Did You Look And Feel? Hands and eyes on?

[firedoc5]

Women do get embarrassed by things like that, just like if they cut your pants off and the socks fell out. Another thing is when they are menstruating. I always made a habit of asking if they were on their period. If so made sure I had a pad to put in place after quick check that not bleeding excessively.

Had a MVA with several ejected out in a muddy field. I was cut up a gal's pant leg when she told the medic that was holding her C-spine that she was on her period and explained that she had a pad and not a tampon. I usually took that into consideration any time I was exposing, especially before applying MAST device. I just never had a patient come right out and explain that. A few weeks later I met her again. She was a friend of a gal I had just started dating. At first she seemed embarrassed when we ran into each other. But she eased up realizing that I didn't think of it and I was just doing my job.

[spenac]

Had a MVA with several ejected out in a muddy field. I was cut up a gal's pant leg when she told the medic that was holding her C-spine that she was on her period and explained that she had a pad and not a tampon. I usually took that into consideration any time I was exposing, especially before applying MAST device. I just never had a patient come right out and explain that. A few weeks later I met her again. She was a friend of a gal I had just started dating. At first she seemed embarrassed when we ran into each other. But she eased up realizing that I didn't think of it and I was just doing my job.

That brings up an important point. I ask all females, trauma or medical, pretty much 10-50 if they are on period or are pregnant, sometimes younger and older. Had one eight year old that had fainted, we get on scene, she is pale. She said she had been feeling very tired all day. I asked if she had started having her period, her mother was like she's to young. The little girl then told her mother she had been having periods for several months already. She did turn out to be on it and had gotten very anemic. It is very important to get hands on. To ask questions. Don't be shy. Do your job or find a new profession.

[spenac]

This was posted on the scenario about my nut is swollen and hurts. It really explains need to examine in depth.

chbare wrote

"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. "

[firedoc5]

On the topic of genitals, we had a cave in at a construction site for a basement. One guy covered up. One medic, who was (let's just say he was my boss,ha ha) stepped down onto him while attempting to dig a little more. The patient suffered a ruptured testicle. It was decided it was from "Denny's"* size 10 boot that did it, not the cave in.

*Trying to protect name of guilty)

With young women, especially after a syncopal episode, one of my first questions are whether they may be pregnant or not. One night at a special occasion at some kind of social club (Elks, Moose, American Legion,etc.) where they were honoring girls, one of them passed out. Asked if she may be pregnant and she said it was possible. Then she asked one of the members if she would still get her award. I don't know if she still got it or not.

I've heard of girls as young as 8 getting their period, and the youngest pregnancy I've heard of was 9. Not for sure if it was true or not.

[Fluffpaw38]

My intstructors always said, Everything BUT taste. 8) hasn't failed me yet. Just let the pt know what your doing at all times, so there is no suprises.

[chbare]

I understand it may be a bit more difficult in the pre-hospital environment to perform these assessments. Always make sure your partner is present and can back you up should somebody say you did something uncouth during your assessment. In the hospital, I am able to grab a female to act as a chaperone when I perform an assessment on a female patient.

Take care,

chbare.

[firedoc5]

I understand it may be a bit more difficult in the pre-hospital environment to perform these assessments. Always make sure your partner is present and can back you up should somebody say you did something uncouth during your assessment. In the hospital, I am able to grab a female to act as a chaperone when I perform an assessment on a female patient.

Take care,

chbare.

EXACTLY. Very good point. Had a call to a fast food place where a girl had passed out. She was on a high school trip. As we were loading her I asked if there was a woman chaperone with the group. Luckily there was. There was an incident in a near by system where the medic did do something, and he was the only one in back. The patient wasn't lying and he got nailed. (served him right :angry5: ) After that we all took extra precaution.

[itku2er]

I think its harder for men to do the hands on in some situtations like the one doc was talking about. Even if you dont do anything wrong by doing your job some people are jsut out for a quick buck and wam you are nailed for inappropriate behaviour. Dont really have that many cases of women getting nailed for it. But still nothing beats a good hands assessment.

[PatrickW]

I don't rely on machines for anything. I use all of my senses. For example, when checking someone's BGL, I don't use a silly high-tech machine. I taste their capillary blood.

Mmm, hyperglycemia.

[spenac]

I don't rely on machines for anything. I use all of my senses. For example, when checking someone's BGL, I don't use a silly high-tech machine. I taste their capillary blood.

Mmm, hyperglycemia.

Only problem with that method is calibration. If you have had candy or soda you will register them as low. If you have not had any food or drink during past 12 hours you will register them high. Because of theses findings I have returned to using a properly calibrated machine.