Did You Look And Feel? Hands and eyes on?

[spenac]

I guess I owe a lot to the vollys that taught me my FR and Basic. First night of class we started doing hands on. I have never had a problem checking a patient. If in doubt I remove more or even fully expose to make sure I miss nothing obvious. I palpate, auscultate. etc. There is nothing to fear about skin. If you chose healthcare embrace it.

[MSDeltaFlt]

You guys are definitley right. The order I was taught for assessment is:

Inspection, Auscultation, Palpation, Percussion (Look, Listen, Feel, Thump). In that order.

Because if you palpate or percuss before you auscultate, you might scew the way something sounds and alter your assessment findings. You must have a methodical approach to patient assessment each and every time. That way nothing is missed.

[spenac]

You must have a methodical approach to patient assessment each and every time. That way nothing is missed.

Extremely true. It also helps in case you are sued or accused of wrong doing. What gets people in trouble they always get to hospital with the hot girl exposed but given same trauma the ugly chick is still clothed. If you do something by a methodical method you don't get distracted by anything and you complete a proper exam on all patients. Your work mates and the people at the hospital become used to the fact that you are consistent and complete in your exams. People trust you because they know that if something happened they would hope you would be the one to examine and treat them.

[AnthonyM83]

If anything, I'm more cautious (aka scared) of stripping/flipping or doing thorough physical exam on the really hot girls...only b/c they're probably used to guys doing all sorts of creepy stuff to them and weasely reasons for touching them. More likely to complain, I think. Than a girl who's not stuck in her head about her looks and knows she's been in a bad accidents and needs this done.

[spenac]

If anything, I'm more cautious (aka scared) of stripping/flipping or doing thorough physical exam on the really hot girls...only b/c they're probably used to guys doing all sorts of creepy stuff to them and weasely reasons for touching them. More likely to complain, I think. Than a girl who's not stuck in her head about her looks and knows she's been in a bad accidents and needs this done.

This is where you need a reputation of always using the same method. Use the same steps with all patients and document each step. I had one OB patient ask the nurse if I was supposed to have examined her and the nurse said yes all OB patients require an exam. The nurse new my routine. That was as far as it went. Had I had a rep of sometimes checking sometimes not would have been easier to have had the nurse say no and perhaps I would have faced an investigation.

So main point do not neglect a complete exam. Verbalize what you are doing and document it.

[spenac]

The 1999 PHTLS book page 44 talking about trauma says "At some time during the evaluation of the patient, all the patient's clothes must be removed and the patient rolled to examine the entire body." " Critical to finding all the injuries". " The EMT should not be afraid to remove clothing"

Page 46 says "See, don't just look. Hear, don't just listen. Feel, don't just touch."

[itku2er]

Page 46 says "See, don't just look. Hear, don't just listen. Feel, don't just touch."

That is so true.....and MS makes some valid points too, the simple things we forget sometimes.

[AnthonyM83]

That is so true.....and MS makes some valid points too, the simple things we forget sometimes.

I thought I reading a relationship advice guide when I read that quote at first!

[itku2er]

I thought I reading a relationship advice guide when I read that quote at first!

anothy you are on the wrong site for that it never happens here in the city.......we only discuss EMS ... :wink: :wink: :wink: :wink: but funny none the less.

[firedoc5]

The fewer "auto-mated" equipment the better. I just don't trust those machines, i.e. BP cuffs, etc.

I was teaching a BTLS class a while back and a buddy of mine was guest speaking. He gave a true scenario where a 22yr. female riding a bike collapsed. No outward visible sign of trauma other than minor abrasions to left hand and shoulder. Got her loaded and started to expose for assessment. Removed her loose fitting sweater, she had GSW to the chest. Evidently with the loose sweater no entry hole noticed. Her padded bra was absorbing blood loss. Can you imagine what it would be like if no one had exposed or did a hands on assessment what would happen when they got to the ER and that wasn't caught in the field? Sad to say, but stranger things have happened.