Abdominal Exam

[ccmedoc]

It is still my opinion that abdominal palpation (palpation in general as well as percussion) is a valuable tool, and to begin instruction at the basic level is not detrimental. I guess I do not fully understand the points you are making; for or against??

As far as the prehospital portion of the article, I do not see where it precludes or prohibits the palpation. MAST is a thing of the past for most areas, but inclusion in the article was prudent for those still in that era, IMHO..

Again this is just my opinion, but I like to be complete in my assessments and teach the same. Due diligence in the palpation of appendix and other suspected abdominal conditions should always be observed also..part of the instruction process I would imagine...

EDIT:..maybe I am too progressive for my own good....

Edited January 1, 2010 by ccmedoc

[VentMedic]

It is still my opinion that abdominal palpation (palpation in general as well as percussion) is a valuable tool, and to begin instruction at the basic level is not detrimental. I guess I do not fully understand the points you are making; for or against??

I am all for a thorough physical exam of the abdomen provided you have adequate education and supervised training to understand what you are palpating. If you are palpating just to palpate and the few things you might assess may not be relevant to the situation or more to do with cold hands and patient comfort, then NO, you should not be palpating the abdomen. If you do it should be gentle and not digging around for a pulsating mass which is only detectable 38% of the time.

Sorry but 120 hours of first aid training just doesn't address all the possible medical conditions to where one is qualified to many any type of differential diagnosis.

As far as the prehospital portion of the article, I do not see where it precludes or prohibits the palpation. MAST is a thing of the past for most areas, but inclusion in the article was prudent for those still in that era, IMHO..

How much does this physician know about prehospital providers to have him be the authority for EMS. Look at that prehospital section.

Again this is just my opinion, but I like to be complete in my assessments and teach the same. Due diligence in the palpation of appendix and other suspected abdominal conditions should always be observed also..part of the instruction process I would imagine...

Again, how many diffent disease processes is the EMT-B trained or educated to identify? There are also many Paramedic programs that don't address how to properly palpate and some have preconceived notions about what a AAA will feel like but have never actually felt on or have it described by someone who has.

[ccmedoc]

Granted, it comes down to education and the ability to understand and process the information gained in the assessment, but this goes for the entire assessment. I think it comes down to being able to identify the common ailments, and knowing the difference between the benign and potential life threats. Not being able to properly assess the patient takes us in to whether they should even be allowed on the ambulance in the first place; a discussion that is a bit long in the tooth. Palpation by itself is one part of the puzzle, abdominal or otherwise. In conjunction to the rest of the assessment, it can be valuable...whether the article's author has the credentials to effectively speak to the EMS community or not...

Bottom line for me is if a provider is tending to patients, they need the tools to do it properly..palpation is a basic tool..it should be taught and used appropriately by all licensed providers.

Sorry but 120 hours of first aid training just doesn't address all the possible medical conditions to where one is qualified to many any type of differential diagnosis.

This I agree with more than I can possibly convey on this forum...

[VentMedic]

Bottom line for me is if a provider is tending to patients, they need the tools to do it properly..palpation is a basic tool..it should be taught and used appropriately by all licensed providers.

However, this should not be confused with the terms in EMS as they relate to "Basic".

[ccmedoc]

However, this should not be confused with the terms in EMS as they relate to "Basic".

Touche'....

[joesph]

Lets try this approach in teaching this new basic, first don't yank his had away you will freak him and the patient. You need to have control of your student prior to the call as a preceptor. Second try out this explanation on palpation " you are looking for lands mines if you see one or find one don't play with it but you do have to look'. What I am trying to express is that you need to palpate the ab to locate any problems but once that is done we (as basics) really don't the skills to produce any more useful findings threw continued palpation. In summation a palpation of the abdomen should be done at all levels but once a significant finding is found then further examination should be weighted with a cost verse gain approach. It is assumed that all other investigative avenues are being used like history vitals etc.

