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Just to add my 0.02. I don't think it is necessary for a woman to have an exam in the field under most circumstances. Obviously if she is giving birth then it might not be a bad idea to take a look. Heavy bleeding will be another reason, but should usually be obvious from the outside. In all other cases, you don't have the proper tools to do the proper exam, so why do it half assed? Does anyone carry a speculum on their ambulance? Has anyone been trained to do a bimanual exam? An exam by someone in the field will add very little (no, I do not mean that to put anyone down) to the pt's care. I would have to say in this case, keep the pt's dignity and let her go through the exam, only once, in the ER.

See, I told you it would be good for you... This is the crux of it here. Nailed it on the head, Dwayne. Except I think the monitor is more than a shiny toy, as I certainly can't distinguish between different kinds of cardiac without seeing a rhythm... (I over-generalize, but you get what I'm saying...) Ding ding ding! We have another winner here... this is an example of good in-depth thinking with regard to expose/not expose. And yikes on that psych call... any chick that can stab herself in the vajayjay and anus with an ice pick needs some serious help... Sometimes we all need a good smack. It's just the way it is. Myself included. Spenac, take heed here. You get so wrapped up in your own posts sometimes that you become *impossible* to actually debate with. Playing devil's advocate is all well and good until you get too lost in it and lose the actual purpose of your debate. And I prefer individuals playing devil's ad to clearly state so within a few posts. Spenac, I don't think you are playing devil's advocate here, I think you're consistently taking an over-exaggerated stance towards the exposure issue, and you always have. Hot damn, Matty, I didn't realize there had been 4 go-rounds with this... and that to me says it all. Want to inject some life into the forums? Don't troll. Part of why I've been absent from the City so long is because I've had better things to do. Seriously- I love the forums, I've learned INCREDIBLE amounts here, but I got sick of the bullshit. That last little bit with Ventmedic coming back as a sock puppet really disgusted me, as I used to respect her and look forward to reading what she had to say. When you're starting nursing school in January, working full-time, taking 14 credits, husband back at school full-time and trying to have a life in between SAR commitments and everything else mentioned above, playing with trolls drops pretty low on the list. I now read a lot of food and healthy living blogs- because there are excellent authors there with very little "ME ME ME!" ego going on. I can read a good, insightful blog about body image issues and nutritional status without getting pissed off and distracted from the million other things I *have* to be attending to, and it provides me with relaxation instead of irritation. Wendy CO EMT-B

Registration opens October 15. Come to lovely Dayton, OH and play. http://www.med.wright.edu/em/CAPLab/index.html 'zilla

I'm just like any other guy on the face of the planet. I like checking out the female form whenever possible. But there are times it's appropriate, and there are times that it's not (not even gonna address the ones that I'd wish I didn't have to see ). To expose a female patient just because she says "It hurts 'down there." isn't enough justification without exploring other avenues first; one of them being a detailed history that's as complete as possible. To expose a patient 'just because we can' ranks right up there with the same thinking process of "This is the way we've ALWAYS done it!". I WILL expose a female patient (with privacy concerns addressed as much as possible) IF there is enough evidence to support the action. Having been both the practitioner and the patient, I can see both sides of the situation here. There is a place and time for everything we do, regarless of the level of licensure we hold. Taking baseline vitals on scene, only helps the doctor decide if the patient is improving with what treatments we've adminstered or if the situation is still 'out of control'. It gives that doctor an idea of the condition of the patient when we 'found them'. I may not be able to do a great deal to mitigate the situation the patient is in, but that doesn't mean that taking baseline vitals and detailed assessments are a waste of time. As far as not posting as much as I used to, I'm taking 15 credit hours per quarter (which translates into around 30 credit hours per semester). I've been quite busy with schoolwork, and I've got some pretty 'heavy classes' to deal with.

