Proper Exam Techniques - Expose or Fail

[spenac]

i don't know if this counts or not but i have never had a doctor put the stethoscope on my skin always on my undershirt.

Guess my doctor likes me more. She always places it on skin.

[spenac]

How many services carry hospital gowns on your ambulances? Perhaps to force all to look listen and feel maybe we should at least require removal of shirts and place gown on. Then easier access to do proper lung/heart sounds, etc.

[spenac]

From the book "SLAM: Street Level Airway Management" found this tidbit on proper exam technique:

"When assessing respiratory movement, it is useful to expose both the chest and the abdomen, and then look along the line of the abdomen and chest from a position close to the patients feet. From there it is often possible to spot small differences in the degree of expansion of the two sides of the chest which may be invisible from directly above the patient."

[tamaith]

spenec, thats the problem im a male and so is my doctor.

[spenac]

From the book "SLAM: Street Level Airway Management" found this tidbit on proper exam technique:

"When assessing respiratory movement, it is useful to expose both the chest and the abdomen, and then look along the line of the abdomen and chest from a position close to the patients feet. From there it is often possible to spot small differences in the degree of expansion of the two sides of the chest which may be invisible from directly above the patient."

Anybody do it this way?

[Jeepluv77]

I've never heard of it, but it does make sense. I think I'll mention it to my teacher/proctors on Monday and see if they or anyone they know do it that way.

[spenac]

I was able to attend a Bob Page 12 lead class a few months back and learned a lot. He had a neat idea, they approached the hospital and asked if they could carry hospital gowns. They now have the patient put that on before IV is placed. This also helps them be able to make sure lung and heart sounds are done on skin. Hospital is happy as they don't have to thread the patients clothes over the IV bag risking snagging and pulling it out. Makes it easier to do your 15 lead as well. Well just some thoughts.

[RavEMTGun]

Sometimes you are merely checking for the presence of breath sounds. In such cases, sometimes (depending on the patient), environmental factors may make it preferential to auscultate through clothes if you can (you can do the real auscultations in the ambulance).

EMT-B's especially are rarely well trained in identifying breath sounds anyways.

Overall, yes. Big problem in EMS. (especially failure to expose for trauma... I've seen chest trauma treated as an AMI when a simple shirt lift would have showed massive contusions.

[Dustdevil]

Sometimes you are merely checking for the presence of breath sounds. In such cases, sometimes (depending on the patient), environmental factors may make it preferential to auscultate through clothes if you can (you can do the real auscultations in the ambulance).

I'll buy that. There are certainly rare circumstances where this would be immediately appropriate, such as that you state. It's just nothing you'd want to make a habit of, like all the EMTs who do palp BPs because they're too lazy or incompetent to take a proper BP, or all those who do "rapid extrication" on every patient, even though it's not indicated. Too many shortcuts out there become routine like that.

And the sound of a diaphragm sliding across a t-shirt sounds exactly like an inhaled breath sound too, so you better be damn sure of what you're hearing.