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Old 01-01-2012
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Question Question about Pain Examination in the CS

Some questions about pain examination:

1) Before starting PE, shall we inform patient that we may elicit pain?
2) Always promise patient that we won't do it again if pt feels pain?
3) If this is the case, how to check rebound if patient complains abdominal pain at 1st palpation? what to say and to do practically?

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Old 01-01-2012
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Don't tell the patient that you'll inflict pain, just ask him/her if there's any painful area before you palpate.

So here's a typical scenario:
  • You: Mr. Smith, I will be feeling your belly. Do you have any area that is painful.
  • SP: Yes. I have sever pain here (he points to the RLQ of his abdomen).
  • You: Alright sir, I will leave that area to the last.
  • You: Do palpation and leave the RLQ to the last. Once you do it the SP will try to express pain to you (keep your hands there) and then suddenly take it off and he'll express pain again.
So at the same time do the initial palpation and the rebound.

Then, you say, I am sorry to have caused this pain, I had to that locate the area of tenderness to reach for a diagnosis.

Another scenario:
Young lady with joint pain. Once you try to move the joint (few milimters even) she shouts in pain.
In that case, stop the examination and say sorry and tell her that you won't examine the full range of movement and in the patient note, write "Right knee examination, very limited range of movement due to exquisite tenderness".

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The above post was thanked by:
aiminghigh (01-17-2012), docwedsengr27 (01-19-2013), mle2resident (01-02-2012), pkul85 (06-04-2013), ronniewhite (01-01-2012), SchatzeAle (02-27-2012)



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