Cutting Clothes

[BossyCow]

Pretty much what Exodus said. We were taught it so we wouldn't freak out when we saw someone giving someone's chest a good noogie, but we were told to use a pinch to the shoulder/clavicle, a pinch to the earlobe, and a pen between the fingers and a gentle squeeze. All of these will cause pain but won't cause any serious damage or bruising.

But then, if they ARE unresponsive and you have to do CPR anyway, you are gonna end up with far more trauma than a sternum rub coudl do. Even still, I stick to a earlobe or shoulder pinch. Does the trick usually. If I have doubts to their faking, I do the hand drop to the face, though that's probably not really approved either.

There's a whole thread devoted to the facial trauma supposedly resulting from the hand drop. I've never seen it in the field and can't imagine it without first taping a brick to the pt's hand... but then... I don't know it all.

 

[medic417]

There's a whole thread devoted to the facial trauma supposedly resulting from the hand drop. I've never seen it in the field and can't imagine it without first taping a brick to the pt's hand... but then... I don't know it all.

:unsure::huh:

 

[triemal04]

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

I suppose...if they allready had traumatic injuries to that area. Which hopefully you where considering before you tried that move. Seriously, if you are causing damage to an otherwise uninjured individual by doing a sternal rub, you are doing something very wrong.

 

[marineman]

We were told to give up on the sternal rub since it's assessing for response to pain and it's really not all that painful (at least the way most people do it, yes I know you can make it hurt). I like the shoulder pinch but honestly it's not that big of a deal, just do something that hurts but doesn't cause harm and see if they react.

If you think your patient is faking real lightly move your pen or finger across their eyelashes, if their eyelids twitch they're with you.

 

[medic417]

I suppose...if they allready had traumatic injuries to that area. Which hopefully you where considering before you tried that move. Seriously, if you are causing damage to an otherwise uninjured individual by doing a sternal rub, you are doing something very wrong.

But how are you sure they are faking. Some patients with CVA's and other problems appear to be faking but they really can not respond. How would you like it if I caused your mother extra pain because I was going to prove she was faking?

 

[Ridryder911]

Use commons sense! Sternal rub is an acceptable painful response and technically so is twisting of the nipple (but I would not suggest that one). One is only inflecting a noxious stimulus, not inflecting danger to the patient. If you are doing danger, your not performing a sternal rub properly. Noxious stimulus is noxious stimulus, I have even seen physicians flip their fingers on the eye. Again, use professionalism and common sense. You are not there to harm them, but I know of many patients that are past the trapezius pinch, and can tolerate most so called "painful response".

You don't check for femoral pulses on a abdominal/back pain, as a Supv. I would be chewing your arse out for doing a poor assessment. There is NO contraindication of assessing pulses femoral, popliteal, pedal, etc on a patient where it might be needed to be assessed. Quit being a fraidy cat if the procedure is warranted, and is part of an assessment then do it. I have never had any complaints even from 80 year old Sunday School teachers. Show me the literature that describes one should not assess central pulses or that it has "fallen out of favor" and I will show you where one should assess pulsating, and quality of circulation; which can only be done by assessing pulses.

 

[medic417]

You don't check for femoral pulses on a abdominal/back pain, as a Supv. I would be chewing your arse out for doing a poor assessment. There is NO contraindication of assessing pulses femoral, popliteal, pedal, etc on a patient where it might be needed to be assessed. Quit being a fraidy cat if the procedure is warranted, and is part of an assessment then do it. I have never had any complaints even from 80 year old Sunday School teachers. Show me the literature that describes one should not assess central pulses or that it has "fallen out of favor" and I will show you where one should assess pulsating, and quality of circulation; which can only be done by assessing pulses.

People that are not willing to touch, look, and listen really need to get out of EMS. If your going to claim to be an EMS Professional do a proper exam. Rid is spot on.

 

[triemal04]

But how are you sure they are faking. Some patients with CVA's and other problems appear to be faking but they really can not respond. How would you like it if I caused your mother extra pain because I was going to prove she was faking?

Uh...well...I'm not sure they are faking. That's why I'm doing it. For :censored::censored::censored::censored:'s sake, what kind of question is that? If you KNOW they are faking then you allready have your answer; leave them alone, or TELL them you know they are faking. If you find someone who is not responsive knowing if they really are and how unresponsive they are is one of the most basic pieces of info we get! And if my mother was found unresponsive on the floor the only way I'd have a problem with you doing a sternal rub was if you didn't do it.

 

[Ridryder911]

But how are you sure they are faking. Some patients with CVA's and other problems appear to be faking but they really can not respond. How would you like it if I caused your mother extra pain because I was going to prove she was faking?

Trust me, the sternal rub is nothing in comparison to the, deep painful reflex, use of a pin (Wartenberg) wheel (sharp pointed steel pins on a wheel), multiple IV's, finger stick, nasopharyngeal airway, foley catheter, hemoccult and rectal tone check that will be shortly performed.

So in comparison, a sternal rub is nothing. Unfortunately that is the consequence of being ill.

R/r 9

 

[medic417]

Uh...well...I'm not sure they are faking. That's why I'm doing it. For :censored::censored::censored::censored:'s sake, what kind of question is that? If you KNOW they are faking then you allready have your answer; leave them alone, or TELL them you know they are faking. If you find someone who is not responsive knowing if they really are and how unresponsive they are is one of the most basic pieces of info we get! And if my mother was found unresponsive on the floor the only way I'd have a problem with you doing a sternal rub was if you didn't do it.

