Prior to my country placment i found the most challenging technique to be lumbar rotation- i found it so hard on my body. So I thought that I would like to alert everyone to a way of doing a lumbar rotation technique which I found to be far easier on my body than the one we have previously been taught at uni. Apparently this is the original Maitland way of doing lumber rotations:
Grade 1: patient side lying with both knees bent up (bend up more for low lumber or less for high lumbar), no rotation through trunk, therapist stands behind the patient in stride stance with both hands hooked over the iliac crest, line of push is down the femur, Grade 1= gentle movement, really good for acute disc/facet injuries!
Grade 2: same as above except the top hand is placed on the patients belly button (some trunk rotation) and the amplitude of movement is greater as it’s a grade 2. If done correctly the top shoulder and the pelvis should be moving in opposite directions with the oscillations.
Grade 3: same as above except the bottom leg is straightened and the therapist supports the top arm at the shoulder (fixates it)
Grade 4: same as grade 3 except the movement is just at the end of range
I found it to be a really useful technique from really acute injuries to chronic conditions. And if the patient find the technique too uncomfortable you can just drop down a grade or likewise you can go up a grade if the technique isn’t forceful enough.
Tuesday 30 October 2007
Different ideas...
On my last placement at a private practice I had a ‘clash’ of ideas with my supervisor. At this particular clinic 4 of the clinicians had over 35 years of experience each- so I found that with a few different principles and clinical reasoning we had very different ideas. I know that they had a lot more experience than me but they were totally unaware of some of the various principles/tests that I had learnt at university. For example = the differentiation between the diagnosis of a lumbar facet sprain and a lumbar disc protrusion. Many of the key sings that would have alerted me to a disc problem i.e. mechanism of injury, presence of neuro symptoms, they said would indicate a facet joint problem. I obviously wasn’t going to argue but I did state the typical signs that we had learnt at uni and they said that they all could indicate either. I know that essentially both conditions are treated in the same way anyway but it was just interesting to see their provisional diagnosis compared to mine.
Monday 29 October 2007
Hand sensory stimulation
Hi everyone
I've just finished one week of my new prac at shents neuro outpt and it has been one hell of an experience so far. Our supervisor is very experienced and has taught us several new techniques, which is starting to get difficult to remember all!
One of the techniques that we've been taught is hand sensory stimulation ( there is another word for it but i've forgotten for now...will keep you posted) It is used for stroke patients who have reduced voluntary control of the upper limb. It involves getting a rigid pencil and having the patient sit over the edge of the bed with a table in front of them to support their affected arm in front of them with the palm facing up. With the pencil, you roll it around the hyperthenar surface of the palm and then you draw lines with the non-lead side, then you colour it in again with the non lead side. After this, the hand is "grounded" which involves other techniques (then practice the Fx task such as picking up a ball). The outcome is quite effective with greater mm activation of the UL. More to come i am sure.
Apologies for the poor explaination!
I've just finished one week of my new prac at shents neuro outpt and it has been one hell of an experience so far. Our supervisor is very experienced and has taught us several new techniques, which is starting to get difficult to remember all!
One of the techniques that we've been taught is hand sensory stimulation ( there is another word for it but i've forgotten for now...will keep you posted) It is used for stroke patients who have reduced voluntary control of the upper limb. It involves getting a rigid pencil and having the patient sit over the edge of the bed with a table in front of them to support their affected arm in front of them with the palm facing up. With the pencil, you roll it around the hyperthenar surface of the palm and then you draw lines with the non-lead side, then you colour it in again with the non lead side. After this, the hand is "grounded" which involves other techniques (then practice the Fx task such as picking up a ball). The outcome is quite effective with greater mm activation of the UL. More to come i am sure.
Apologies for the poor explaination!
theatre
hi everyone,
i have had the opportunity to view a couple of procedures in theatre this prac, and as gross as it sounds i thought it was a great experience.
whether you have the opportunity to see a cesarean, hip or knee surgery, or any other kind, i definately recommend it if you have the stomach for it.
by observing exactly what goes on in surgery, you definately find it easier to treat the patients on the ward - and with a lot more understanding/sympathy!
the surgeons are helpful also (in my small experience) and they took the time to explain things to me and teach me something interesting.
i hope most of you have had this opportunity as well, and if not then definately ask your supervisors!
i have had the opportunity to view a couple of procedures in theatre this prac, and as gross as it sounds i thought it was a great experience.
whether you have the opportunity to see a cesarean, hip or knee surgery, or any other kind, i definately recommend it if you have the stomach for it.
by observing exactly what goes on in surgery, you definately find it easier to treat the patients on the ward - and with a lot more understanding/sympathy!
the surgeons are helpful also (in my small experience) and they took the time to explain things to me and teach me something interesting.
i hope most of you have had this opportunity as well, and if not then definately ask your supervisors!
