Proper Exam Techniques - Expose or Fail

[Jeepluv77]

I know here(in Virginia) if you do not expose on your states you fail automatically, regardless of what else you may do "perfectly". I haven't taken the NREMT-B(decided to keep going through school) but was lead to believe it was the same way. If that's so, then it leads me to believe it's pure out laziness. And to not expose when assessing a trauma? To me, that sounds like it could be edging on negligence. How can you do an appropriate trauma assessment without looking at the injury?? Ex- You have a fractured femur. You splint it, finish your "assessment" on scene, and go at a nice leisurely pace. But since you didn't look at it, you didn't know that it had severed the femoral artery was pouring blood into the closed injury. Your pt has serious complications(or even dies) because by the time you realized he was going into shock and prepared to treat it was too late. Maybe that's a little extreme an example, but it hopefully illustrates the damage that can be done by not taking those few extra seconds to cut away clothing.

[Emtgirl101]

Ive noticed alot of emts do it but not sure i under stand this post. sooo very lost>

[EMS49393]

I'm too brazen to be bashful. I hate to say it, but being female in this profession is a real advantage when it comes to stripping down for assessment. Patients don't think twice when I tell them I have to listen to their lung or heart sounds. I never have any problems doing ECG's. I never have any problems stripping my trauma patients. There are a few men in my company that have run into problems in the course of doing their job. Most of that stems from not being properly taught how to perform assessments on female patients with utmost modesty. I feel that if you bothered to call 911, you better not mind getting a little naked for me, and a lot naked for the ER. I'm not making any excuses for male providers, I'm just saying it's a sue happy society and that could put some fear into the occasional male.

You touched my booby, and I'm calling my lawyer!

[RatPack]

I know here(in Virginia) if you do not expose on your states you fail automatically, regardless of what else you may do "perfectly". I haven't taken the NREMT-B(decided to keep going through school) but was lead to believe it was the same way. If that's so, then it leads me to believe it's pure out laziness. And to not expose when assessing a trauma? To me, that sounds like it could be edging on negligence. How can you do an appropriate trauma assessment without looking at the injury?? Ex- You have a fractured femur. You splint it, finish your "assessment" on scene, and go at a nice leisurely pace. But since you didn't look at it, you didn't know that it had severed the femoral artery was pouring blood into the closed injury. Your pt has serious complications(or even dies) because by the time you realized he was going into shock and prepared to treat it was too late. Maybe that's a little extreme an example, but it hopefully illustrates the damage that can be done by not taking those few extra seconds to cut away clothing.

Whatever level you operate at you need to be competent in recognition of life threatning injuries. In any event if there is enough force applied to the body to fx a femur then complete exposure is needed to address other possible injuries that are present and could be masked by the pain of the femur fx.

You can tell by looking at a fx femur that it has severed the femoral artery and is bleeding internally? This is where being able to assess all aspects of the pt to determine possible injuries. This example isnt that difficult, vital signs alone should tell you if internal bleeding is present. They will lose volume and usually quickly and that will be reflected in their vital signs.

You have to treat the whole person, injuries to specific systems will usually affect other systems.

[spenac]

I just do not understand why so many have trouble. As a man in EMS for way to long I have only had one female patient that was oposed to getting exposed for her assessment. She was a teenage pregnant in labor. After explaining the need to keep an eye on her so the baby would not be hurt she willing let me check her multiple times during transport. As to lung and heart sounds and visualizing while doing so no complaints. Lifting breasts to do 12 lead no complaints. Palpating an alert patient head to toe including all no complaints. Having patients disrobe and examine and cover no complaints young or old.

Point is do your job. If you always do you job right and consistently there is nothing to fear. Now if the hospital notices only the hot patients are stripped and the ones so ugly even their mothers would not hug them are not you will have problems.

