Distended abdomen, shortness of breath


• Scene – history from nurse

• En route – vitals, IV attempt, EKG, TT

• Hospital – CT scan, lab work


• Response to treatment – unknown


Mark Shelton Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Abdominal distension

Differential Diagnosis

• Bowel obstruction

• Ascites

• Liver failure

• Congestive hear failure

• Malnutrition

• Neoplasm (malignancy)

• Hepatitis

Patient Workup History:

• Patient states – has had distention for 3 weeks, some pain for 1 week. Has had pedal edema in the past. Had hernia surgery 4 years ago and he thinks that the mesh is causing some of these problems with his stomach. He has had masses in his upper abdomen that migrated to lower abdomen.

• Caregiver states – the nurse practitioner stated that pt has elevated liver enzymes and needs a further work up at hospital.

Physical Exam

• GCS – 15

• EKG – possible junctional

• CGB – unk

• Physical findings – Distended ABD, HTN, pedal edema up into knee

Editor’s Notes

The paramedic does a great job of repeating the answers to some questions as the patient at times is difficult to understand. Ascertaining an accurate history, without leading questions, is a critical skill for clinicians.

-Dr. David Spiro

Suggested References


Hepatitis C



• Gender: Male

• Age: 60 years

• Height: Not Available


• Temperature: 98.5 F/36.9 C

• Blood Pressure: 156/84

• Heart Rate: 68

• Respiratory Rate: 16

• Pulse Oximetry: 99% RA

Signs and Symptoms

Distention of abdomen, positional SOB.

History Medical

• PHM: alcoholism, hep C, cirrhosis of liver, HTN, spinal stenosis.

• Allergies: some kind of a thyazide.

• Dispatch info: Abdomen enlarged.


• Lives in personal residence & uses public transportation.


• Senna, oxycodone, medicinal marijuana

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