Non-compliant kids
Greetings.
I have just commenced a placement of the paediatric variety, which has been both fun and challenging in the first week. I would like some assistance with the well established problem of getting kids to do what you want them to do. I had a young client (almost 5 years old), who was less than co-operative, especially when asked to do activities that she was well aware she would find difficult. Some of these things (when we finally got her to do them) she could perform quite well. My supervisor was able to get her to do things without her realising that she was doing them, but my strategy really came down to bribery with stickers. I realise that this may not always be effective, so with a child like this, with self esteem issues, how could I get her to attempt difficults tasks?
I have just commenced a placement of the paediatric variety, which has been both fun and challenging in the first week. I would like some assistance with the well established problem of getting kids to do what you want them to do. I had a young client (almost 5 years old), who was less than co-operative, especially when asked to do activities that she was well aware she would find difficult. Some of these things (when we finally got her to do them) she could perform quite well. My supervisor was able to get her to do things without her realising that she was doing them, but my strategy really came down to bribery with stickers. I realise that this may not always be effective, so with a child like this, with self esteem issues, how could I get her to attempt difficults tasks?
Sunday 28 October 2007
combining techniques
Hi all,
just wanted to share an treatment session where i combined a number of techniques to produce an effective treatment. We had a patient with infective pneumonia (and on Xray- a very prominent right upper lobe consolidation). The patient was intubated at the time. We decided we would position the patient in high sitting (with the help of nurses and orderlies) to provide some postural drainage, and adjust the ventilator settings to hyperinflate (hence get some increases in collateral ventilation and shear secretions etc etc) At the same time as we hyperinflated, I also provided some rib springing at end of expiration to increase lung volumes and some expiratory vibrations focused on the right upper lung zone to loosen secretions. After a few cycles lasting a minute or so each, we suctioned very large amounts of sputum via his ETT, and on auscultation there was a significant decrease of the amount of coarse crackles which were heard prior to treatment. Overall, it was very useful combining all three techniques for treatment.
just wanted to share an treatment session where i combined a number of techniques to produce an effective treatment. We had a patient with infective pneumonia (and on Xray- a very prominent right upper lobe consolidation). The patient was intubated at the time. We decided we would position the patient in high sitting (with the help of nurses and orderlies) to provide some postural drainage, and adjust the ventilator settings to hyperinflate (hence get some increases in collateral ventilation and shear secretions etc etc) At the same time as we hyperinflated, I also provided some rib springing at end of expiration to increase lung volumes and some expiratory vibrations focused on the right upper lung zone to loosen secretions. After a few cycles lasting a minute or so each, we suctioned very large amounts of sputum via his ETT, and on auscultation there was a significant decrease of the amount of coarse crackles which were heard prior to treatment. Overall, it was very useful combining all three techniques for treatment.
Tuesday 23 October 2007
mothers and babies...
Hi all,
have just started an interesting but rather emotional prac this week doing womens health. i am dealing with mothers who have just given birth (anywhere from 12 hrs to 6/7 days post so far), and therefore have some very emotional patients!
i have found that this placement, more than any others i have been on, requires a LOT of communication and how well you do your job nearly depends more on your manner/personality than skill and knowledge. there are so many different patients with differing circumstances that there is no set routine to your vistits and sessions - you just have to judge it once you get in there. some i have found quite challenging include mothers who have lost their baby during birth, and those who have very fragile family (husband) situations and no support.
it is much harder to plan your day/patients as often your timing is not the best and so you have to go and treat someone else or find something else to do. often the only 'treatment' you are able to carry out for the patient is leaving them with some pamphlets and checking up on them again later to see if they have any questions, which often isnt ideal.
however, it is great doing such a different prac and apart from the challenges i am really enjoying it, and just thought i would share some of the things i have learnt so far!
have just started an interesting but rather emotional prac this week doing womens health. i am dealing with mothers who have just given birth (anywhere from 12 hrs to 6/7 days post so far), and therefore have some very emotional patients!