Of course it was me that gave you the negative. Normally you're whining and whatever nonsense you spout in the chat room keeps others feeling sorry for you and prevents them from doing so. But why do you assume that I'm a jerk for giving you a negative? Why can't you, like an adult, assume that I thought that your arguments were shallow, one dimensional, self serving, cookbook Basic level medicine and simply not good educational material on the board? Isn't that what the votes are for? To show others my opinion of your thoughts, either exceptionally good, or exceptionally bad? You continue to espouse 'proper' exam. And I couldn't agree with you more. You simply go so far out into left field that your opinion loses my support. Wasn't it you, months back, that said that if we let a speeding car pass, or one drive through a yellow light without calling the police that we may have just allowed a kidnapper to escape with his victim and that we should be ashamed? That's what I'm talking about. Your thinking is so one dimensional. It's too shallow. You sound as if you're constantly doing scared medicine. "What will the ER complain about? What can I claim that I do that everyone with think is very unusual and heroic?" I'm hoping that I misunderstood you when you asked why we take blood pressures when it won't change my treatment as I can't raise or lower blood pressure? I can do both...did I misunderstand? If so, then I apologize, if not, then they should shred your medic ticket today, right now. I hope that you're a good provider, but I don't believe that you are, and I'll tell you why. You are too inflexible. You take the first thing that pokes itself in front of your nose and makes sense to you and you commit to it, fully unwilling to change your mind. The very best educational moments in my short career have come from exposing my own process to others, having them say, "But what about X?" At which point I often said, "Holy shit...I don't know how I missed that..I screwed the pooch on that one." Also, your skin is so thin as to be near transparent. No one simply disagrees with you because they don't respect your opinion. They "don't like you" or "have it out for you" or some other such nonsense. I've been watching for the shout out, if we still have them, saying something that resolves in, "Oh poor me, everyone is so mean!" Ive not known a provider, and I've known a few really good ones now, that are so easily offended, nor so quick to discount a valid opinion as simply mean spirited harassment. I've gone to the friggin' mat with Dust, ak, an many others here much smarter than myself and at times left feeling pretty good, at other times bloody and beaten, but still I count each here that has intellectually bashed my head in amongst some of my closest friends. When Wendy used to correct my grammar and spelling I wanted to choke the shit out of her! But I know present myself, though not as well as I'd like, much, much better than I did before she took me to task. (Watch, now she's going to shred this post...and I'll say thank you, though perhaps it will be hard to understand through my gritted teeth.) Do I like you? No idea. I've not given you enough thought to develop an opinion. Why do I care then if you give opinions that I disagree with? For two reasons. First, I believe that there is great power in strong debate. If I confront your best argument with my very best argument, perhaps we'll both leave with some wholly unexpected piece of knowledge that neither of us would have gleaned on our own. Secondly, and much more importantly, there are many, many young, and/or new providers here that come with the belief that we are here to help them, as well as learn from them. You are willing to take an argument that you believe Dustdevil would have made, only he was most often right, and present it simply to feed your ego, to have the young/new come to you and say, "My God! You are so brave!! I would never ask a woman to expose her vagina and use her hands to spread her labia! You're a rockstar!" You plant the seeds that will send them into the ER glowing only to have the ER physician say, "What were you thinking? Where did you go to school? Are you an idiot!?!" Do I believe that you would always employ those interventions? I don't. I believe that often you simply present them, and then swear by them, for effect. What is a proper exam? Initial impression, good sets of serial vitals, an in depth current/past history to include current medications whether compliant or not, an attempt to get a decent feel for my pts frame of mind, and depending on their chief complaint exposure up to the point that I believe it is necessary to support or retard my working diagnosis. SPO2, monitor, etc? Sure, if indicated, but they are mostly toys and I can't really think of a time that I couldn't guess what they were going to say before I read their fancy little screens. And as expected, you ignored my questions, which I'd presented carefully to make them relatively easy. Do you spread the cheeks of your 70 y/o hemorrhoid pt? Palpate? Do you expose your kidney stone pt that has radiating pain into her groin? Ask her to spread her labia for a peek inside just in case your working diagnosis is incorrect? I worked with a new medic that wanted to put 15L NRB on every pt that she believed needed O2. I suggested that she use more appropriate amounts when required. She said, "Why? It's not going to hurt them, and it's better too much than too little." I told her that in the vast majority of cases that she was right, the pt was not going to be hurt, but she was. That the people that view her treatments, or take transfer of care of her pts are going to expect her to know how to determine, and then use, appropriate interventions. She thought I was silly and is now little respected around her peers, and worse, her betters. That seems to be what you're suggesting here. I will expose the genitals and ask an already damaged pt to spread her labia so that I can best examine her whether or not my thorough exam reveals that this is a prudent step. A vagina is an amazing and wondrous thing, but I promise you this. No matter how macho you think you are, how many "babes you've bagged", nor how many books you've read or videos you've watched, you will never know more about the inner workings of that freaky little machine than it's owner. Peds and trauma excluded of course. Is it leaking icky stuff? Sure, and it smells nasty! I can't justify being down there under the guise of alerting the ER to this fact. Is it swollen? Yeppers! How come? Beats me, and I can't justify collecting that information under the guise of alerting the ER. Is she tachy, diaphoretic, appearing to be trying to smuggle a giant watermelon under her shirt while she screams "I think it's coming!!!" Ah, see, this might dictate not only a peek, but a good hard look. But my physical exam already told me what to expect before I dropped her drawers, right? I once exposed a rape victim and examined her genitals because she claimed that her attackers had stabbed her multiple times in the rectum and vagina with an ice pick. And the area was a mess. It was ugly, disturbing, but it turned out that she had inflicted the wounds herself. Did I need to expose her? I believe that I did, as I could see blood through her clothing at the vagina and rectum and believed that bleeding control might be necessary. Would I have exposed her if I hadn't seen blood? Absolutely, as she told me that she had been stabbed in that manner and I'd want to look for signs that she had compartmentalized bleeding or that it had perhaps been tamponaded (? Not sure that that is a proper word) in some way. I also checked femoral/pedal pulses, checked cap refill, and did a lower extremity neuro exam on the way to the ER (as well as prudent, associated interventions) in case there was hidden vascular/nerve damage. Those are things that I believe the ER might benefit from knowing at, or prior to my arrival. A lot of people here have tried to express their views of your opinions and you've narrowed it down to "everyone thinks I'm right except those that don't like me" again. You need to let that go brother. Many here, such as Wendy, Matty, Dust, akflightmedic, Kaisu, etc, etc, have told me that at times I'm an arrogant, ignorant asshole. And you know what? In each case I went back, reread the posts that caused them to draw those conclusions, and I can't think of a time that they were wrong. Despite my best efforts, sometimes I simply go off into the ditch. And I thank the powers that be that there are people here willing to say, "I know you think that you're right here, but you need to trust me when I tell you that you are thinking and behaving in a way that you wouldn't like if you could see it from the outside looking in." Step back from the self pity man. Stop making an argument simply because you believe you will look ignorant if you reverse your position once chosen. There is not a single person here that I respect that doesn't say, on a regular basis, "I don't know" or "ooops, I see your point." It won't kill you...trust me. Dwayne

