Cutting Clothes

[medic417]

Ok. Could they have lifted up the underwear to look... without having to cut it off?

Honestly moving underwear around would probably make a patient feel like you were trying to get a peek at their privates more than if you were to cut off or slide off underwear. Expose then cover with a sheet or blanket. Put them in a hospital gown. Be consistent and do the job. If fear of lawsuits affects patient care at some point that is more likely to get you sued where you will lose than just doing the job as needed and consistently.

 

[Ridryder911]

Don't want to receive painful response to be checked or have a nasopharyngeal airway placed, then quit faking it. Sorry, I will not be mean but I have no tolerance for fakers as well. I will be place them privately and be VERY blunt & whisper to them; if I am medically educated enough to treat them, I am medically educated to tell B.S. from the real deal. So for time sake, you can continue your performance or awaken and discuss the problems. If you wish to continue the charade, then you must surfer the consequences of those with that symptoms and I can assure it is not nice.

Usually, they will usually make a remarkable recovery. The option is theirs. It is not torture, they have a choice.

R/r 911

 

[downunderwunda]

There is no reason why an initial assesment cannot be mad on the raodside with minimal cutting. If you find something then certainly explore it further. My principal is Primary assessment, collar, KED, into wagon then cut, cut, cut.

Patient modesty is always a primary concern. You can do a proper assessment in your car, & yours are bigger than ours. You can do a good seconday with notes on where to explore on a tertiary, prior to transport. The only time i will deviate from that is if there is too much claret & I need to determine the cause there & then.

 

[Fir Na Au Saol]

After reading this entire thread, it seems pretty simple really, if you have your brain switched on and are using it. Do what medically needs to be done for each patient. If they're talking to you, talk to them. Tell them what is going on and why you need to do this or that examination or procedure. If they're not talking to you, do what medically needs to be done for each patient. If the family is standing there watching you, tell THEM what is going on and why you need to do this or that examination or procedure. Now granted, that isn't always that easy with a critical patient, but do what you can.

Think. Communicate. Document.

That's my $0.02 of free opinion, YMMV.

 

[medic417]

After reading this entire thread, it seems pretty simple really, if you have your brain switched on and are using it. Do what medically needs to be done for each patient. If they're talking to you, talk to them. Tell them what is going on and why you need to do this or that examination or procedure. If they're not talking to you, do what medically needs to be done for each patient. If the family is standing there watching you, tell THEM what is going on and why you need to do this or that examination or procedure. Now granted, that isn't always that easy with a critical patient, but do what you can.

Think. Communicate. Document.

That's my $0.02 of free opinion, YMMV.

Actually even if you are sure patient has no ability to know what is happening you should tell them what you are doing. You might be surprised when they recall the rude comments you made about them once they wake up. Plus that keeps you in the habit of talking to your patient as well as you may hear yourself and decide no I should do this different.

 

[Sasha]

What if you are wrong and they are not faking? Now you have done harm. First rule is do no harm.

Be realistic. Sometimes you HAVE to do harm, and a sternal rub is very low on the "harm" scale. It hurts, two seconds later, it still kinda aches, and then you're done with it.

Sternal rubs are needed to asses the "P" in "AVPU". I'm not gonna use my pen on their nail, or go around pinching people. Sternal rub is my "P" assesment of choice

Would the same apply to those who start saline locks "just in case"? They don't need it at that point, IVs hurt, so they're doing harm. Should they all have their licenses pulled?

 

[medic417]

Be realistic. Sometimes you HAVE to do harm, and a sternal rub is very low on the "harm" scale. It hurts, two seconds later, it still kinda aches, and then you're done with it.

Sternal rubs are needed to asses the "P" in "AVPU". I'm not gonna use my pen on their nail, or go around pinching people. Sternal rub is my "P" assesment of choice

Would the same apply to those who start saline locks "just in case"? They don't need it at that point, IVs hurt, so they're doing harm. Should they all have their licenses pulled?

Actually starting IV's just to start them is bad medicine. If you have no reason to suspect any possible need of meds or fluid and that the ER is just going to release them you have no business starting an IV. Honestly doing it w/o need is either an attempt to punish the person wasting your time or it is a way to bump the bill to ALS grade, which is fraud.

Oh and I already admitted to need of stimuli for the "P" in AVPU. Please don't beat me no more.

 

[Shishkabob]

Can't forget traction in traction splints... causes pain for the better good.

 

[medic417]

Can't forget traction in traction splints... causes pain for the better good.

Yes but once in place and bones realigned by traction most patients even w/o pain meds say it hurts less than it did before traction applied. Of course now I do not do it w/o pain meds but when as a basic I just had to tell them this will hurt like heck.

 

[Sasha]

Actually starting IV's just to start them is bad medicine. If you have no reason to suspect any possible need of meds or fluid and that the ER is just going to release them you have no business starting an IV. Honestly doing it w/o need is either an attempt to punish the person wasting your time or it is a way to bump the bill to ALS grade, which is fraud.

