In a 3-day course in civilian first-aid here in Japan, they taught us that once we determined that AED use was necessary, all upper body clothing had to come off, but before we ripped/cut it off, we should say “excuse me, I’m going to remove your clothing now” to the unconscious patient.
Obviously this part isn’t mandatory, but they suggested saying it for the benefit of bystanders: it shows that you know what you’re doing and that you are showing consideration for the patient.
Also, our teachers mentioned that unlike average Japanese fellers, foreign men often have a great deal of chest hair. Sometimes the AED will have a razor in there; if not, they suggest using one of the AED pads to rip off a swatch to ensure good contact. Not to hijack this thread, but if any EMT folks or anyone who knows could let me know if this is common in the US–or anywhere else–I’d appreciate it.
In 4 years of ambulance duty, I’ve worked 15 cardiac arrests. Most have been women; but one man I worked I had to dry shave to get the pads on. FWIW, the guys you shave have to be of near gorilla furriness to require shaving. He did not survive, so I didn’t hear him bitch afterwards about razor burn.
The ambulances from my squad had disposable razors for such occasions.
Not so much of a big deal for the AED, as the pads are very big, very sticky and tend to be on areas with less chest hair, even for really hairy men; usually they go on the upper right chest just below the collarbone and on the left lateral chest. It takes quite the hair sweater to prevent a good contact, I would guess that no more than 10% of patients require any sort of emergent shaving.
I’m not sure how effective it would be to place one on the chest and rip it off bandaid style, the adhesive has a more gel-like quality to it and it would probably still leave quite a bit of hair underneath. As long as there was an extra set of pads, it would be better than nothing in some situations I guess. Typically, in a true cardiac event, a worse problem is profuse sweating, so usually the best thing is to wipe the chest as dry as you can get it before you place the pads.
We did use disposable razors to clear chest hair for 12 lead ECG leads, but those are a lot smaller (1" x 3/4") so they need pretty much direct skin contact to work best. Later on we upgraded to an electric “surgical razor” although it just looks like a plain old sideburn trimmer with a disposable head on it. One time I went on a scene call for chest pain and found the patient in the bathtub with his SO shaving his whole chest with an electric razor, he complained that last time they didn’t bother to shave him and it hurt like hell ripping all of his hair off when they changed/removed his electrodes.
Nitpick, airway comes before breathing or circulation.
Once in the ER, a folded towel or pillow case will provide reasonable coverage without interfering, although we wouldn’t bother if we’re still at the compressions and difibrilator stage.
We carried disposable razors. Used them only once. Fellow was lycanthropic.
Feeling the need to point something out here. This is real life. Wives stand eight feet away, vomiting through hands clenched over their mouths. Sons scream " you fucking save her I swear to god I will fuck you up". With focus, care, speed, skill and the right level of professional detachment we do all we can to beat Death.
I would never have consciously been disrespectful of modesty but you respect life before all else.
Ya know, I think I’m going to coin the phrase ‘lycanthropic hirsutism,’ see if it will gain traction. It’s got that pseudo-medical sound to it, like status hispanicus, or supratentorial etiology.
A friend in my WoW guild who’s a nurse told us a story about a young woman who was getting rather hysterical in the waiting room as they worked on her mother. He said she was sitting there rocking back and forth, going “Lordy lordy lordy lordy…oh Jesus…lordy lordy lordy…” over and over again.
He said they diagnosed her with “Brachylordia with junctional Jesus.”
He had to explain it to the non-medical types in our group.
I work in a hospital that delivered nearly 10,000 babies last year. I don’t work in L&D, but wind up there quite a bit. You really do get every type of person there.
Some are so modest that they cover everything that is not necessary (even head, hair and sometimes face) for the delivery and banish all but the most essential personnel from the room (including all males) or to behind a curtained wall, and stay covered on the delivery bed until the end.
Then there are some completely exhibitionist who videotape everything and wander the room naked, rocking on their birthing balls or soaking in a tub (if appropriate) with 3-4 visitors present (our maximum limit allowable).
Sometimes during a really dramatic delivery, the person leaves behind the normal character they are and seems to become someone else for a while. Sweet people may become mean, mean people may become quiet and meekly follow instructions as though they are trained.
Our task is to meet your needs while effecting a safe-as-possible delivery, and we can be very flexible about it as long as things are going as planned.
I once myself delivered an extremely premature baby cord first who then wouldn’t come on out, so I was transported down the hall to the OR for a ‘splash and slash’ c-section with a Doctor’s hand up my vagina pushing the baby and cord off the cervix (back into the uterus) so the baby would not lose his blood supply. I was on my back. I may have been naked at that point- I don’t recall now. It wasn’t a big deal to me at the time. The “hand” Doc kept calling out the baby’s heart rate which was in the 60’s (very low for a newborn).
Then I did this same procedure to another woman in my same situation. She was naked, having just come from the shower when her cord prolapsed, so I had the nurses throw a sheet over us as we ran her on a stretcher to the OR. I had her on her hands and knees and then needed to flip her onto her back and onto the operating table- without losing my position on the baby. He had a heart rate of about 90 and came out squawking. I would have thought this last maneuver would have been unpleasant, but she didn’t complain. I suspect she was very distracted at the moment.
We do put up a drape on a woman having a c-section that blocks her view. The docs ‘exteriorize’ the uterus to clean it and the gutters, to check the tubes and ovaries, look for bleedy stuff, and then put it all back. Most folks aren’t prepared to or don’t appreciate seeing their internal organs being moved around like that.
"a great deal of chest hair. Sometimes the AED will have a razor in there; if not, they suggest using one of the AED pads to rip off a swatch to ensure good contact. Not to hijack this thread, but if any EMT folks or anyone who knows could let me know if this is common in the US–or anywhere else–I’d appreciate it. "
I was told to do this in my last CPR class about a year ago.
Imagine a large greyish deflated football laying across your abdomen with a doctor busily sewing it up and then stuffing into a hole that looks about the right size for a softball. Or don’t imagine it.