[Lone Star]

The bottom line here exists as this:

I'm not aware of any paramedic program that lets you just 'skip' any/all of the education at the 'lower license levels'. Here in GA, and in MI...I know for fact that you have to have to have taken the EMT-B course as a prerequisite for the paramedic program. GA requires an active license at one of the 'lower levels' in order to take the paramedic class.

That being said, the education of the EMS provider is based on a 'building block principle'. Each progressive level is based upon what was taught at the 'lower level' then expounded upon. Even MD's and DO's have to take 'pre-med' courses. Wouldn't this be the same as 'Doctor Basic'?

The EMT-B courses provide the 'basic building blocks' for patient care. There is a general consensus of opinion that the palpation of the abdomen is a basic skill for patient assessment. Since the EMT-B course teaches 'the basics' then it only stands to reason that this skill will be taught there. As one moves 'up the food chain' of EMS license levels, more and more information will be gained as to what the findings mean....

Not one of you 'anti EMT-B' crowd entered into this field knowing what you know now. You, like the rest of us 'lowly EMT-B/EMT-I crowd', had to start at the bottom! Unfortunately, it appears that you have forgotten 'where you came from'...

I'm not going to get into the whole 'Basic's bagging on Medics/Medics vs all other license levels' thing. That subject, as previously stated is 'long in the tooth' and has been beaten to death far too many times.

The reasons for not advancing to the Medic license level are as varied as the individual who verbalizes them. Those who have 'risen above the basics' and have delved deeper into patient care have a responsibility (at least in MY eyes) to teach those just entering into the field, and along the way...perhaps encouraging them to advance from the 'basics' to be able to provide better, more definative care for their patients; not trashed/bashed/flamed because they're a lower license level than you!

[Siffaliss]

Some good points here. I still disagree however, with the original poster 'yanking' the EMT's hands away. Unless one felt it was an immediate life threat to the patient, a simple "hey hold off on that for now" could have sufficed. As a green practitioner who is learning the ropes, they need directions and explanations. As someone else already stated, if you didn't want your EMT assessing patients that should have been made clear PRIOR to the ridealong.

Although EMS is an industry that tends to 'eat their young', remember that you were once green as well.

[VentMedic]

That being said, the education of the EMS provider is based on a 'building block principle'. Each progressive level is based upon what was taught at the 'lower level' then expounded upon. Even MD's and DO's have to take 'pre-med' courses. Wouldn't this be the same as 'Doctor Basic'?

So much for some not confusing "basic tools" with EMT-Basic.

Before you get on your "anti-EMT-B crowd" high horse, did you read the comments in the posts about people being properly trained and educated? I speciffically used examples of medical students and doctors. No med student or resident will touch a patient in anyway that they have not been previously instructed to or given the okay by their seniors. That including intubation, IVs, palpation or any number of exams. EMS providers should also be held to some standard when it comes to performing certain "skills" and that especially pertains to education.

A 110 hour EMT course also can not be compared to a 4 year pre-med degree especially when the majority of EMT courses in the U.S. require no prerequisities...not even A&P. Thus, how do you know what you are palpating with such limited knowledge? Basically all you can tell is where it hurts and how hard or soft the abdomen is but again, those are patient specific and can be subjective to the exam itself.

I went through a college degree program for Paramedicine which required 2 semesters of A&P before starting EMT-B and then continued on through Paramedic. I believe that is the way several others did their programs. I did not need to stay an EMT-B for 10 years to master a few first aid skills. However, having A&P prior to EMT-B did make that much easier and definitely made palpation skills easier if you knew what organs are in the abdomen.

Also, a Paramedic that can not think beyond EMT-B is of no use on an ALS truck. The "Basic" attitude must go away to understand what the true "basics" of EMS are in order to provide critical thinking and advanced PATIENT CARE.

Edited January 1, 2010 by VentMedic

[chbare]

So, is there evidence that basic EMT abdominal assessments are inherently unsafe in a patient with a suspected AAA?

Take care,

chbare.