I know here(in Virginia) if you do not expose on your states you fail automatically, regardless of what else you may do "perfectly". I haven't taken the NREMT-B(decided to keep going through school) but was lead to believe it was the same way. If that's so, then it leads me to believe it's pure out laziness. And to not expose when assessing a trauma? To me, that sounds like it could be edging on negligence. How can you do an appropriate trauma assessment without looking at the injury?? Ex- You have a fractured femur. You splint it, finish your "assessment" on scene, and go at a nice leisurely pace. But since you didn't look at it, you didn't know that it had severed the femoral artery was pouring blood into the closed injury. Your pt has serious complications(or even dies) because by the time you realized he was going into shock and prepared to treat it was too late. Maybe that's a little extreme an example, but it hopefully illustrates the damage that can be done by not taking those few extra seconds to cut away clothing.

Whatever level you operate at you need to be competent in recognition of life threatning injuries. In any event if there is enough force applied to the body to fx a femur then complete exposure is needed to address other possible injuries that are present and could be masked by the pain of the femur fx.

You can tell by looking at a fx femur that it has severed the femoral artery and is bleeding internally? This is where being able to assess all aspects of the pt to determine possible injuries. This example isnt that difficult, vital signs alone should tell you if internal bleeding is present. They will lose volume and usually quickly and that will be reflected in their vital signs.

You have to treat the whole person, injuries to specific systems will usually affect other systems.

Actually JessiR is right. By exposing they may see indications long before vitals tank.

Rat you are right treat the whole person. Take all the evidence based on what is seen, felt, heard, machines, etc and make your diagnosis and start treating.

[WolfmanHarris]

I have never not exposed an area being assessed. Only debate is whether I can pull the clothes out of the way enough or whether I need to undress, cut, etc.

What drives me nuts is when people only listen to each lobe of the lungs once and when I listen I find their A/E so diminished I listen carefully for a few breaths to make sure I can hear any adventitious sounds. If you need to take the time to listen, don't rush.

I used to see this with my First Responder students until I got in the habit of going to Value Village and picking up a dozen or so old t-shirts and pants per course so that they can actually cut them if necessary and I can get them bloody with moulage. Same with buying enough guaze and dressings so that they actually open them up and use them properly.

Practice the way you intend to practice.

[Chief1C]

Cut or don't cut? What do you do when they refuse to be examined or have their articles of clothing cut/removed? I always assure them, in the ambulance, that we'll keep them covered up w/ a sheet. No promises about after they leave our care. Some, saying something like, we need to assess you to make sure that you don't have any injuries that we can't see, that are life threatening, and they go along. Others are just adamant, that no matter how badly they're injured, they will not be made nude or etc.

[RatPack]

Actually JessiR is right. By exposing they may see indications long before vitals tank.

I will have to disagree, internal bleeding is usually never visable to the naked eye, its a late sign.

[WolfmanHarris]

Cut or don't cut? What do you do when they refuse to be examined or have their articles of clothing cut/removed? I always assure them, in the ambulance, that we'll keep them covered up w/ a sheet. No promises about after they leave our care. Some, saying something like, we need to assess you to make sure that you don't have any injuries that we can't see, that are life threatening, and they go along. Others are just adamant, that no matter how badly they're injured, they will not be made nude or etc.

I think its a matter of projecting both confidence and competence. If you have any reservations about exposing a body part, the patient will pick up on this and feel uncomfortable. I've seen fellow students who approach every patient interaction with an approach that's a variation on "Umm... okay, ma'am what we need to do now, if that's all right with you, is lift up your shirt so that we can take a look for any problems, is that okay?" Even when the patient agrees, they often seem hesitant. For a variation on this, watch the various ways that students ask male patients to move their penis and testicles out of the way of the pubis rest on the sager splint. "Umm... sir I need you to get your... friends, out of the way so we can put this on you."

[spenac]

I will have to disagree, internal bleeding is usually never visable to the naked eye, its a late sign.

Actually skin gets warm before BP and puls changes show up. If not exposed and touched it will be missed.