visual inspection

[girlmedic408]

Hi all, I would like to know if you picked up a patient 2 months pregnant that had passed out if you would do a vaginal visual. Pt stated she did have some spotting ealier on. Thanks

[mike]

I assume by you saying that she had passed out that she was CAOx3 when you where there? I would be very hesitant to do a visual inspection honestly.

[strwblue]

After deleting a very long answer to your question. I will simple say that with the information you offered my answer is NO. Ask the patient the how any pads have you used question. That will give you a better idea than a vaginal exam at that point in the pregancy.

[strwblue]

And just for arguement sake vaginal exams are generally not a ALS skill.

[CornholioMedic]

Unconscious? NO! If there's obvious signs of vaginal bleeding through the clothes, document that but do NOT drop their drawers. If she is delivering a term baby, that would be different. 2 months along....forget that noise.

[princessmedic]

In a word NO! here is my thought in more than one word, she is only 2 months prego we can not stop the bleeding or treat it, why do I need to see it, always safe to start an IV after assessing BP, you know if you need to give fluid bolus or not. Plus I have a who wha and I do not need to see anyone elses if I can help it!

[kjrff23]

I have to agree with everyone else so far. At 2 months most women don't even show they are pregnant so I don't see the value of an exam here unless an actual injury had occured and the OB wasn't the problem. Even if she miscarried, the exam would be moot unless she had uncontrolled bleeding and even then just pack it to stop, 2 large bore IV's and hang the bags on blood tubing if you got it.

[fm_emt]

Even on the BLS level, at 2 months there's nothing that we can do about it and nope, we wouldn't look.

Too many damn lawyers around these days anyway. If the patient absolutely insisted, I'd think about having one of the female EMTs do it, and I'd definitely document the hell out of the entire situation.

Otherwise, no.. it can wait until we got to the hospital.

[PSYCtest040]

NO! That is why the OB/GYN makes all that money.

[wvditchdoc]

I agree with the above post as to not looking. It does no good and will more than likely not affect the treatment given. IV if necessary, transport to the hospital.

[medic pathetic]

You know, i'm thinking about protocol here, because we have a "stay and play" philosophy. That is, we do as much on scene as we reasonably can. It cuts down on time spent out of your seatbelt in the back of the truck, ect.... I'm thinking that if she's unconcious at the time, and we're unable to wake her, she's getting pantsed. For a visual at least, for a visual and a rectal temp at most. Here we do rectal temps on anyone unconcious and unresponsive though whenever it's practical/time permits, so even if she's concious the visual would either occur in the house, or the back of the truck. They are all about being as detailed as reasonably possible. I remember a call for a 3 month pregnant teenager getting in a fight over her boyfriend with two other girls at a club (she got all offended when i questioned her smoking and clubbing while pregnant behaviour) She said she thought there may be something leaking out. I did a visual then and before we dropped her at the hospital. What i don't remember is wether or not she had prenatal care. That may have been a factor on wether or not to do the visual. We were right btw two hospitals and if the visual turned up anything questionable, she'd be going one hospital; if i didn't she'd be going to the other.

Then there was the other time (Which just happened to be the call i was was involved in a fleet incident) where the woman was complaining of some discomfort and spotting after having her baby in a hospital 3 days ago. Minimal spotting, but she called us because she didn't have a car. We decided to go ahead and do the visual in the house and i'll be darned if we weren't staring at her uterus the moment she lifted her night gown. Can you say prolapsed?

[jdemaio]

Nope, not me, I wouldn't.

[drthrockmorton]

hmmm, is she unconscious? If so, I would do a complete visual inspection to check for trauma/hemorrhage. However, I would stop short of removing her knickers (what a great word!) unless I saw obvious vaginal/rectal hemorrhaging.

If she is conscious, I would leave her clothed unless she indicated that she was hemorrhaging and required intervention.

Of course I'd suspect ectopic preg. or abortion with hemorrhage; support any hypotension accordingly.

So for pure "inspection" reasons, I would have to agree with the majority and say NO.

Cheers

[wvditchdoc]

Here we do rectal temps on anyone unconscious and unresponsive though whenever it's practical/time permits, so even if she's conscious the visual would either occur in the house, or the back of the truck. They are all about being as detailed as reasonably possible.

CAN YOU SAY HELL NO! Do you realize the type of people that you normally find unconscious?? LMAO I mean there is detailed and then there is TMI (too much information). :glasses1:

Also, the difference between a rectal temp and axillary temp is only going to be a few degrees. Besides, if they are cold, warm them up or if they are hot, cool them off.

I think the general consensus is there really is no reason to look. You are just going to support the end results (hypo-tension or hemorrhage) and get them to the hospital. As far as looking to determine what hospital you are going to take them to, that really shouldn't matter anyway. Any hospital, as far as tertiary care goes, is better than the back of your rig in the majority of cases. The rare case that medic pathetic cited (prolapsed uterus), I would hope to hell that the woman would be complaining about that and it wouldn't have to be something you just said "Oh Shit" and found.

