Trauma strip every patient?

[DwayneEMTP]

I was reading an article in this months Jems labeled "Underexposed: The neglected part of the physical exam"

(May-2006 pg.40-43, Mark Rock)

It seems to says that every patient should be stripped if you are to perform a proper assessment. This applies to medical and trauma, with no regard to apparent severity of the issues.

"We should approach a physical exam" (comprehensive physical exam, secondary survey, or detailed physical exam are the terms used throughout the article) "in the same way we do vital signs: something that is performed on each and every patient we make contact with, regardless of complaint or apparent condition."

Also:

"It's truly disheartening to watch paramedics start IV lines on patients wearing shirts. ... Delivering a patient in this manner indicates that the providers have not performed a proper physical exam"

It's hard to believe that this is the standard. When I went on my ride-alongs in the Basic Academy we didn't strip anyone completely....

I'm just wondering if there are providers that do actually strip everyone...? Or did I somehow fail to read between the lines and grasp the concept of this article...?

After reading the posts slamming Wankers who "just want to strip somebody!" I was a little surprised by this article...

I look forward to your replies...

Dwayne

[AZCEP]

Considering the majority of patients don't require any procedures to be done, and, aside from visual exam, you can palpate through most clothing, why in God's name would we completely disrobe every patient?

Critical trauma--clothes are history

Critical medical(especially cardiac/respiratory)--clothes are gone

Most others, I will leave at least one layer of clothing in place. If just for the patient's comfort.

There are very few strangers that I will feel good about stripping in front of, so why would I expect my patients to be okay with it?

[Ridryder 911]

I agree, one should use common sense. I can assure you not every patient is stripped in ER or even a trauma center as well, the author needs to work and learn in that environment, before making anal statements. Yes, you should be sure that there is no injuries, yes, expose patients in major trauma, but for the 30 year old that twisted his ankle being bare butt naked is not appropriate.

The same as medical calls, grandma is complaining of diarrhea you are going to strip her down as well?...The ER Doc , going to check your hemorrhoids for that lacerated finger ?.. I think not.

This is why I went to school, this is why I spent thousand of hours of clinical rotations in obtaining experience of being able to determining how to perform an assessment and which should be deferred and those that should be addressed.

Be safe,

R/r 911

[AnatomyChick]

A Happy Trauma Patient is a Naked Trauma Patient... that's the principle that I teach.... (although, if I'm in a traumatic accident and I wake up and am nake, NO ONE is going to be happy... )

I do think that the stripping should be done with concern to modesty and with common sense. If someone amputates their hand in a saw, I think we have to consider that we "may not" need to take his pants and underoos off. Think of it as a case by case thing.. if you consider that there is ANY possiblity of injuries under the clothing.. off they come!

[medik8]

:shock: OMG! Please....It is absolutely absurd to think that everyone needs their clothes removed. Like Rid and others have said, use common sense. I think AZCEP's post reflected my feelings most accurately.

Major/Critical Trauma= adios to your clothes, most definitely. And unless it's really critical or big time trauma, even then I use modesty when possible (meaning I don't just let everything flop around... :shock:) I cut the clothes in such a manner that when i discover that area is "trauma free"... I can pull the flaps back over. Otherwise, I just use a blanket. I've seen lots of medics expose...and then leave things exposed while the patient is just lying there, shivering, in pain. Not cool.

Major medical; again cardiac/resp= clothes off. Again, as comfortably and as best done as possible.

(arrests...duh...self explanatory to everyone... I hope...)

I admit, if someone's dying, screw the modesty. They definitely are NOT going to care about it in that case...

This is, once again like many other things, common sense. Definitely expose your patient enough to perform a thorough assessment WHEN NECESSARY. But, let's not get stupid with it.... :roll:

xoxo

8

[hammerpcp]

:tard: Whoever wrote that article is stupid, or you misread it. I can't tell you which since I haven’t seen it. Generally speaking blanket statements, especially for such an inexact science like medicine, are inherently wrong. Should I have disrobed the pt I just carried who had a booboo on his elbow? Of course not. To say that I should is just plain ridiculous.

[akflightmedic]

I try to strip my clothes off on every call. It is essential to patient care.

[medik8]

I don't know about you all...but I'm getting a job as AK's partner... :blob4:

Holy crap.... :shock:

Naked EMS....sounds good to me...maybe it would make the patients feel more comfortable if we exposed ourselves as well. Heyyyy...now that's an idea....

xoxo

8

[csr]

I try to strip my clothes off on every call. It is essential to patient care.

NOw that's funny. Thanks for the laugh.

[Ridryder 911]

I try to strip my clothes off on every call. It is essential to patient care.

TMI.....TMI.... vivid images :shock: ...I bet you are careful where they place the sharps !