Spenac, time for you to go back to the basics... It'd be a good idea for basics to sit a patient up that has a high blood pressure, and lay a patient down for low blood pressure. There, that was simple. -5 for a stupid question. If you don't know how a cat scan can change the treatment, then go get a book. -1, for simple ignorance. Spenac, this could be such a great topic, but, being such a poser, you sure can run it into the ground. The sad thing is, I agree with a lot of what you say, but you're merely an echo, IMO. You have also echoed yourself, multiple times. Please, let me reference everyone to these posts, by none other than Spenac. This fetish of your's about exposing patients is really starting to be an old tune... You first posted about this subject on 06 May 2007 Here is a link. On 21 Jan 2008, you brought up the subject again. Reading through, its not a bad thread at all. Its title is "Did You Look And Feel? Hands and eyes on?". But, after your last post on 7 April 2008, why, I guess you just love talking about exposure so much, you bumped it on 22 Oct 2008. If you would like the link, Click Here. Oh, I almost forgot ! -5 for not using the search feature and duplicating a topic. But that just was not enough. On 17 March 2009, you just had to revisit the topic. And by the way, I just loooove the name of this thread "Proper Exam Technique - Expose or Fail". So, you apologized earlier for what seems to others to be an attacking delivery message. With a topic title like Expose or Fail, what makes you think we'd take it as attacking... Anyways, I'm sure everyone would like to see a link. Click Here -10 for not using the search feature and duplicating a topic, twice now. Also, another -5 for being hypocritical towards others about using the search function. Then there is the current thread. Here. The 4th time now that you have discussed it. Except now, as I have observed over the years, you have become much more pompous about your position. So, I guess -20 for a triplicate post and not using the search function, another -10 for being a hypocrite again, and another -5 for not using spell check, and other -5 for just being egotistical about this topic. Folks, honestly, this is a good topic to discuss, if you read some of the older topics, you'll see some posters from back in the day with some good things to say. Again, all Spenac is doing is echoing others, and then himself. I just hope people can see it for what it is.

You know you're a Firefighter if… 1. You can tell what type of fire it is by the smell of smoke 10 miles away. 2. You have ever had a heated debate over the color of firetrucks. 3. You have ever spent 10 min trying to force open a door only to have someone come along and open it by turning the handle. 4. You have ever taken 10 or more showers in 1 day. 5. You lay out your cloths from that day so if there is a call at night you can find them quickly. 6. You take great joy in smashing the windows of a car parked in a fire zone or in front of a hydrant. 7. You have ever been airborne without an aircraft and water was your thrust. 8. You always wear red suspenders. 9. You have ever slept in a hosebed. 10. You carry a ton of specially modified tools in your pocket. 11. You ever cursed out someone for armor-alling the seats to make them look nice. 12. You've ever clung to the air horn chord for dear life because the driver is insane. 13. You have ever played jingle bells at Xmas time on the air horns to clear traffic. 14. You double your weight every time you go on a job a building. 15. You have ever said, "she's hot tonight" and not been talking about a girl. 16. You have ever had "yoda ears" 17. You have ever called a person found after a fire a "crispy critter" 18. You have ever smoked and there wasn't a cigarette in sight. 19. You have ever stomped out a fire with your boots because you couldn't wait for water. 20. You have ever walked 3 miles into the woods in 100 degree heat in full turnout gear and a 5 gal or more water can strapped on your back just to put out a fire.