Cutting Clothes

[reaper]

That is taking it a little to far. This is medicine. Do the job!

 

[Sasha]

Actually Tim Phalen in 12 lead video lifts by cupping breast. So education is palm not back of hand. But I see why most use back of hand.

Are you kidding? As if EMTs and Medics aren't in enough danger of molestation accusations.

I use the back of the hand AND I'm a woman.

 

[Ridryder911]

Actually Tim Phalen in 12 lead video lifts by cupping breast. So education is palm not back of hand. But I see why most use back of hand.

So? Tim is not an authority. He is just another educator as many of videos is full of flaws as well.

Agreed. That's why they also taught us to check for sternum fractures with the blade of our hand rather than flat hand or fingers, and why you only do a check on a femoral pulse in the most dire of situations.

Actually the reason for side hand is produce direct pressure on the sternum itself to see if rib/cartilage will occur.. nothing r/t sexual groping. As well, I check femoral pulses all the time on serious patients. Location should NEVER prevent assessment techniques. I can place my hand into the pants, etc. to check. Personally I don't care what people think, I am there for the patients sake. My actions will reflect that. If they are concerned I will immediately educate them of such.

Folks it comes down to this, act professional and as if you are doing your job as you should, and attempt to show some dignity and nothing will occur. If you need to assess, assess, yet use common sense. Real trauma patients get stripped, medical patients get stripped as needed. I can assure you as a Nurse & Paramedic (being male) I have performed thousands of exams and procedures on both sexes. If one acts as it is part of their job and performs such consistent then there should be no problem Be respectful, place a towel, sheet, over as needed and provide dignity.

R/r 911

 

[jester_1269]

back of the hand, definately. You're not helping anyone if you get your cert sued out from under you.

 

[enjoynz]

We had a cyclist that was snuged off her bike by a small truck.
She didn't want her new expensive riding jacket cut off,
so had to deal with the pain of us taking it off the normal way.
Her choice, not ours!
I'm not sure if insurance can cover claims for expensive clothes?
Guess with the excess, it's not really worth it.

Cheers Enjoynz

 

[Aidey]

How does everyone feel with cutting the clothes of a homeless person? In New England or anywhere north of the Mason-Dixie line.

Most, if not all of the hospitals I've transported to had clothes bins with random stuff in them that they would give to patients who needed it. Where I volunteered there was only one hospital in the area and I think the stuff there was donated by both the employees and a couple of local charities/church groups. So I generally didn't have any qualms about cutting their clothes.


I was taught up the center of the legs, down the sleeves if you are cutting the whole sleeve, up if you are only cutting part way up (say to expose a wrist or elbow). For non button up shirts I was taught to cut in a Y or T pattern to get the front of the shirt off. I generally cut depending on the situation and what is going on. Like others have said, I've had patients refuse to have their clothes cut, only to change their mind because of pain.

On the side subject of 12-leads and breasts, I was always taught to ask the patient to hold their breast out of the way first, if they couldn't, then use the back of your hand. Even though I'm female, that is the way I've always done it.

 

[Outbac1]

Folks it comes down to this, act professional and as if you are doing your job as you should, and attempt to show some dignity and nothing will occur. If you need to assess, assess, yet use common sense. Real trauma patients get stripped, medical patients get stripped as needed. ..... If one acts as it is part of their job and performs such consistent then there should be no problem Be respectful, place a towel, sheet, over as needed and provide dignity.

R/r 911

I agree. Act professional and provide dignity as required.

 

[medic417]

So? Tim is not an authority. He is just another educator as many of videos is full of flaws as well.




Actually the reason for side hand is produce direct pressure on the sternum itself to see if rib/cartilage will occur.. nothing r/t sexual groping. As well, I check femoral pulses all the time on serious patients. Location should NEVER prevent assessment techniques. I can place my hand into the pants, etc. to check. Personally I don't care what people think, I am there for the patients sake. My actions will reflect that. If they are concerned I will immediately educate them of such.

Folks it comes down to this, act professional and as if you are doing your job as you should, and attempt to show some dignity and nothing will occur. If you need to assess, assess, yet use common sense. Real trauma patients get stripped, medical patients get stripped as needed. I can assure you as a Nurse & Paramedic (being male) I have performed thousands of exams and procedures on both sexes. If one acts as it is part of their job and performs such consistent then there should be no problem Be respectful, place a towel, sheet, over as needed and provide dignity.

R/r 911

LOL. I actually laughed when I saw the video, just thought I would bring it up since he is supposed to be an expert. It causes another problem you can not use that hand for anything else if you palm the breast. Using the back of the hand allows use of your fingers to hold, wires, etc.


