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Old 01-27-2012
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Question Proper SP Draping

Is it necessary to completely unfold the sheet in order to drape the patient from their waists down past their toes? Like many, I immediately put the sheet on the patients when I walked into the room, but I usually unfold it only a couple of times and not all the way. The sheet size was sufficient enough to cover waist down to lower leg with the patients supine, but the ankles and feet were exposed on every patient (this made it easier to check for edema and pedal pulses). The sheet was also big enough for me to properly move it up and down when I needed to expose the abdomen without accidentally exposing something else.
Will I get credit for proper draping, or did I have to completely cover the patient from the waist down with the bed sheet completely open? I know this might seem like a foolish question, but I'm concerned that the checklists that SPs use are really specific in the things they look for, so splitting hairs seems necessary.

Thanks.
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Old 01-27-2012
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SPs wouldn't check you on how far your draping goes, they just check you for doing it.

So you are good, don't worry about it.

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Old 01-27-2012
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Quote:
Originally Posted by StepTaker View Post
SPs wouldn't check you on how far your draping goes, they just check you for doing it.

So you are good, don't worry about it.

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That's quite a relief, thank you. Since you seem to know so much about this, would you mind if I asked a couple more questions?

I know you're never supposed to do auscultation over the gown, but on all my female patients, I untied the gown and listened on skin for the lungs and then didn't have them completely pull down the gown in front so they were just sitting there in their bra while I listened to the heart. For the heart, I listened to the first 3 heart areas on skin, but then for the mitral went over the gown because I couldn't reach to that area while still keeping the patients covered. My first question is: is it important to listen to 6 areas on the posterior lungs for full credit/check mark, or can 4 sometimes suffice (assuming it isn't a case in which a thorough pulmonary exam is warranted)? My second question is: will I get the check mark for a proper cardiac exam since I listened to 3/4 heart locations on the skin, or does their checklist read something along the lines of "Auscultated heart (underneath gown)" and I won't get the credit because my 4th location was on top of the gown? Both of these questions are similar to my draping one in that I feel the scoring can be subjective when it comes to these areas because who knows how the SPs will grade.

Thanks so much for your help. By the way, how do you know so much about this stuff pertaining to what the USMLE looks for?
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Old 01-28-2012
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The ideal auscultation of a female's heart is to listen to all four valve areas and if that entails uncovering the gown and bra then we must do it.

However, for obvious reasons, most US physicians do not do that and they just do what you did. Therefore, if you weren't 100% checked by the SP for your heart auscultation, I don't think it's going to affect your overall performance significantly. People with much bigger mistakes still passed the CS.

As for the posterior lung auscultation, it's perfectly fine for four areas in non-respiratory cases.

As how do I know this much, it's because I've been moderating this forum for long time and because I always talk to medical students and med school Professors and I read most of the CS books. But remember that many of my posts are just personal opinions derived from my experience with no solid reference or guidelines to quote, I maybe right and I maybe wrong.

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Quote:
Originally Posted by StepTaker View Post
The ideal auscultation of a female's heart is to listen to all four valve areas and if that entails uncovering the gown and bra then we must do it.

However, for obvious reasons, most US physicians do not do that and they just do what you did. Therefore, if you weren't 100% checked by the SP for your heart auscultation, I don't think it's going to affect your overall performance significantly. People with much bigger mistakes still passed the CS.

As for the posterior lung ausculHtation, it's perfectly fine for four areas in non-respiratory cases.

As how do I know this much, it's because I've been moderating this forum for long time and because I always talk to medical students and med school Professors and I read most of the CS books. But remember that many of my posts are just personal opinions derived from my experience with no solid reference or guidelines to quote, I maybe right and I maybe wrong.

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Your opinion and expertise on these subject matters are certainly appreciated, so thank you very much.

Regarding the heart auscultation, do people get partial credit for that, or is it simply an all or nothing deal and my credit will subjectively be decided by each female patient?
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Quote:
Originally Posted by Dr. Pepper View Post
Regarding the heart auscultation, do people get partial credit for that, or is it simply an all or nothing deal and my credit will subjectively be decided by each female patient?
I think it's all-or-none, which is better for you because it's unlikely that your female SPs will uncheck you for over-the-gown auscultation of the mitral area
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