Or, they're started because hm... Last time I checked we weren't doctors, we couldn't diagnose what's REALLY going on with the patient, and no one is every really "stable" but "potentially unstable" and you want to have that line in case they need meds, but at this point you have no plan for meds or fluids.

The last ride time I had, I started a saline locked IV just because the patient didn't feel right, but there was nothing outwardly wrong with him. I felt better with one just in case his condition changed. Not because I was "punishing him" and I don't really care what the cost of transport is billed as, neither did my preceptor due to the fact it wasn't private.

In the middle of transport patient had a seizure which we easily treated because of previously established IV access.

Still call it bad medicine?

 

[medic417]

Or, they're started because hm... Last time I checked we weren't doctors, we couldn't diagnose what's REALLY going on with the patient, and no one is every really "stable" but "potentially unstable" and you want to have that line in case they need meds, but at this point you have no plan for meds or fluids.

The last ride time I had, I started a saline locked IV just because the patient didn't feel right, but there was nothing outwardly wrong with him. I felt better with one just in case his condition changed. Not because I was "punishing him" and I don't really care what the cost of transport is billed as, neither did my preceptor due to the fact it wasn't private.

In the middle of transport patient had a seizure which we easily treated because of previously established IV access.

Still call it bad medicine?

You didn't do it just because, you did it because based on what the patient said made you feel more comfortable in case. That was justified. But the caller with a stubbed toe that doesn't even hurt anymore has no bruising or swelling, no other complaints, just decided he wanted to go let a doctor see it does not need an IV.

And regardless of what they teach you in school you do make a field diagnosis. If you did not you would not have any needs for any medicine or equipment. You would just sit beside them for the ride and do nothing. So don't start the I don't diagnose crap you know better than that.

 

[Fir Na Au Saol]

Actually even if you are sure patient has no ability to know what is happening you should tell them what you are doing. You might be surprised when they recall the rude comments you made about them once they wake up. Plus that keeps you in the habit of talking to your patient as well as you may hear yourself and decide no I should do this different.

Good point. I do make a habit of talking to all patients. CVA and seizure Pts often can hear and remember even if they can't respond. This has earned me copious thanks from a couple of seizure Pts.

 

[Sasha]

You didn't do it just because, you did it because based on what the patient said made you feel more comfortable in case. That was justified. But the caller with a stubbed toe that doesn't even hurt anymore has no bruising or swelling, no other complaints, just decided he wanted to go let a doctor see it does not need an IV.

And regardless of what they teach you in school you do make a field diagnosis. If you did not you would not have any needs for any medicine or equipment. You would just sit beside them for the ride and do nothing. So don't start the I don't diagnose crap you know better than that.

Oh of course you speculate what you THINK it is, I do it all the time on rides and if I'm in the same ER later that day, ask the doctor what was going on with the patient to see if I was right or way off base.

However if you start giving your patients a dx or tell the doctor there's nothing wrong with that patient, you BETTER be 100% right or you make yourself look like a butt.

 

[medic417]

Oh of course you speculate what you THINK it is, I do it all the time on rides and if I'm in the same ER later that day, ask the doctor what was going on with the patient to see if I was right or way off base.

However if you start giving your patients a dx or tell the doctor there's nothing wrong with that patient, you BETTER be 100% right or you make yourself look like a butt.

I guess I must be just better than the average medic as doctors do ask what my diagnosis is.

 

[Sasha]

I guess I must be just better than the average medic

So you keep telling everyone.

 

[medic417]

So you keep telling everyone.

Yes I do. Your welcome. B)

 

[Aidey]

The only hospital I ever transported to was also the hospital where I did my clinicals, giving me an advantage because most of the doctors at least recognized me.

The doctors who liked EMS would ask for a diagnosis, the doctors who didn't wouldn't. I've had doctors say "Ok we've got the patient, see ya, bye" and I've had others stand there with me and we've thrown DDs back and forth House style. (Those are usually the "I don't know what the heck is going on, someone else figure it out" calls).

Either way, whether doctors like it or not we are forming at least a working diagnosis. I think it's a sign of a good relationship when they listen to what we are saying. It may have nothing to do with the caliber of the medic, and more to do with the ego/attitude of the doctor.

 

[BossyCow]

I guess I must be just better than the average medic as doctors do ask what my diagnosis is.

Only doctors diagnose. Period. While an ER doc may ask you for what you think might be going on, he is only really asking for your rule out.

 

[PapaBear434]

Only doctors diagnose. Period. While an ER doc may ask you for what you think might be going on, he is only really asking for your rule out.

The way it was described to me is this: We don't have medical opinions or diagnosis, we have medical assessments. It's up to the doctor to do the former.

 

[medic417]

Only doctors diagnose. Period. While an ER doc may ask you for what you think might be going on, he is only really asking for your rule out.

Then all meds including Oxygen must be removed from the ambulance. W/o at least a field or working diagnosis we can do nothing. Deciding which protocol to follow requires you to examine and diagnose. It may not be a definitive diagnosis but it is a working diagnosis. Honestly if we can not diagnose anything you could not even put a bandage on a laceration because you could not diagnose that the patient is bleeding. Its just ridiculous to say we do not diagnose.