Abdominal Exam

[kohlerrf]

How thin was this patient? Seriously...on an "regular sized" adult, you shouldn't be able to see that. I just did a paper on permissive hypotension, and came across a quote (although for the life of me I can't find it again). However, it did say something along the line of a patient can bleed in the realm of 2L into the abdomen without it being noticed visually (distending). This being said...I would find the whole sitution implausable.

I would agree I have never seen a bulge in the abdomen except for a herina however in many people who have a relatively flat abdomen while supine you can often see the pulsation of the abdominal aorta. Give a try and look for it and you may be surprised.

[ccmedoc]

I get from the thread that everyone assumes that after inspection of the abdomen, the very next step would be palpation or percussion..general assessment procedure would follow the pattern: Inspection, palpation, percussion, auscultation..generally this is correct.

Where an abdominal assessment differs is the ordering of the vary same tools. For the abdomen it should be: Inspection, auscultation, palpation, then percussion. There are a number of reasons for this change, mainly to attain an accurate assessment. If there will be pain associated with palpation (and there usually is), then you would want to inspect the abdomen and auscultate it before you interrupt bowel sounds or other abdominal signs by causing said pain and guarding. Even if the palpation is not necessarily painful, the agitation will alter peristalsis and bowl sounds..You may ask what do bowel sounds have to do with anything??? You should read up on abdominal assessment...(i.e. hyperactive bowel sounds with intense pain = ?). You may never see this sign if you are pushing and thumping right away..

My point is that in the OP asking about an abdominal assessment, the auscultation should have been performed after the inspection; certainly after seeing the protrusion in the lower abdomen.This would lead the astute clinician (I know.. ) to adjust palpation accordingly or even postpone it until later after USS, CT, or MRI..or until the physician took patient care.

Adequate abdominal assessment could, and should, be done without undue pain. Following correct sequence of assessment can clue the clinician into the next appropriate procedure. With the proper assessment training, that is...But maybe I expect too much..

My opinion:

IPPA = upper chest A/P, flank, and select epigastric assessment

IAPP = Abdominal assessment (ALWAYS)

Always attempt to minimize pain.....

(EDIT:grammar)

Edited January 26, 2010 by ccmedoc

[AnthonyM83]

My point is that in the OP asking about an abdominal assessment, the auscultation should have been performed after the inspection; certainly after seeing the protrusion in the lower abdomen.This would lead the astute clinician (I know.. ) to adjust palpation accordingly or even postpone it until later after USS, CT, or MRI..or until the physician took patient care.

I don't think auscultation of the abdomen is regularly practiced in EMT class, and treating it as a BLS call, that might be why that wasn't done first.

I would agree I have never seen a bulge in the abdomen except for a herina however in many people who have a relatively flat abdomen while supine you can often see the pulsation of the abdominal aorta. Give a try and look for it and you may be surprised.

Correct. Reading through the "Suggested Readings" list at the end of some prehospital care books, you'll find books that list inspection and palpation of aortic pulsations as part of the physical exam. Not that this means you should or need to, but it is something quite regular to find in most healthy people.

[Dustdevil]

I don't think auscultation of the abdomen is regularly practiced in EMT class...

I often honestly wonder if they're even practising chest auscultation in EMT class anymore. It used to be that a new grad EMT could be reasonably relied upon to at least identify and interpret the basics, such as rales, rhonci, and wheezes. It seems to be extremely rare to find this anymore. But boy, they can sure regurgitate the theoretical criteria for busting out the EpiPen.

[Arizonaffcep]

I would agree I have never seen a bulge in the abdomen except for a herina however in many people who have a relatively flat abdomen while supine you can often see the pulsation of the abdominal aorta. Give a try and look for it and you may be surprised.

Well hell, I can see that on myself and I'm about 20 lbs overweight . That being said, it's the pressure wave is what you are seeing affecting the surrounding tissues, and NOT the actual outline of the aorta itself. That'd be really impressive. Maybe in Ethiopia?