Abdominal exam question

[Adam Swartz]

I for instance now have cancer in my abdomen and am missing my colon, appendix, gallbladder. I have a genetic abnormality that caused all this. I have both Stage IV colon cancer w/mets to the pancreas and I also have Stage IIIB Sarcoma in the luq. The odds of two primary cancers with separate metastases is 16% or less. Sarcoma is 1% of cancers diagnosed and my tumor is, .1% of Sarcoma with only 1 diagnosis of the tumor per 3-4 million people. In regards to palpation of the abdomen and knowing what you're feeling my abdomen would throw you off. You can guess where my pain is from based on history. My tumor is generally not palpable unless you deeply palpate and if you do that you should expect a rather loud scream. Apologies if I went to far off topic.

[kohlerrf]

I never palpate the abdomen. no new information will be gained that would ever change your treatment and the possibility (although remote) exists that you may exacerbate what is acutely a minor problem and make it a major problem.

[ERDoc]

Several people have said that palpating the abd can cause a problem. Can anyone cite any legitimate literature that confirms this?

[HellsBells]

I never palpate the abdomen. no new information will be gained that

would ever change your treatment and the possibility (although remote)

exists that you may exacerbate what is acutely a minor problem and make

it a major problem.

Such As what? thats a particularly vague statement.

Several people have said that palpating the abd can cause a problem.

Can anyone cite any legitimate literature that confirms this?

Particularly the OP's question about palpation of pts with spinal injury. This is a little off topic, but I find the whole idea of spinal immobilization absurd and unproven.

[ERDoc]

Such As what? thats a particularly vague statement.

Particularly the OP's question about palpation of pts with spinal injury. This is a little off topic, but I find the whole idea of spinal immobilization absurd and unproven.

Agree on all points. Show me the evidence.

[BEorP]

I also have a big problem with the resistance that we often seem to have to doing any assessment that won't directly impact how we care for the patient. In an unconscious, apneic patient from the rough side of town should I bother to look at the pupils or should I just bag them since that is what I'm going to do regardless? Should we not bother to do 12 lead for suspected cardiac ischemia patients in places without STEMI bypass since it will not directly change our treatment?

Not doing assessments because it won't directly affect something that we will be doing goes down a dangerous slippery slop to being anything but health professionals.

[Bieber]

And what would you do differently if they had RUQ pain versus LUQ pain? All you'll be doing in the field is increasing the pain/anxiety of the patient with an exam that will be conducted in the ER as soon as the doc walks into the patients room. If they're complaining of lower abdominal pain and female, we consider it an ectopic until proven otherwise...no palpation necessary in the field for that... if it's RLQ pain then we will consider appendix until proven otherwise also, again, no palpation necessary in the field.

The patient, if they are reliable can point to where it hurts and you'll have a good idea of where the pain is and what could be involved.

In the field, there shouldn't be a clinical need to deep palpate the abdomen...if you suspect an abdominal aortic aneurism then you definitely shouldn't be palpating the abdomen as the pressure could cause a big problem.

Abdominal pain is tough even for the doctors, you have visceral pain and somatic pain, just too many variables to allow for a reliable exam in the field.

As to the OP, the idea might be that in the process of assessing the abdomen you could rock the patients lower thoracic and lumbar regions causing problems. While I doubt on the average patient that palpation could directly cause trauma to the spine, the rocking and shifting that can happen during an exam could displace a fracture. Just a thought, no way of telling what the author was getting at in your CE.

Kate, I'm starting to get the feeling that you favor a minimalist approach to out-of-hospital health care. Maybe I'm wrong... In any case, the physical exam is crucial to making an appropriate field diagnosis and tailoring treatment plans accordingly. If the pain is too severe for the patient to tolerate the examination, it is appropriate to provide analgesia to help mediate that pain before continuing on.

The notion that "if it won't change your treatment, you don't need to know it" seems so entirely out there that I can't for the life of me divine where it comes from, though you're certainly not the first person to suggest it. Also, as an aside, there's really no evidence to suggest that palpation of the abdomen in the presence of a AAA will exacerbate it... Nor have there ever been any incidents of iatrogenic spinal cord injuries in the setting of spinal trauma...

Just my $0.02.

-Bieber

[scubanurse]

Kate, I'm starting to get the feeling that you favor a minimalist approach to out-of-hospital health care. Maybe I'm wrong... In any case, the physical exam is crucial to making an appropriate field diagnosis and tailoring treatment plans accordingly. If the pain is too severe for the patient to tolerate the examination, it is appropriate to provide analgesia to help mediate that pain before continuing on.

The notion that "if it won't change your treatment, you don't need to know it" seems so entirely out there that I can't for the life of me divine where it comes from, though you're certainly not the first person to suggest it. Also, as an aside, there's really no evidence to suggest that palpation of the abdomen in the presence of a AAA will exacerbate it... Nor have there ever been any incidents of iatrogenic spinal cord injuries in the setting of spinal trauma...

Just my $0.02.

-Bieber

A lot of that probably has to do with the system I was in for a long time. Basic EMT's couldn't even do BGL checks. I've also been out of the field for a few years, and in those few years is when the big push to have field providers perform more interventions has happened.

[Bieber]

A lot of that probably has to do with the system I was in for a long time. Basic EMT's couldn't even do BGL checks. I've also been out of the field for a few years, and in those few years is when the big push to have field providers perform more interventions has happened.

Is there something inherently wrong with that, though?

[Chief1C]

Back in the day.. ha ha.. when I first began, which was a mere 14yrs ago.. we covered a truly massive area. Went to the edge of our 1st due, more than 30 miles out and picked up a chest pain patient. An ALS Squad unit assisted, did an EKG didn't find anything...and released care. Sent us on our way to the ER, which by patient choice, was over 45min away. Pain came in waves, so I called a different paramedic unit to intercept. Just because. I went head to toe, b/c that's what I was taught. Felt something strange, it was like a balloon rapidly inflating and deflating, a balloon within a balloon. The vitals, as I recall, were relatively normal. Then the patient had a sudden onset of pressure in the abdomen, with pale skin, diaphoresis and hypotension. Medic got on, did the EKG, said, probably an MI, stop at the nearest ER. I suggested it was something more, which he sort of ignored b/c I was fresh out of the box. Described it. He felt. Met a chopper along the road. Patient survived his ruptured AAA.

I've had several AAA patients, and I always thought - should I palpate or shouldn't I? Will it cause it to rupture? Usually, they were already ruptured.