Abdominal Exam

[kohlerrf]

I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever!

Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

[JPINFV]

Shrugs... because it's a part of a full exam? Distention, tenderness, pulsating masses, etc are all going to be found on palpation. Heck, why don't we go the full 9 yards? Examine, auscultate, percuss, palpate? Do you not let your EMT-Bs and ride alongs listen to lung sounds?

[medicKristina]

I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever!

Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

I have been taught from Basic level through to Paramedic - Palpate the abdomen for rigidity and tenderness. In this case, obviously it was tender. However, rigidity would have led you to suspect internal bleeding. I'm curious, what was your diagnostic impression of this patient? Are there additional S/S that you didn't post? Also, what were his vital signs?

[dera]

I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever!

Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

Why NOT teach them? I for one believe that it is an important part of doing a complete assessment. And I agree with the previous poster about lung sounds. It isn't hard to learn, and provides valuable information. EMTs have long had skills removed from their education, and in some cases, now it is being reintroduced (Combitube and other airway adjuncts). Remember the old EOA?

[Chief1C]

Was the 'lump' pulsating? Moving? Tender? Was it an umbilical hernia? What color was it? Tenderness around it? Just curious.

Do your protocols tell you not to touch the abdomen in any way, for any patient? Or is that just something you set as your own standard of care?

[Lone Star]

I was called to a 57 y/o man complaining of a sudden onset of mid line abdominal pain while sitting in his office doing some paper work. Patient has a history of hypertension and high cholesterol and is non compliant with his meds. Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line. While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever!

Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

First off, in EMS we use ALL of our senses as we make our clinical observations, and offer differential diagnoses. We have to be able to 'paint a picture' for the recieving staff, so they can take the appropriate steps in continuing patient care.

Since there are a myriad of 'abdominal complaints', palpation will help narrow down the chief complaint of 'my belly hurts'.

You claim to be a paramedic, and yet you don't advocate a 'full focused exam' strongly leads me to question your ability to be teaching students!

Was the 'lump' pulsating? Moving? Tender? Was it an umbilical hernia? What color was it? Tenderness around it? Just curious.

Do your protocols tell you not to touch the abdomen in any way, for any patient? Or is that just something you set as your own standard of care?

Repeating this poster's comments, I would love to see what you're basing the 'Don't ever touch the abdomen' philosophy on. As the poster asks, is this in your protocols, do you have case study to base this on; or is it just your own 'personal standard of care'?

[AnthonyM83]

While in route to the hospital my EMT "ride along" placed him on oxygen, moves down and begins to palpate the abdomen? I yanked his hands up telling him not touch the any of my patients abdomens, ever!

Regardless of what anyone thinks is wrong with this patient, could someone please tell me why we still teach EMTs to palpate the abdomen!

EMT's are still taught this, because it is the standard of care, thus it would negligent for an educational institution not to teach it. It most areas, it would also be negligent for a healthcare provider not to adhere to it without specific reason not to.

It also concerns me that it surprised you that the EMT attempted to practice his assessment. It surprised you to the point that you had to yank on his hand.

Palpation is part of the physical exam and can provide information that supports suspicion of a life-threatening condition.

Please elaborate on the situation that occurred, you thinking, and why you assumed we'd all be on the same page with you about not teaching EMT's to palpate.

[daedalus]

Standard part of a physical exam of a patient with a c/c of abdominal pain. Inspect, auscultate, palpate, percuss. Although, a ride along should have asked before he/she preformed patient care in your ambulance.

[Lone Star]

Standard part of a physical exam of a patient with a c/c of abdominal pain. Inspect, auscultate, palpate, percuss. Although, a ride along should have asked before he/she preformed patient care in your ambulance.

So if its a student on the truck to gain the clinical experience required ...they still need to 'ask permission'? I thought thats why they were there in the first place...to get 'real life hands on experience'.....

[daedalus]

So if its a student on the truck to gain the clinical experience required ...they still need to 'ask permission'? I thought thats why they were there in the first place...to get 'real life hands on experience'.....

You bet. I am almost done with paramedic school, and while I am working at my EMT job I still ask my paramedic permission before doing certain things. As a EMT ride along student, your primary responsibility is just to observe. You may be asked to assist with vital signs or other simple procedures within your scope of practice, but other than that, you should not start conducting your own examination of a patient or starting to do something on your own without being asked. My two cents, anyways.