Help my right nut is swollen and hurts

[Don1977]

and what does the nut in question look like? as compared to the other nut?

Um, I dont plan on assessing no ones nut, he will get vitals taken and transproted.

[spenac]

Man I see why we have so much trouble being seen as Healthcare Professionals. My medical director might let me get away w/o actually palpating because as somebody mentioned we really would not be sure what we are feeling and honestly would not affect our treatment. But to not visualize. That is just not doing your job. How serious is it? If you fail to look and turns out it is turning black and you don't know it you can not give an accurate report to the hospital, perhaps even delaying important care needed as they may just laugh it off as just another viagra complication.

Personally I was taught day one of first responder class that EMS is a eyes and hands on business. That w/o seeing and touching you are missing vital information that might affect even hospital care as they may base their triage based on what we say.

So back to original patient he gets to ER and thankfully ERDoc is on duty and bored so he immediately asks you what did it look and feel like. Those that took a look say appeared bigger and normal color but no one descibes how it feels. ERDoc asks did you check all sides of it? No just saw the front. As ERDoc lifts and looks he sees that on the backside it is getting dark colored. He immediately gets patient into surgery and repairs what had been a simple hernia that had just gotten twisted and started strangulating. With ERDocs excellent skills your patients pride and joy remains in tact and in working condition.

[Just Plain Ruff]

Actually I think that palpating it would have provided quite a bit of interesting info.

1. level of pain on manipulation

2. If you examine the right versus the left then you would have a good idea of size comparison (and not to your own coconuts)

3. I believe if you lift a testicle and it causes pain it's a good sign of epididimytis I think(at least that's what I remember on reading about it)

EMS is hands on guys, how can we provide a adequate exam or evaluation if we just look at it.

I know this is late but the guy probably waited in the ER for hours prior to our own ERDOC to step in a look at it and get the guy to surgery. But had one of us examined and looked at the affected area he might have gotten to surgery quicker.

But then again, it's all armchair quarterbacking.

[spenac]

Thank you Ruff. That is exactly the point of this scenario to help drive home that we need to get hands on. I am surprised the looks on other medics faces when I go to touching and looking at patients to evaluate area of complaint. It surprises me how few look at the chest of patients with chest pain.

[ERDoc]

With ERDocs excellent skills your patients pride and joy remains in tact and in working condition.

:lol:/ Go me!!!

Seriously though. It is very important to look, listen and feel (ok, maybe in this case it is not important to listen). You physical exam can uncover some subtle findings. The main differential in a case like this is torsion, epididymitis, hernia, orchitis and a few other things. If one testicle is riding higher and possibly rotated you can be more concerned about torsion. If the pain feel better by elevating the testicle you should think epididymitis. That being said, you will be hard pressed to find an ER doc that will base their treatment on their physicial exam. There are just too many bad consequences if you miss a torsion, so more than likely most patients are going to get an US.

[Just Plain Ruff]

the first time that a medic misses a GSW on a guy that they didn't look at the back when the boarded him will be the last time they don't look. Plus it actually should be the last time they take care of a patient but that's for another thread.

If you don't look, listen, feel and touch then you aren't doing your job.

[spenac]

Ruff and ERDoc we need your insite on this topic:

http://www.emtcity.com/phpBB2/viewtopic.ph...&highlight=

[Eydawn]

I will palpate and assess any body part that I feel necessary to examine for my patient's well being. This includes genitalia if the situation calls for it.

Here's the problem I have with this particular scenario... by touching this patient's testicles, I really am not gathering any information that will help me treat him, and my physical exam will be repeated in the ER. All I would be doing is an exam that will be painful to the patient.

I will *visually* inspect it and ask the patient to manipulate it because he has a much better idea of how much pain everything is causing him, but I won't subject him to pain from my assessment because it won't save time on anything or benefit him, short or long term. I'm not a doctor. I don't know enough physiology for my physical exam to be of much benefit in this particular instance. He's not bleeding out from it, nor is it obstructing his airway... so as a BLS technician, what good does it do me to palpate it? I'm thinking about my limits here.

I can't reverse torsion, nor repair a hernia, nor cure an infection in the field. If I could do so, and my physical exam would allow me to differentiate between them and administer the appropriate treatment, I certainly would do so. The point is, my exam is not going to change my treatment, it's going to cause the patient more pain and distress, and the information isn't enough to begin an immediate treatment course.

Wendy

CO EMT-B

[spenac]

I will palpate and assess any body part that I feel necessary to examine for my patient's well being. This includes genitalia if the situation calls for it.

Here's the problem I have with this particular scenario... by touching this patient's testicles, I really am not gathering any information that will help me treat him, and my physical exam will be repeated in the ER. All I would be doing is an exam that will be painful to the patient. Wendy

CO EMT-B

Perhaps your description of what you feel might give the doctor the clue that something serious is up. Don't be bashful and never doubt the input you might give even as a basic. I have had a female complaining of pain to a breast. In palpating compared to the other found a hot spot. Doctor met me as I wheeled patient in and patient started getting immediate treatment. Had I just said patient complains of breast pain/ non cardiac related she would have waited hours to be seen. I do not know full details but she was admitted to the hospital. So that little tid bit that causes no changes in my care can get patients much needed care quicker.

[Just Plain Ruff]

you are right Wendy, it will not change your treatment but by noting that there is a blackened area or whatever the color of that area was on his bag might have saved him from sitting in the ER for longer than necessary.

It also might have saved him from having to wait for surgery until the doctor can get to him.

Nut pain does not elicit a lot of urgency in the ER especially if it's been going on for over a month.

But if the bag is looked at and assessed then you can tell the doc or the nurse, "the back of the bag is this color or whatever" then this might decrease his wait for surgical intervention.