Trauma Naked?

[mark90]

I was in an MVA a month ago. Paramedics cut off my shirt, and strapped me on a backboard. When I got to the E.R, I was conscious, with no visible injuries, just a bit of a headache. Yet, I was almost immediately stripped completely naked. I laid there fully nude for what seemed like an eternity while I was examined. Then the nurse put a cup over my member and told me to pee. I wasn't able to, so they put a catheter in me.

I asked them to cover me several times, but the trauma team refused, even when i was given an ultra sound i was not covered up.

This just doesn't seem normal to me. Is this standard procedure or did I just get stuck with a bad trauma team.

Please help me figure this one out.

Thanks,

Mark.

[claybob]

If I were conscious and believed I didn't have an injury that had anything to do with my genitals I would have fought them tooth and nail if they started ripping my clothes off. Are we really forced to allow that abuse? I'm sure there are very few people out there that would consider that abuse, but I would. It should be my choice. I could very likely be hurt much more than I thought I was at the time, but if I asked them to at least slow down a little and talk to me about I would expect them to listen. And yes, my modesty and dignity IS as important to me as my life.

[rn/writer, RN]

If I were conscious and believed I didn't have an injury that had anything to do with my genitals I would have fought them tooth and nail if they started ripping my clothes off. Are we really forced to allow that abuse? I'm sure there are very few people out there that would consider that abuse, but I would. It should be my choice. I could very likely be hurt much more than I thought I was at the time, but if I asked them to at least slow down a little and talk to me about I would expect them to listen. And yes, my modesty and dignity IS as important to me as my life.

Again, fighting tooth and nail stands a good chance of making things worse, because it fits the profile of someone with a head injury. Combative behavior, especially if it looks out of proportion to the situation, would almost certainly intensify medical attention.

I'm not saying that you shouldn't feel the way you do. Your feelings are your feelings. But you should know what might happen if you go the route of putting up physical resistance.

I hope that if you ever find yourself in such a dilemma, you can connect with someone well enough to get them to work with you and forestall any major altercation.

[NYCRN16]

If I were conscious and believed I didn't have an injury that had anything to do with my genitals I would have fought them tooth and nail if they started ripping my clothes off. Are we really forced to allow that abuse? I'm sure there are very few people out there that would consider that abuse, but I would. It should be my choice. I could very likely be hurt much more than I thought I was at the time, but if I asked them to at least slow down a little and talk to me about I would expect them to listen. And yes, my modesty and dignity IS as important to me as my life.

How would you know if you had an injury if you were involved in major trauma? How about bladder injury, needing to put a catheter to check for blood in urine, these are all necessary. That is in no way abuse. If you are consious and able to ask for explainations, than of course you have the right to, but if you are not or have a major head injury and are not rational, than we must do what we must to save your life. If you don't want to be fully assessed for injuries in the event of a major accident, than by all means, don't seek medical attention, and any injuries that result from you refusing an exam, you are responsible for. What I can't stand, is people like you who would refuse an exam, injury would follow because of this, and then you would sue us for any disability as a result of this.

[J.R.theR.N2b]

if a patient involved in a trauma presented to the emergency room, relatively calm and coherent, and during the examination told you that he did not want part of the workup done, what then would be the likely reaction of the medical staff? you state that if the patient yells, fights, or appears combative he would be considered not competent due to his injuries, and treated against his will. i would like to ask just what may be the outcome if he were to calmly explain to staff that he wished to refuse the urinary catheter? patients in this situation are scared and frightened, and forcing unwanted, painful procedures upon them would seem to greatly increase patient's anxiety. i preface this by saying i do NOT want to sue anyone, especially someone abiding by my wishes.

[NYCRN16]

if a patient involved in a trauma presented to the emergency room, relatively calm and coherent, and during the examination told you that he did not want part of the workup done, what then would be the likely reaction of the medical staff? you state that if the patient yells, fights, or appears combative he would be considered not competent due to his injuries, and treated against his will. i would like to ask just what may be the outcome if he were to calmly explain to staff that he wished to refuse the urinary catheter? patients in this situation are scared and frightened, and forcing unwanted, painful procedures upon them would seem to greatly increase patient's anxiety. i preface this by saying i do NOT want to sue anyone, especially someone abiding by my wishes.

I think the trauma situation people have been describing is those of a life and death matter, major trauma. Most likely, a person with such major trauma are not going to be coherent enough, if consious at all, to make decisions, and delaying treatment would cause death. If in the situation the patient is found to be coherent, and able to make decisons on his/her own because the trauma is not significant, than he/she has a right to refuse treatment. However, you must then realize that because of the refusal, there could be some internal injury that nobody knows about that cannot be found or will delay finding because of fear. Is it not worth it to have a catheter inserted which is not as painful as the person thinks, and to miss an injury which may render the person unable to urinate normally for the rest of their life? How about a rectal exam? Refuse this exam, and possibly miss a bowel injury, now you have to have a colostomy bag forever? Of course these are extreme examples, but that is why I think it is foolish to refuse necessary procedures if the decison can be made by the patient, and that is why if the patient is incoherent, consent is implied that they would want to save themselves from something like this happening to them.

