness that requires emergency surgical intervention
Mittelschmerz is pain due to ovulation
Mittelschmerz is a benign preovulatory lower abdominal pain that occurs midcycle and can affect women
Lower lobe pneumonia targets the lower part of the lungs
Lower lobe pneumonia symptoms include cough, fever, shortness of breath, chest pain, and crackles heard in the lower lungs
Sickle cell crisis is a painful episode in patients with sickle cell disease due to blockage of blood vessels by abnormally shaped red blood cells, resulting in sudden severe pain, fever, swelling, and breathing difficulty
Testicular torsion is a twisting of the spermatic cord, which supplies blood to the testicle, resulting in severe pain, swelling, and redness
Hypercalcemia is abnormally high calcium levels in the blood and can cause abdominal pain, nausea, vomiting, constipation, confusion, fatigue, and frequent urination

Acute Coronary Syndrome (ACS)

ACS is a group of conditions that occur when the blood flow to the heart is blocked
Most common symptoms are pressure, squeezing, tightness, or a burning sensation in the chest
ACS pain is typically located in the chest and can radiate to the arms, back, neck, jaw, or epigastric area
ACS pain typically lasts longer than 15 minutes and may be persistent or intermittent
Other symptoms of ACS include nausea, vomiting, excessive sweating, shortness of breath, palpitations, or irregular heartbeats
Hemodynamic instability is a possible sign of ACS and may include hypotension, tachycardia, or altered mental status

Atypical Presentations of ACS

Women are more likely to report atypical symptoms such as fatigue, shortness of breath, nausea, and abdominal pain
Diabetics may experience silent ischemia or atypical symptoms due to neuropathy
Older patients often present with vague symptoms like confusion, weakness, or fatigue

Pre-Hospital Management of Acute Coronary Syndrome (ACS): MONA

MONA is an acronym that represents the key components of pre-hospital management for patients experiencing acute coronary syndrome (ACS)
Morphine: Administer 2.5–10 mg IV, every 5-15 minutes, to a maximum 20 mg
Oxygen: Titrate oxygen to maintain SaO2 > 94%, administer supplemental oxygen if SaO2 is below 94%, patients with known or suspected COPD should aim for an SaO2 of 88-92% to avoid hypercapnic respiratory failure
Nitrates (Glyceryl Tri-Nitrate, GTN): Available as a spray or tablet, repeat every 5–10 minutes if chest pain persists and blood pressure is >90 mmHg systolic, do not administer if the patient has low blood pressure
Antiplatelet Medication:

Endotracheal Intubation

A normal capnogram (measure of CO₂ levels in exhaled air) is the best indicator of proper ET tube placement
ET tube in the esophagus will show little to no CO₂ in the exhaled air
Higher Than Expected CO₂ Levels:
- Hypoventilation: Reduced respiratory rate leads to CO₂ accumulation in the body
- Increased CO₂ Production: Conditions that elevate metabolic activity such as fever or sepsis
- Reduced CO₂ Excretion: Conditions that impair ventilation such as COPD
- Medications: Administration of sodium bicarbonate can increase blood CO₂ levels
Lower Than Expected CO₂ Levels:
- Hyperventilation: Increased respiratory rate causes CO₂ removal
- Reduced Cellular Respiration: Evaluate if the heart is functioning normally and if oxygen is adequately delivered to tissues
- Cardiac Arrest: Poor quality CPR can impact CO₂ levels
Total Absence of ETCO₂ should be addressed urgently and may indicate:
- Misplaced endotracheal tube in intubated patients.
- Possible equipment failure.

Poisoning

A poison is any substance that interferes with normal bodily functions after it is swallowed, inhaled, injected, or absorbed
Toxicology is the branch of medicine that deals with the detection and treatment of poisons

Types of Poisons and Their Effects

Metabolic Interference:
Example: Cyanide
Effect: Disrupts cellular respiration.
Organ Damage:
Examples: Heavy metals (e.g., lead, mercury) and paracetamol.
Effect: Can lead to liver or kidney damage.
CNS Depression:
Examples: Diazepam, heroin.
Effect: May cause coma and respiratory/circulatory failure.
Respiratory and Circulatory Impact:
Example: Carbon monoxide.
Effect: Affects oxygen transport and can lead to hypoxia.
Corrosive Agents:
Examples: Bleach, acids.
Effect: Cause tissue damage on contact.

Diagnostic Approach and Management of Poisoning

Clinical Examination: Use the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) along with a glucose check to assess the severity of poisoning
Toxidromes: Many poisons produce distinct symptoms (toxidromes), which assist in identification.

Management

Supportive Treatment: Most treatments are supportive, including intensive care settings
Specific Antidotes: Some poisons have specific antidotes (e.g., naloxone for opioid overdose).

Classification of Poisoning

Unintentional or Accidental Poisoning:
- Most frequently seen in children under five.
- Common substances: tablets, household chemicals, and certain plants.
- Older Children and Adults: May accidentally ingest chemicals from bottles with unclear labeling.
Deliberative Poisoning:
- Accounts for one-third of all acute poisoning cases.

Mass Poisoning: Overview and Response

Definition: Mass poisoning refers to situations where multiple individuals are affected by a toxic substance, leading to a public health emergency.
Possible Sources of Mass Poisoning:
- Industrial Accidents:
  - Chemical Spills: Accidental releases of hazardous chemicals in factories or during transport can result in widespread exposure.
  - Chemical Manufacturing Plants: Explosions or leaks in facilities producing toxic substances can endanger nearby communities.
- Domestic Accidents:
  - Carbon Monoxide Poisoning: Often occurs due to faulty heating systems, poorly ventilated spaces, or the use of gas appliances. Symptoms can affect multiple household members.
- Terrorist Attacks:
  - Use of Nerve Agents: Intentional release of chemical weapons, such as sarin or VX, in public spaces can lead to mass casualties.
  - Biological or Chemical Warfare: Attackers may use toxins to incapacitate or kill large numbers of people.

Symptoms of Early Poisoning

May mimic common conditions such as anxiety or flu and include:
- Nausea
- Vomiting
- Headaches
- Dizziness
- Confusion
- Shortness of breath

Safety and Response Measures

Personal Safety:
- Do Not Put Yourself at Risk: Avoid entering areas suspected to be contaminated without proper protective equipment.
Call for Specialist Assistance:
- Hazardous Area Response Teams (HART): Trained teams equipped to handle hazardous materials incidents.
- Chemical, Biological, Radiological, and Nuclear (CBRN) Teams: Specialized units capable of identifying and responding to chemical or biological threats.
Emergency Response:
- Evacuation: If safe to do so, evacuate affected individuals to minimize further exposure.

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Description

This quiz covers essential concepts related to acute abdomen, including causes like peritonitis, bowel obstruction, volvulus, and ovarian torsion. It highlights symptoms and complications associated with these conditions, providing a concise overview for students. Enhance your understanding of acute abdominal emergencies with this informative quiz.