Did You Look And Feel? Hands and eyes on?

[itku2er]

I am with Jake .......I expose in ambo privacy on scene. To me listening BBS through clothes isnt an option, too much room for error.

Ok what about the use of manual cuffs you all use them or the automatic ones?

And pulse checks rely on the machine or do you feel them?

[AnthonyM83]

Oh, and add LA to the list of places not to visit.

I've given all my EMT partners explicit instructions. If I'm involved in a trauma, do NOT wait for county medics. Go straight to the trauma center. And if he HAS to b/c of my condition, go into LAFD borders...they're just a bit better than county...but it's still LA...oh and travel away from these hospitals' service areas.

We had a conversation the other day. Would you rather go to one of the local ERs shot in the hand or the farther trauma center shot in the head? I think everyone answered shot in the head...

[itku2er]

Is it that bad out there anthony?

[spenac]

I am with Jake .......I expose in ambo privacy on scene. To me listening BBS through clothes isnt an option, too much room for error.

Ok what about the use of manual cuffs you all use them or the automatic ones?

And pulse checks rely on the machine or do you feel them?

I prefer manual at least for first set and if serious prefer manual confirmation prior to any meds. For long transports auto is nice to keep an I on patient but never rely fully on them.

I don't touch patients so guess machine for pulse. Just kidding hands on even helps confirm in some instances your EKG to some extent.

We have to invade peoples space. Do so in a confident manner explaining what your doing and most have no problem because other healthcare professionals do it so they expect it.

[AnthonyM83]

Is it that bad out there anthony?

On a lot of the routine calls, it's fine...yeah they do most basic stuff that they have to...get a line if you HAVE to give a med, give albuterol, take an EKG to make sure it's not a STEMI, check sugar. They handle the basic necessary stuff and just hand it off to the hospital (though since overcrowded they might not get the best tx and not right away).

But pretty much anything else that can be justified (at least on paper, not in reality) to go BLS, they just ship off code 2...with often hours of waiting in ER hallway for bed. Lies on paperwork, so pt doesn't get accurate tx or testing.

Or anything critical that's different from norm, it turns into a circus. People die that seem like they could have lived. Any difficult intervention isn't done.

There are some exceptions. Some good medics (and some that would like to be good medics...heart in right place, but not well-trained/educated) but even then they're limited b/c of limited protocols (b/c others blew it for them) and influenced by other medics not to follow up on stuff...

[itku2er]

I guess coming from a small town there isnt a real wait to get into our er so this is amazing to me. Yes simple minds are easily entertained. But anyway, all our traumas are flown out if they are major enough all GSW are and most MVC's are if they are major injury the major trauma centers here are 2 hours away.

[Cookie]

I was always taught to Look, Listen and Feel. How a person assesses a patient without doing the above is beyond me, yet I have seen some try or attempt to do it. Even assisting in classes I tell them they have to look what they are assessing, listen to it and feel it.

[spenac]

Really this made me think back to an old topic:

http://www.emtcity.com/phpBB2/viewtopic.ph...71&start=45

While it was agreed not all need to be naked, based on what people are saying here definitly need to expose area of compaint, touch, and listen.

[Just Plain Ruff]

Let me discuss the need for touching, feeling and just basically assessing hands on for your patietn.

I worked in a small ER in a town of about 9000 people.

We had a old country doc who was a phenomenal doc. He sponsored me to go to ATLS and not just as a observer but one who got to do all that the doc's got to do.

Well, he had externs that followed him around from the osteopathic medical school.

There were two different patients who would come in. One with a artificial leg and another with an artificial eye.

He would have his externs evaluate them and give a report.

Many times the externs would come back and give a report that pulses were bilateral in both legs or the eyes were normal.

He asked them to go back and check again and several times the externs would come back with the same report.

He would then proceed to have a loud discussion with the extern and then show them the errors of their ways. A couple of times those externs would pack their bags and go home in disgrace.

He said he didn't want a doctor who first off didn't do a full evaluation and then would lie to him when they repeated the exam.

I've had students in the past who were scared to lift the breast up to put the 12 lead electrodes on therefore getting a incorrect 12 lead reading. One was so poorly done that the Ekg originally showed less than 1mm elevation in 2 3 and AVF but when I asked them to lift the breast and do it again it showed 3-5 mm of elevation.

I've had students listen for breath sounds thru their shirts. It wasn't surprising that they originally missed the pneumo that had developed but after telling them to cut off the shirt they caught it.

I have had partners who wouldn't touch the patient no matter what.

We have the technological tools and diagnostic tools that enable us to sit back, drink our coffee and monitor the patient. Not even a ambulance with a million dollars of equipment, fully state of the art equipment and eventually we will have the ability to use the doctors wand that we see on star trek, none of that compares to the 5 senses that we have been given by God or whoever you believe in.

It's easy to rely on the bells and whistles that our company buys us to put in the ambulance but to not be hands on and use the senses we have then we are nothing more than the Geeksquad.

It's disconcerting that the current crop of students are not taught the basics but even more disoncerting that we have medics/emt's out there who let it slide.

Like I said in a different thread, the first time that someone misses a GSW to the back of an unconscious patient by not exposing and looking should be the last time they take care of a patient.

[Just Plain Ruff]

one other thing, when I was helping teach a EMT class about 10 years ago several of the students would not do any touching of the patient whatsoever.

MVC patient, head on scenario, unresponsive patient. Not once did they touch the patient. I would not give them any answers and shortly the patient coded.

They asked me why I killed them and I said, I didn't, you did. They asked why. I said that you didn't touch them and you missed the 4 GSW to the back.

That particular student began to touch the victims in scenarios.

Others refused to touch even after all their patients would die and several never made it out of class.