I agree checking for response is appropriate. But if you know someones faking I see no reason to torture them. If they are faking then they probably have a mental issue so are still in need of medical care. Just transport and let the docs tort......... um treat.

 

[medic417]

Trust me, the sternal rub is nothing in comparison to the, deep painful reflex, use of a pin (Wartenberg) wheel (sharp pointed steel pins on a wheel), multiple IV's, finger stick, nasopharyngeal airway, foley catheter, hemoccult and rectal tone check that will be shortly performed.

So in comparison, a sternal rub is nothing. Unfortunately that is the consequence of being ill.

R/r 9

Thats the truth. Whoever designed many of Medicines practices was a sadist.

 

[marineman]

I agree checking for response is appropriate. But if you know someones faking I see no reason to torture them. If they are faking then they probably have a mental issue so are still in need of medical care. Just transport and let the docs tort......... um treat.

That's my take on it. I like to find out if their faking or not using the eyelash thing but in the hospital an unresponsive patient getting the full work up is much worse than any painful stimuli so I let them be in their happy little I fooled the EMT world for a while.

 

[triemal04]

I agree checking for response is appropriate. But if you know someones faking I see no reason to torture them. If they are faking then they probably have a mental issue so are still in need of medical care. Just transport and let the docs tort......... um treat.

Ok, I don't have any problem with that. But you always need to determine if they are faking or not; your post came across as not doing a sternal rub because it was painful and the person might be able to feel it. Continuing to cause someone pn when you know flat out that they are faking is wrong. Telling them that you know what is going on and what the end result will be if they continue with their behavior...much more effective.

 

[medic417]

Ok, I don't have any problem with that. But you always need to determine if they are faking or not; your post came across as not doing a sternal rub because it was painful and the person might be able to feel it. Continuing to cause someone pn when you know flat out that they are faking is wrong. Telling them that you know what is going on and what the end result will be if they continue with their behavior...much more effective.

Describe in detail the procedures that Rid listed and if that doesn't scare them into a quick recovery they really do have mental issues that need addressed.

 

[Jon]

That is about the only time I try to save something is when cutting a rider's leathers. Go for the seams, or right next to it so they can be repaired, or if there are laces (like up the sides of pants/chaps) go for those as new lacing is easy to obtain

And if youre cutting a jacket, make sure it's not a down filled one, they make a mess, unless you want to look like you've been tarred and feathered.

Leathers and riding gear are expensive.

Biker Gang "Colors" are even more valuable, to those that worry about them. It is something to be conscious of.., good point.



As for "Fully" naked. Although I understand why - I challenge you to explain what injuries that "traditional" undergarments would hide in such a way that you couldn't move them slightly to visualize.

**TRADITIONAL - If it is a college kid wearing boxers that are longer than my gym shorts... yeah - they have to go**

If the patient is conscious - leaving them with some shred of dignity might be a good thing. Yes - there is a fear of lawsuits... and it may be overstated... but I really don't want to have to go to court to deal with a false claim.

 

[Jon]

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

Really?

Standard of care is to document A.V.P.U.

How can you assess P vs. U in an apparently unresponsive patient without painful stimuli?

 

[medic417]

Leathers and riding gear are expensive.

Biker Gang "Colors" are even more valuable, to those that worry about them. It is something to be conscious of.., good point.



As for "Fully" naked. Although I understand why - I challenge you to explain what injuries that "traditional" undergarments would hide in such a way that you couldn't move them slightly to visualize.

**TRADITIONAL - If it is a college kid wearing boxers that are longer than my gym shorts... yeah - they have to go**

If the patient is conscious - leaving them with some shred of dignity might be a good thing. Yes - there is a fear of lawsuits... and it may be overstated... but I really don't want to have to go to court to deal with a false claim.

Had one trauma many years ago that appeared OK as in no blood on underwear. The medic left underwear on her. Got to hospital with her vitals dropping. When hospital cut away her under wear they found her vagina packed. She was bleeding out internally with no outward show of blood because of the packing. Had he removed the underwear he would have seen that and could have at least been more aware of her possible injurys.

 

[medic417]

Really?

Standard of care is to document A.V.P.U.

How can you assess P vs. U in an apparently unresponsive patient without painful stimuli?

Your correct you do need a test for stimuli response. I mispoke because I get so tired of those that keep trying to prove someones faking. Perform one stimuli test and quit trying to out play the fakers. Now with longer transports you will have to get AVPU score again, but it is not continuous torture of the faker.

 

[Jon]

Had one trauma many years ago that appeared OK as in no blood on underwear. The medic left underwear on her. Got to hospital with her vitals dropping. When hospital cut away her under wear they found her vagina packed. She was bleeding out internally with no outward show of blood because of the packing. Had he removed the underwear he would have seen that and could have at least been more aware of her possible injurys.

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

Your correct you do need a test for stimuli response. I mispoke because I get so tired of those that keep trying to prove someones faking. Perform one stimuli test and quit trying to out play the fakers. Now with longer transports you will have to get AVPU score again, but it is not continuous torture of the faker.

I concur with you - but I'm not sure that was what the OP was implying he was doing.

 

[micsaver]

My girlfriend is a vet student and we often get into great medical discussions. Her contribution is this: "My patients don't wear clothes (unless they are poodles) and don't fake anything. If they hurt, they hurt, and if they are nearly dead, they are nearly dead, period. They can, of course, bite you, kick you, and step on you. Then again, humans can too. I think I have the better deal." -_-