Did You Look And Feel? Hands and eyes on?

[firedoc5]

I don't rely on machines for anything. I use all of my senses. For example, when checking someone's BGL, I don't use a silly high-tech machine. I taste their capillary blood.

Mmm, hyperglycemia.

I'm not even going to ask about UA's. brushteeth

[spenac]

So all joking aside. There are important steps in checking patients completely.

1. Explain what your doing even if they appear out of it.

2. Protect patient privacy as much as possible.

3. Do not hesitate to check completely. Look ( see skin ), Listen ( on skin ), Feel ( skin )

4. Act like you have done it before and will do it again.

5. Develope a method and stick to it every patient.

[firedoc5]

So all joking aside. There are important steps in checking patients completely.

1. Explain what your doing even if they appear out of it.

2. Protect patient privacy as much as possible.

3. Do not hesitate to check completely. Look ( see skin ), Listen ( on skin ), Feel ( skin )

4. Act like you have done it before and will do it again.

5. Develope a method and stick to it every patient.

Excellent advice. :thumbup:

[spenac]

On a couple of other topics I was just surprised at how hands and eyes off people are in treating their patients. I was taught in all 4 levels of EMS school I have taken or taking that to do a good exam requires all our senses except taste, and sometimes taste comes into play as odor is so strong you taste it. What do you see, feel, smell, hear? I was taught that if a person complains of something say stomach pain you expose and see if anything visible, then you palpate starting on the areas w/o pain moving to the painful area, finally you auscultate the area. During this you may note various odors. Even in clinicals a the hospital I was asked to do all the above and even had Docs bring to my attention some of what I was feeling or hearing.

So my question is am I the only one taught this way? While it may not affect our immediate care of the patient do you feel it is still part of a proper EMS exam? What are your thoughts?

Just curious if any new thoughts about this subject have come to mind. I feel it is an important subject that all and especially the many new EMT's that have joined us recently need to consider.

[spenac]

Well?

[paraloco]

Speaking out of my @ss, I am thinking that most hang-ups about doing a complete exam are just that, products of our own fears, not recalcitrance on the part of the patient. I have never had a female patient hesitate to allow me to examine any part of her that I believed necessary to examine. I explain why, ask permission, and assure that privacy will be respected. The one time my company got sued over my actions, not even the patient disputed that I acted professionally, or without consent. She/he/it was out for a fast buck. We fought it, the jury saw it for what it was, and she/he /it walked away with jack$hit. Some medics I know will not do a perineal exam, even on a patient in labor. They'll look really stupid and feel worse the day they bring in a presenting limb, Freddy Krueger's hand protruding, etc, and did not bother to check. Having said that, its prudent to have another in there with you, if you have the option.

[spenac]

Speaking out of my @ss, I am thinking that most hang-ups about doing a complete exam are just that, products of our own fears, not recalcitrance on the part of the patient. I have never had a female patient hesitate to allow me to examine any part of her that I believed necessary to examine. I explain why, ask permission, and assure that privacy will be respected. The one time my company got sued over my actions, not even the patient disputed that I acted professionally, or without consent. She/he/it was out for a fast buck. We fought it, the jury saw it for what it was, and she/he /it walked away with jack$hit. Some medics I know will not do a perineal exam, even on a patient in labor. They'll look really stupid and feel worse the day they bring in a presenting limb, Freddy Krueger's hand protruding, etc, and did not bother to check. Having said that, its prudent to have another in there with you, if you have the option.

Excellent points. People expect that medical professionals will be looking, listening, touching. So if you don't do a complete exam of your patient it is your negligence if you miss something.

[AnthonyM83]

Since the topic is revived, let me ask a different question that might lead to discussion.

In systems were ALS always responds, do you always visualize an injury that BLS has already wrapped? If not, could this be a liability for you if they mistreated somehow (thought an open fx was closed or somehow missed neuro compromise)? If so, doesn't that cause pain to patient manipulating the splint or wrap again?

[Arizonaffcep]

Since the topic is revived, let me ask a different question that might lead to discussion.

In systems were ALS always responds, do you always visualize an injury that BLS has already wrapped? If not, could this be a liability for you if they mistreated somehow (thought an open fx was closed or somehow missed neuro compromise)? If so, doesn't that cause pain to patient manipulating the splint or wrap again?

Yes, and no. I will usually unwrap my present to visualize, unless there is a bleeding control issue. If there is, then I leave it alone, perhaps even add to the wrapping (if needed).

[firedoc5]

Yes, and no. I will usually unwrap my present to visualize, unless there is a bleeding control issue. If there is, then I leave it alone, perhaps even add to the wrapping (if needed).

That's pretty much how I did it. However, I hope the BLS person who did the initial bandaging paid attention and knew what they were doing. If I trusted them I just went by what they said. But all to often would have same ya-hoo that just saw it was bleeding so they wrapped. Didn't say how deep, how wide, etc. Once had a guy with an arterial bleed and the BLS person, while still wrapping it had no idea it was arterial and didn't know why it wouldn't stop bleeding. Idiot. A three week rookie still in EMT class could have known that.