Uhhhh....

I get an ambulance (my last patient of the day), a young female with abdominal pain.  She is obviously in pain, screaming in a shrill high pitched voice "aren't you going to help me?".

Shift change for the doctor's is only 10 minutes away, I know the doctor that is getting ready to leave won't see her so I order a few ATPs (advance triage protocol, the doctors in our ER have agreed on certain tests that can be run if they present with certain symptoms such as abdominal pain).

After putting in the orders I go in to assess the patient so I know a little better what is going on and where.  When assessing the abdomen it is protocol to listen for bowel sounds with your stethoscope before palpating (follow the link to hear bowel sounds).  If you palpate (examine by touch) before listening you can agitate the bowels and hear bowel sounds that may not have been there.

Because of the continuous shrill screams from the patient I knew I wasn't going to be able to hear anything through the stethoscope so I skipped this step and went to the palpation to determine where the pain was located.

I wish all patients had a flat belly like this...

The abdomen is divided into 4 quadrants.  As long as you listen and palpate all the sections it doesn't matter where you start.  I usually start away from where they claim their pain is located.

Tonight my patient had pain in the left upper quadrant (LUQ) so I started palpating on the right side.

She wasn't too patient with my assessment and decided to grab my hand and show me where her pain was located.

Unfortunately (for me) she placed my hand right on top of her naked, sagging breast.  Being the professional I am I moved the breast aside and palpated the belly underneath.  My brain, on the other hand, was screaming.  This is in no way ideal.  Nasty.....

Clint Eastwood's face sums up how I felt after "palpating" her mammary...