Eydawn Posted January 22, 2008 Share Posted January 22, 2008 You're right, looking and noting the color is exactly what I'd do. See above. I guess I still am having a hard time imagining what I could feel that I could describe to a doc to expedite the guy being seen... I know color is a key here... but... ? See where I'm coming from? Again, temperature difference... if he really couldn't feel a difference because he didn't have good thermoreceptors in his hands, yeah... I'd check for that... Wendy CO EMT-B Link to comment Share on other sites More sharing options...
hammerpcp Posted January 22, 2008 Share Posted January 22, 2008 Well, I am not looking or touching. Their is no life threat. there is no treatment I can provide. I will base my priority assessment on the level of distress th pt was in and that all. As far as symptoms and signs I will ask the pt to describe for me. This is not negligence. I wouldn't know what I was looking for anyway. It is out of my realm of expertise. I wouldn't do a pelvic exam on a woman either. Link to comment Share on other sites More sharing options...
Kiwiology Posted January 22, 2008 Share Posted January 22, 2008 Testicular torsion. Been there, done that, got two tylenol at ED for it (I protested and asked the sleepy looking resident for something stronger!) and it went away on its own. Mwahahah no surgery for me! Link to comment Share on other sites More sharing options...
spenac Posted January 26, 2008 Author Share Posted January 26, 2008 Why are we so squeamish about touching? Our job is a hands on job. Link to comment Share on other sites More sharing options...
Chief1C Posted January 26, 2008 Share Posted January 26, 2008 Why are we so squeamish about touching? Our job is a hands on job. Sounds like you just wanna feel'em up.. Link to comment Share on other sites More sharing options...
chbare Posted January 26, 2008 Share Posted January 26, 2008 I have been watching this thread with some interest for a while. Allow me to weigh in? Why would we not perform a focused assessment of the genitals? This is the patients primary complaint and part of our care involves performing a physical exam. We should have ruled out and treated any life threats during out primary exam. Now, we can perform a focused exam. I remember having to do this at the medical station back when I did my NREMT-B, so the concept is not beyond the basic EMT. True, the stupid stations usually require you to focus on a chest pain or poisoning and call for you to help with a self assisted med; however, the concept is still intact when we hit the real world. Why would we not perform a brief physical exam and ask a few specific questions? I took care of an elderly lady a few weeks ago who was taken to the ER for vaginal bleeding. The EMT refused to perform an exam and told us that kind of assessment was outside of her scope of practice. If she would have simply taken a look and performed a brief exam of the area, she would have clearly noted a prolapsed uterus. This is a pretty significant finding to miss IMHO. There are a few simple things that we can do: -First, look at the genitals. Note color, swelling, the presence of any skin abnormalities, and look for discharge or blood. -Next, get hands on. Gently palpate and note any abnormalities to the best of your abilities. The text book finding know as the Prehn Sign may provide us with some tangible information. (Elevation of the teste decreases pain with epididymitis, while pain increases with torsion) -Finally, ask detailed questions about the history. Time of onset, dysuria, chills, fever, sexual history and possibility of STD's, and surgical history to think of a few. True, you may not be able to treat these conditions in the field; however, your assessment findings may prove valuable to the receiving facility and help expedite definitive care. People can easily slip through cracks in the ER and emphasizing key findings may expedite treatment to a person with a suspected serious problem. Torsion for example. You cannot treat massive internal hemorrhage in the field, but you let the ER know your findings and emphasize the possible critical nature of the patient based on you findings. While GU complaints may be less glamorous, assessing a suspected emergency should not be based on the system involved. Just one last thing to add: Testicular torsion is considered a true urologic emergency. If the testicle is not de-torsed, it will die and necrose. This will result in the loss of the testicle. Last I remember, we are in the business of emergencies. Sadly, I suspect most EMT schools spend very little time covering the GU system. Take care, chbare. Link to comment Share on other sites More sharing options...
spenac Posted January 26, 2008 Author Share Posted January 26, 2008 chbare Excellent response. I can not understand why so many are afraid to do their job. Trust me I have no desire to grab a guys nuts, but if thats where his complaint is I need the info to pass along to the doctor. Perhaps as chbare mentioned my actions just might get them definitive care faster. If you are afraid to touch you really need to get past that fear or else look for a new job. Link to comment Share on other sites More sharing options...
hammerpcp Posted January 26, 2008 Share Posted January 26, 2008 chbare Excellent response. I can not understand why so many are afraid to do their job. Trust me I have no desire to grab a guys nuts, but if thats where his complaint is I need the info to pass along to the doctor. Perhaps as chbare mentioned my actions just might get them definitive care faster. If you are afraid to touch you really need to get past that fear or else look for a new job. I absolutely disagree with you both. It is NOT part of my job. It will have no benefit to the pt. Period. Absolutely non productive and inappropriate. Link to comment Share on other sites More sharing options...
Fluffpaw38 Posted January 27, 2008 Share Posted January 27, 2008 Its an assessment....it wouldnt kill the patient......im talking to the guy above me.... :shock: Link to comment Share on other sites More sharing options...
mobey Posted January 27, 2008 Share Posted January 27, 2008 There are a few simple things that we can do: -First, look at the genitals. Note color, swelling, the presence of any skin abnormalities, and look for discharge or blood.-Next, get hands on. Gently palpate and note any abnormalities to the best of your abilities. The text book finding know as the Prehn Sign may provide us with some tangible information. (Elevation of the teste decreases pain with epididymitis, while pain increases with torsion)-Finally, ask detailed questions about the history. Time of onset, dysuria, chills, fever, sexual history and possibility of STD's, and surgical history to think of a few. True, you may not be able to treat these conditions in the field; however, your assessment findings may prove valuable to the receiving facility and help expedite definitive care. People can easily slip through cracks in the ER and emphasizing key findings may expedite treatment to a person with a suspected serious problem. Torsion for example. This will result in the loss of the testicle. Last I remember, we are in the business of emergencies. Sadly, I suspect most EMT schools spend very little time covering the GU system. chbare. Hmmm lets see, Proper thourough assesment, apply critical thinking, treat, transport, then act as a Pt advocate? What do you think your job is?? If this was a severe toe pain in a diabetic would you visualize and touch? Or is seeing and touching stinky necrotic diabetic feet not your job either? Link to comment Share on other sites More sharing options...
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