[Pilotdan]

There is no need to visualize w/o obvious signs of trauma. I would want vitals, monitor, medical history, and IV if needed

[kojoff]

Hi all, I would like to know if you picked up a patient 2 months pregnant that had passed out if you would do a vaginal visual. Pt stated she did have some spotting ealier on. Thanks

Im kinda curious, are you a fellow ghettomedic or are you a pt looking for some answers. I do know of some so called medics that will be happy to strip a good looking pt, male or female, and say they are just being thourough(sp). This is the type of person( or sub-human) that gives the rest of us a bad name. If you are a pt looking to find a court case against a medic or even a basic, I do not appreciate you pretending to be one of us. If you are a fellow ghettomedic ( and I will give you the benifit of the doubt) then you should know the answer from the ethical, and legal issues part of the classes you had to take to get to where you are. It is not cool to strip a pt just to get a look at a nice pair or what appears to be well hung.

Dont mean to sound like Im going off, but the question raised a flag to me. Im usually a rather nice person.

[DabbleDuke]

You know, i'm thinking about protocol here, because we have a "stay and play" philosophy. That is, we do as much on scene as we reasonably can. It cuts down on time spent out of your seatbelt in the back of the truck, ect.... I'm thinking that if she's unconcious at the time, and we're unable to wake her, she's getting pantsed. For a visual at least, for a visual and a rectal temp at most. Here we do rectal temps on anyone unconcious and unresponsive though whenever it's practical/time permits, so even if she's concious the visual would either occur in the house, or the back of the truck.


NEVER WOULD I DO A RECTAL ON ANYONE, protocol or not. F that!! They don't pay enough. And I wouldn't look either. Like the one guy said, if she's bleedin that bad, you should be able to see it through the clothing. Your just setting yourself up if you look.

[jd1]

There would have to be a DAMN GOOD REASON for me to do a visual for "spotting". I am a firm believer in the don't put ur a** on the line if you don't have too approach. There are way too many ppl in the world who can benefit from a law suit that would end my career. If there was an ovbious injury then yes, but I would document the hell out of why I did. Hope that helps.

[anthonyt]

And so, I am sitting here at the station thinking about this and I think...

What the hell are some people thinking? For what reason would you look? Ok, for a moment lets consider that there is blood running down her legs and saturating her clothing. She's cramping, and maybe even unstable. What are you going to do? We're not surgeons. We're not equipped to treat a vag or rectal bleed except maybe to throw a trauma dressing over it to contain the blood. In this case... the clothing is not an issue. There is still NO need to look at someones cooch, unless you are birthing a baby.

But then I think... The best way to control bleeding is direct pressure at the wound site, right????? And if the blood is coming from inside the vagina, or rectum, you would have to put something inside it to apply "direct pressure." Yeah, you're right, that's just sick, and wrong a so many levels... lol.

[CornholioMedic]

Depends....if you've got some huggies..LOL!

Just say NO! to rectal temps.....Hell, I never even considered doing those to my own children.

T, you are a VERY sick man....it's almost sexy.:icon_pray:

[PSYCtest040]

If it's just one of the run of the mill jobs the visual should be;

1. Is the pt ACO?

2. Is the airway open?

3. Is the pt breathing?

4. Is there lots of red stuff spurting out?

If the answer is yes, yes, yes, and no then the visual is done.

[CornholioMedic]

4. Is there lots of red stuff spurting out?



If there is, it's time for the super duty tampons.....yes...I WENT there....lmfao!

[PSYCtest040]

If there is, it's time for the super duty tampons.....yes...I WENT there....lmfao!

Ever serve time as a combat medic? I swear to GOd there were tampons packed in the aid bag for just that reason.

[wvditchdoc]

Ever serve time as a combat medic? I swear to GOd there were tampons packed in the aid bag for just that reason.


Tampons are like the "Jack-of All Trades" trauma dressing. Kinda like Duct Tape......"If you can't Duct it, FU*K IT!" They really are the shit when it comes to GSW's. :glasses1:

[emtpnut]

My answer=NO. Unless thers redstuff spurtin out all overthe place then maby but otherwise no cuz you dont know what alls gonna crawl outa there. (hehe sorry) anyway. Like mentiond thers to many lawyers that enjoy that sorta stuff. And personally if I dont see a seveer life threat then evan if the pt begd me im gonna answer no and explain that it can wait... thats just my opinion...

[CornholioMedic]

That was my old MOS (91A1) back in the day, but never saw combat.

[PSYCtest040]

That was my old MOS (91A1) back in the day, but never saw combat.

I did my time as a (31V later 31U) in the 25th ID but some how got shanghied as a combat life saver.

[CornholioMedic]

It's called never volunteer. Except of course when it comes to Base CQ duty or Battn. CQ. I almost always wound up getting to screw off everytime I volunteered for that...lol.

[girlmedic408]

Hi all Iam glad to hear from all of you about the Peek in the panties. I also agree don't look if you don't have to. I was just wanting an opinion from some others. It kinda freaked me out to hear about someone looking at this ladies critter when there was what I thought no need. She was alert x3

[wvditchdoc]

I did my time as a (31V later 31U) in the 25th ID but some how got shanghied as a combat life saver.


31C here, later 31U. CG's RTO in the 82nd. Got to love it. Oh yeah I went the the Combat Life Taker Course as well. :glasses1: