Abdominal Exam

[Kiwiology]

To assess for rebound tenderness, palpate the abdomen deeply and then quickly release the pressure. If the patient reports increased pain when pressure is released, he has rebound tenderness, which represents aggravation of the peritoneum and may indicate peritonitis

I was taught'd with the edumkuashin that we should no longer assess for rebound ternderness, as to why, search me .... I'd venture an edumoocatered guess that it's probably of little value and considerable pain to the patient.

Edited January 16, 2010 by kiwimedic

[VentMedic]

I was taught'd with the edumkuashin that we should no longer assess for rebound ternderness, as to why, search me .... I'd venture an edumoocatered guess that it's probably of little value and considerable pain to the patient.

If you don't have IV acces and meds to alleviate the pain you cause, may one shouldn't do something intentionally that will cause pain to exacerbate. If you are purposely looking for tenderness there is a chance you'll find it or create it.

Edited January 16, 2010 by VentMedic

[spenac]

Maybe we should not transport as we could wreck or hit a pot hole and cause the patient pain.

[VentMedic]

Maybe we should not transport as we could wreck or hit a pot hole and cause the patient pain.

If you going to intentionally drive in a manner that may cause pain, then may the patient should have something for pain. If you hit the pothole unintentionally then there shouldn't be a need.

We do medicate patient before and during a transport that will be painful. That includes a variety of scenarios be it in the field, on a helicopter or a CCT truck.

If a procedure causes a patient pain, we do not allow the person to remain in pain if at all possible. Yes, some examines are painful and some patients may not get medicated before but one would hope they will get some relief after.

[spenac]

If you going to intentionally drive in a manner that may cause pain, then may the patient should have something for pain. If you hit the pothole unintentionally then there shouldn't be a need.

We do medicate patient before and during a transport that will be painful. That includes a variety of scenarios be it in the field, on a helicopter or a CCT truck.

If a procedure causes a patient pain, we do not allow the person to remain in pain if at all possible. Yes, some examines are painful and some patients may not get medicated before but one would hope they will get some relief after.

Well pain meds then after assessment same idea as you say for painful transport. No difference.

[AnthonyM83]

I was taught'd with the edumkuashin that we should no longer assess for rebound ternderness, as to why, search me .... I'd venture an edumoocatered guess that it's probably of little value and considerable pain to the patient.

There's no official rightness or wrongness to checking it, but one can gather much of the same information by percussing the abdomen and possibly causing less pain.

Edited January 19, 2010 by AnthonyM83

[Dustdevil]

If you don't have IV acces and meds to alleviate the pain you cause, may one shouldn't do something intentionally that will cause pain to exacerbate. If you are purposely looking for tenderness there is a chance you'll find it or create it.

Quoted for profundity.

[Arizonaffcep]

Patient had not eaten lunch yet and tells us the pain feels as if something is "pulling apart" in his belly and lifts up his shirt to reveal an vertical 5-8cm oval lump in his abdomen just off the mid line.

On scene the patient was outwardly stable. From the history, visualization of the abdomen and vital signs this pt was potentially unstable 2 large bore were started in route, and run kvo, on arrival I advised the ER staff I was treating a rule out AAA and they confirmed it by a sono. Patient was taken to the O.R. he burst on the table but was saved.

How thin was this patient? Seriously...on an "regular sized" adult, you shouldn't be able to see that. I just did a paper on permissive hypotension, and came across a quote (although for the life of me I can't find it again). However, it did say something along the line of a patient can bleed in the realm of 2L into the abdomen without it being noticed visually (distending). This being said...I would find the whole sitution implausable.

[kohlerrf]

Maybe we should not transport as we could wreck or hit a pot hole and cause the patient pain.

Are you saying if you transport and don't hit a pot hole you should press on their abdomen until they show signs of pain? Or how about we treat the pt on all the other facts in evidence after taking a complete history and performing a physical exam excluding abdominal palpation? If your pt was orthostatically hypotensive, tachycardia, pale and cool with or without abdominal pain how would your prehospital treatment change?

[spenac]

Are you saying if you transport and don't hit a pot hole you should press on their abdomen until they show signs of pain? Or how about we treat the pt on all the other facts in evidence after taking a complete history and performing a physical exam excluding abdominal palpation? If your pt was orthostatically hypotensive, tachycardia, pale and cool with or without abdominal pain how would your prehospital treatment change?

No I'm saying it's stupid not to do a proper exam because you may cause some pain. If you are not willing to risk causing some pain you should even drive as you are just as likely to cause pain and discomfort with the bouncy ambulance ride. So do your job and do a proper exam. A proper examine requires seeing, listening, and yes touching.