Consistency is what will keep you out of trouble. Be professional. Do the job.

 

[emtidon]

I agree with you.Usually if you explain to the patient in a nice calm manner,that you need to see whats going on.The patients in my case have been more than willing to let me cut the clothes.

 

[emtidon]

Down filled jackets are best cut somewhere other then the back of your rig.let someone else clean the mess.

 

[medicdan]

Down filled jackets are best cut somewhere other then the back of your rig.let someone else clean the mess.

Down-filled jackets are best NEVER cut, hasn't AD taught you anything*?



* Think Kelly Grayson.

 

[emtidon]

Down-filled jackets are best NEVER cut, hasn't AD taught you anything*?



* Think Kelly Grayson.

but if you have to expose to see why your skier who landed on their torso after coming off a jump can't breath and you need to C-Collar.I'm just saying the jacket needs to come off and if it needs to be cut,cut it.It just would be nice to do it where its someone elses clean up responsibility.

 

[Airwaygoddess]

Got to see how it went in and if it came out.......

Gun shot wounds and stabbings are strip and flip but remember if cutting clothes and it is a crime scene TRY not to cut through places where bullet holes and knife cuts are. These are now evidence. As folks have said here already, blankets for warmth and patient modesty, have the back of the ambulance warmed up for the patient to help with slow down the progression of shock. Remember to keep yourself and your partner safe also!!

 

[PapaBear434]

Actually the reason for side hand is produce direct pressure on the sternum itself to see if rib/cartilage will occur.. nothing r/t sexual groping. As well, I check femoral pulses all the time on serious patients. Location should NEVER prevent assessment techniques. I can place my hand into the pants, etc. to check. Personally I don't care what people think, I am there for the patients sake. My actions will reflect that. If they are concerned I will immediately educate them of such.

I know why we do the sternum the way we do, but it used to be that you could just reach down and poke around with your fingers. Now they want you to use the blade, so I was told, so that it erases the "groping" motion. It's also why the sternum rub to check for responsiveness has fallen out of favor. Well, in addition to the fact that it could cause even more damage should that person have a chest trauma.

As far as the femoral goes, they had to specifically tell us not to check that pulse point unless the patient is completely unresponsive. Sure, seems like common sense. But one of my fellow classmates got into the field and went for a femoral on a conscious and somewhat alert stroke patient (apparently she was completely there mentally, just no ability to verbalize) and the woman freaked the hell out. Investigation conducted, and it was concluded that he was doing the right thing and the wrong time, and the woman (who actually recovered almost completely, surprisingly) and her family shrugged it off as good intentions from a noobie. So of course they had to go and issue to the entire department to be careful and not do a femoral unless someone is completely unconscious/crashed, as the coherent patient you do this to may not be so forgiving as this woman was.

It's just another layer of CYA on the part of the department.

 

[micsaver]

... It's also why the sternum rub to check for responsiveness has fallen out of favor.

That's the first I have heard of that. I took class less than a year ago and we were taught to do the sternum rub to check responsiveness. When did this change come about and what is recommended instead of it?

 

[exodus]

That's the first I have heard of that. I took class less than a year ago and we were taught to do the sternum rub to check responsiveness. When did this change come about and what is recommended instead of it?

We were taught sternum rub so we wouldn't be surprised if we saw it in the field, but they said it's no longer used, and now we should use a clavical area pinch.

 

[medic417]

Actually Tim Phalen in 12 lead video lifts by cupping breast. So education is palm not back of hand. But I see why most use back of hand.

Here is the video for your consideration:

http://www.youtube.com/watch?v=TFcyiCKyaZ4&feature=related

 

[Juxel]

We were taught sternum rub so we wouldn't be surprised if we saw it in the field, but they said it's no longer used, and now we should use a clavical area pinch.

Maybe I'm a little old school, but I'm particularly fond of a good sternal rub, especially if I suspect the person is faking. The alternatives are more useful to assess for localization of pain. You should be familiar with a trapezius muscle squeeze, supraorbital pressure, and mandibular pressure. Just remember not to use the latter two on a patient with facial injuries.

 

[medic417]

Maybe I'm a little old school, but I'm particularly fond of a good sternal rub, especially if I suspect the person is faking. The alternatives are more useful to assess for localization of pain. You should be familiar with a trapezius muscle squeeze, supraorbital pressure, and mandibular pressure. Just remember not to use the latter two on a patient with facial injuries.

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

 

[PapaBear434]

That's the first I have heard of that. I took class less than a year ago and we were taught to do the sternum rub to check responsiveness. When did this change come about and what is recommended instead of it?

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.