Abdominal Exam

[1EMT-P]

Dust, I am sorry but I have to respectively disagree with you. When I first became an EMT in the 80's we were taught how to do an assessment & what was considered normal vs abnormal & what that might mean & why. It is important for all EMT's & Paramedics to be able to not only assess their patients but to document & relay their findings to the ED staff. Examples: Decreased Circulation, Motor & Sensory with a dislocation/fracture, Trauma: Flail Chest, Fractured Femur etc.

[CBEMT]

Let's also keep in mind that whether we like it or not, an abdominal exam is part of the EMT-B curriculum and, more importantly, the standard of care. I think it's a dangerous for a provider at any level to take the stances of some here regarding the limitations of EMT-Basics and put them into practice with patients in contravention of their regulatory oversight and medical direction.

A first-year law student could plant the idea in a jury's head that if Mr. or Miss EMT had only followed his training and performed an abdominal exam, Mr. Husband and Father of 3 would still be alive today.

Edited January 6, 2010 by CBEMT

[Tom B.]

Let's also keep in mind that whether we like it or not, an abdominal exam is part of the EMT-B curriculum and, more importantly, the standard of care. I think it's a dangerous for a provider at any level to take the stances of some here regarding the limitations of EMT-Basics and put them into practice with patients in contravention of their regulatory oversight and medical direction.

A first-year law student could plant the idea in a jury's head that if Mr. or Miss EMT had only followed his training and performed an abdominal exam, Mr. Husband and Father of 3 would still be alive today.

Only if the EMT failed to transport the patient to the hospital, transported the patient to the wrong hospital, or neglected to notify the triage nurse at the hospital that the patient was complaining of abdominal pain.

You have to cause harm to be negligent.

Tom

[Dustdevil]

Vent, Dust, Tom I am going to have to disagree. No offense intended and perhaps it is because of the environment that I started my EMS journey in but I feel not doing a complete examination which includes touching the patient is failure to render proper care, examination. And even if the EMT does because of cold hands trigger an occasional false alert it is better than no alert when they do get it right.

The failure is in sending EMTs to do a paramedic's job in the first place.

Only if the EMT failed to transport the patient to the hospital, transported the patient to the wrong hospital, or neglected to notify the triage nurse at the hospital that the patient was complaining of abdominal pain.

You have to cause harm to be negligent.

Exactly

[daedalus]

Yes; however, I still stay away from utilising the term. There exists major differences between dissections and aneurysms and utilising the term dissecting AAA only adds to the confusion. There is even more confusion as dissections are not typical of the abdominal aorta, but we call a AAA a dissecting AAA when the intima is breached? Clearly, this becomes quite confusing very quickly.

Take care,

chbare.

Good to know. Thanks for the new info. I think we both understand what eachother is saying.

[AnthonyM83]

By telling the ER that you suspect an acute abdomen based on history vitals etc...and not pushing and probing you may buy the pt the times he needs to see the pro's on this subject. Above all do no harm.....

Since you're talking about urgency, what about buying the patient time by recognizing a potential AAA based on pulsation (38% is a pretty good stat, 1/3)? Especially since current literature is saying rupture from palpation isn't a danger.

Also, as far as the 4 years of medical school comments...students are often palpating abdomens at under 4 or so months of school, in theory "supervised" but not always directly supervised.

BLS also often gathers preliminary information for reporting purposes without the full knowledge to interpret it. Paramedics, often do the same. This idea isn't new...and one can never know enough, unless one goes to medical school (and even then apparently not full knowledge).

Alright, still trying to catch up on the posts in this thread...

[AnthonyM83]

As a EMT ride along student, your primary responsibility is just to observe.

Wow, that's what contributes to crappy EMT education right there.

You say their education is not enough to even practice skills on patients under direct supervision. So, what makes it okay for you and your coworkers to perform those skills on your own?

[daedalus]

Wow, that's what contributes to crappy EMT education right there.

You say their education is not enough to even practice skills on patients under direct supervision. So, what makes it okay for you and your coworkers to perform those skills on your own?

You think that someone with maybe only a month done of EMT class (my class put us through our ride alongs at about 1/4-1/2 the way through the semester), should be preforming an assessment of an emergency patient on their own accord? I don't. By observing, I mean soaking in information like a sponge and helping out where asked. An EMT student should be expected to be able to take a blood pressure or put a patient on oxygen, but both only after being asked by the paramedic on scene. They should not be palpating an abdomen without asking, when this may not even be indicated. In some patients, the pain may be so severe that they will barley tolerate the initial exam of their abdomen by the paramedic, and do not need to be prodded again by the EMT student who does not even have knowledge of anatomy and physiology. ( You can argue all you want that some people may have taken an A&P class prior to EMT class, but it simply is not required so we will always be looked at by the lowest standards).

[VentMedic]

Since you're talking about urgency, what about buying the patient time by recognizing a potential AAA based on pulsation (38% is a pretty good stat, 1/3)? Especially since current literature is saying rupture from palpation isn't a danger.

It isn't a danger until the patient decompensates quickly on you which can also be from pain as well as increasing the leaking. I have seen this and it isn't pretty.

Also, as far as the 4 years of medical school comments...students are often palpating abdomens at under 4 or so months of school, in theory "supervised" but not always directly supervised.

Med students have several semesters of A&P as well as a cadaver lab to know where the organs are. They do get supervision during this process which can be very lengthy even if it is in some of the undergrad labs.

No other profession would allow their students to just do whatever after just a few hours of training and especially without any prequisites.

What the student can and cannot do should be established by the preceptor and the student should respect that.

[AnthonyM83]

You think that someone with maybe only a month done of EMT class (my class put us through our ride alongs at about 1/4-1/2 the way through the semester), should be preforming an assessment of an emergency patient on their own accord?

Why would they be doing it on their own accord? They should be doing it under your direction, since you're a part of their education.

( You can argue all you want that some people may have taken an A&P class prior to EMT class, but it simply is not required so we will always be looked at by the lowest standards).

How is that different from your education as a working EMT?

It isn't a danger until the patient decompensates quickly on you which can also be from pain as well as increasing the leaking. I have seen this and it isn't pretty.

You've seen decompensation from the palpation or decompensation that naturally occurs? If the latter, then the palpation can help give you a sense of urgency and perhaps help you with transport priority decisions.

Med students have several semesters of A&P as well as a cadaver lab to know where the organs are. They do get supervision during this process which can be very lengthy even if it is in some of the undergrad labs.

No other profession would allow their students to just do whatever after just a few hours of training and especially without any prequisites.

What the student can and cannot do should be established by the preceptor and the student should respect that.

Negative Vents, A&P is a not a prerequisite for medical school and many students have not taken it. The A&P they do get in school (depending on the school) may only be in specific systems by the time they start doing exams during 1st year preceptorships. Additionally, supervision is not always "direct" for all patient contacts. And their physical exam skills lab time may be limited to less than 10 hours (maybe 2 of abdomen).

I've been present for all physical skills labs a local prestigious medical school. In the end they get great training, but with their first exams they have practice time similar to some EMT.

Now, that doesn't invalidate the arguments made about needing better education before attempting skills.