[birdgardner]

How would you know if you had an injury if you were involved in major trauma? How about bladder injury, needing to put a catheter to check for blood in urine, these are all necessary. That is in no way abuse. If you are consious and able to ask for explainations, than of course you have the right to, but if you are not or have a major head injury and are not rational, than we must do what we must to save your life. If you don't want to be fully assessed for injuries in the event of a major accident, than by all means, don't seek medical attention, and any injuries that result from you refusing an exam, you are responsible for. What I can't stand, is people like you who would refuse an exam, injury would follow because of this, and then you would sue us for any disability as a result of this.

A few weeks ago, I transported (as an EMT) a boarded and collared DUI rollover victim, no significant injuries in my judgement. He did end up trauma naked, totally cooperative, but when he said he had to pee, urgently, we held a urinal for him. About 700 cc, no blood. We took the urinal in with him, ER doc said "You have no idea how important that is." Sure we do. Saved him being cathed. Why not give the poor guy on the board at least that courtesy when possible?

[Batman24]

Patients react differently to traumas. Some are calm and others are clawing. There is no way of knowing if these patients are truly okay unless a full assessment is done.

No one really wants a rectal or a cath but they can be very necessary where traumas are concerned. If the patient is coherent you can explain why something is being done and let them know you will keep them as covered as possible to protect their modesty.

In some instances they will put a urinal over your member to see if you can pee on your own first and then proceed to a cath if you can't.

[JBudd, MSN]

If you are calm and rational, I'll likely give you a chance to use a urinal, unless you have abd trauma that means I need a speciman with no chance of external blood contaminating it.

I had a fellow that thought he was fine, expect for the compound fracture of the ankle. We maintained Cspine anyway, despite the fact he'd been up walking around after a fall. Turned out to have a blown C1 fracture.

[NYCRN16]

A few weeks ago, I transported (as an EMT) a boarded and collared DUI rollover victim, no significant injuries in my judgement. He did end up trauma naked, totally cooperative, but when he said he had to pee, urgently, we held a urinal for him. About 700 cc, no blood. We took the urinal in with him, ER doc said "You have no idea how important that is." Sure we do. Saved him being cathed. Why not give the poor guy on the board at least that courtesy when possible?

IF possible is the key word. If he was unresponsive, or was responsive but was unable to urinate, than would you still not cath him to check for blood? Nothing is so black and white, its not all or nothing. Some things are done, some aren't depending on the situation. If the patient asked you to take off the c-collar because he didn't like it, would you?

[birdgardner]

How about a rectal exam? Refuse this exam, and possibly miss a bowel injury, now you have to have a colostomy bag forever? Of course these are extreme examples, but that is why I think it is foolish to refuse necessary procedures if the decison can be made by the patient, and that is why if the patient is incoherent, consent is implied that they would want to save themselves from something like this happening to them.

Rectal exam being called into question. Probably more of a neuro than a GI exam anyway. Rectal exams can rarely result in cardiac dysrhythmias, so not entirely benign.

G.Guldner, A. Brdzenski. The American Journal of Emergency Medicine, The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma. Volume 24, issue 1. (Jan. 2006). Pp. 113-117.

Esposito, Ingraham, Luchette, Sears, Santaniello, Davis, Poulakidas, Gamelli. The journal of Trauma . Reasons to omit rectal exam in trauma patients: no fingers, no rectum, no useful additional information. Volume 59(6) (Dec. 2005). Pp 1314-1319.

Guldner, Babbitt, Boulton, O'Callaghan, Feleke, Hargrove. Academic Emergency Medicine. Deferral of the Rectal Examination in Blunt Trauma Patients: A clinical decision rule. Volume 11 (6). Pp. 635-641.

Porter, Ursic. The American Surgeon. Digital rectal examination for trauma: Does every patient need one? Volume 67 (5). Pp. 438-441.

[birdgardner]

IF possible is the key word. If he was unresponsive, or was responsive but was unable to urinate, than would you still not cath him to check for blood? Nothing is so black and white, its not all or nothing. Some things are done, some aren't depending on the situation. If the patient asked you to take off the c-collar because he didn't like it, would you?

Absolutely, in those cases, a cath would be appropriate. But when the pt can pee in a urinal, the cath should not be automatic. (Ladies out of luck, unless they can hold it and are quickly cleared from Cspine.)

[NYCRN16]

Rectal exam being called into question. Probably more of a neuro than a GI exam anyway. Rectal exams can rarely result in cardiac dysrhythmias, so not entirely benign.

G.Guldner, A. Brdzenski. The American Journal of Emergency Medicine, The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma. Volume 24, issue 1. (Jan. 2006). Pp. 113-117.

Esposito, Ingraham, Luchette, Sears, Santaniello, Davis, Poulakidas, Gamelli. The journal of Trauma . Reasons to omit rectal exam in trauma patients: no fingers, no rectum, no useful additional information. Volume 59(6) (Dec. 2005). Pp 1314-1319.

Guldner, Babbitt, Boulton, O'Callaghan, Feleke, Hargrove. Academic Emergency Medicine. Deferral of the Rectal Examination in Blunt Trauma Patients: A clinical decision rule. Volume 11 (6). Pp. 635-641.

Porter, Ursic. The American Surgeon. Digital rectal examination for trauma: Does every patient need one? Volume 67 (5). Pp. 438-441.

Rectal exams are still done in many situations, as well as rectal temps. They love to guiac everyone