Rectal pain and diarrhea – Paramedic student places an IV en route


• Scene – assess

• En route – vitals, IV, Fluids, trendelenberg, CBG, TT


• Unknown


Elliot Williams, Paramedic Woodburn Ambulance


David Tauber, EMT Editorial Board

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


• IV placement
• Diarrhea

Differential Diagnosis

• Diarrhea

• Hypotension

• Dehydration

• GI bleed (upper vs. lower)

Patient Workup History

• Patient states – He can’t control his bowels and would like to be evaluated. He’s been having diarrhea today; no blood, just brown and runny.

Physical Exam

• Rectal pain, hypotension

• GCS – 15

• EKG – First degree AV block

Editor’s Notes

Three points around this student case to consider: 1) put chux (blue pads) in your IV start kit. Then if you are starting the IV on your lap it keeps your uniform from blood contamination. In the dirt it gives a clean starting field. In the house it keeps the furniture clean (which even if you save their life they will complain about messiness to the service chief). 2) The cleaning of the pts arm was at best poor. Use of only one cleaning pad, going back and forth over the same spot, palpating the cleaned area with exam gloves, and starting the IV lower than the that was actually the area cleaned. 3) awareness of a steroid in the med list and the possibility of causing fragile veins

~ David Tauber, Director of Paramedic Education, Yale New Haven Sponsored Hospital


• Gender: Male

• Age: 84 years

• Height: Not Available


• Temperature: 97.4 F/36.3 C

• Blood Pressure: 81/39

• Heart Rate: 70

• Respiratory Rate: 16

• Pulse Oximetry: 98%

Signs and Symptoms

Back pain; hip pain; diarrhea; rectal pain

History Medical

• PMH: COPD, HTN, asthma

• Allergies: None

• Dispatch info: Back and hip pain


• Lives alone his sister lives near by, and they check in with each other every day.


• ASA, vit D, lisinopril, Plavix, doxazosin, metoprolol, atorvastatin, spriva, albuterol.

Related videos