i have found that this placement, more than any others i have been on, requires a LOT of communication and how well you do your job nearly depends more on your manner/personality than skill and knowledge. there are so many different patients with differing circumstances that there is no set routine to your vistits and sessions - you just have to judge it once you get in there. some i have found quite challenging include mothers who have lost their baby during birth, and those who have very fragile family (husband) situations and no support.
it is much harder to plan your day/patients as often your timing is not the best and so you have to go and treat someone else or find something else to do. often the only 'treatment' you are able to carry out for the patient is leaving them with some pamphlets and checking up on them again later to see if they have any questions, which often isnt ideal.
however, it is great doing such a different prac and apart from the challenges i am really enjoying it, and just thought i would share some of the things i have learnt so far!
Monday 22 October 2007
ICU patients
I have just completed my last prac in ICU. Over the four weeks, i saw a huge variety of patients-all very sick and most of the time, difficult to see. I found myself sometimes getting quite upset seeing these type of patients, especially the young head injured/spinal injured patients who are essentially the same age as you. It was hard not to get upset as from all our studies at uni of anatomy/neuro, we have the knowledge of what is happening to them and have some idea of their prognosis, which a lot of the time, was not good. From having a particular couple of patients the whole time throughout my placement, it was hard not to somehow get attached to them and their families. The patients left ICU as soon as they were medically stable but it was hard not being able to follow them through and see their progress, seeing as you have formed somewhat of a relationship with them over time. From completing this placement, I realised it gave me good perspective of what a patient looks like/deals with within an acute stage and how they are when heading into rehab (though i would have liked to see some of my patients within the rehab stage) Anyone have any thoughts about this?
Positioning really does work!
Hey all,
At the moment I'm on prac in ICU. We have a patient who is a recent C4 complete quadriplegic. His Chest Xray shows left middle zone consolidation (though it is improving with comparison to previous Xrays). We were called to see him as his oxygen saturation had dropped to 86% after being turned. He was lying on his right side and on auscultation his right lung had widespread crackles and exp wheezes. We did some ventilator hyperinflation, combined with some exp vibes and numerous suctions but to no avail. We needed to reposition him as the secretions had appeared to drain into his "good " lung (right) and since this was preferentially perfused, it was compromising his gas exchange. Even though it required 5 of us to reposition him onto his left side (halo traction and cervical spinal precautions), it was defiantly worth it! His oxygen saturation instantly rose back up to 98%. The now drained left lung became the dependent lung and was therefore better perfused, therefore maximising his gas exchange. It was really good to see an effect occur almost immediately and was valuable to see how simple, yet effective positioning is.
At the moment I'm on prac in ICU. We have a patient who is a recent C4 complete quadriplegic. His Chest Xray shows left middle zone consolidation (though it is improving with comparison to previous Xrays). We were called to see him as his oxygen saturation had dropped to 86% after being turned. He was lying on his right side and on auscultation his right lung had widespread crackles and exp wheezes. We did some ventilator hyperinflation, combined with some exp vibes and numerous suctions but to no avail. We needed to reposition him as the secretions had appeared to drain into his "good " lung (right) and since this was preferentially perfused, it was compromising his gas exchange. Even though it required 5 of us to reposition him onto his left side (halo traction and cervical spinal precautions), it was defiantly worth it! His oxygen saturation instantly rose back up to 98%. The now drained left lung became the dependent lung and was therefore better perfused, therefore maximising his gas exchange. It was really good to see an effect occur almost immediately and was valuable to see how simple, yet effective positioning is.
Saturday 20 October 2007
Golf Tips
Hi all,
I really have run out stuff to write, so this week, I will share some knowledge (related to physiotherapy) which I’ve learnt from golf.
During golf swing, momentum comes from your wrist, elbow, shoulder, torso and pelvic. Technically, if you have a greater ROM of these joints, you should be able to hit the ball further.
Few years ago, when Tiger Wood lost the US Open, he employed a physiotherapist to enhance his performance. The physio had developed some thoracic rotation AROM and stability exercise for Wood and he claimed Wood’s thoracic ROM has improved by 15% after treatment. Interestingly, Wood had won the US title for the next 2 years (Believe it or not?)
I was talking to one of the pros in Wembley golf course; he told me many novices tend to grip the golf club too hard and a small proportion of them will develop trigger fingers. His advice to prevent trigger finger is to educate novices to release grip after 10-15 swings when they are practising at the driving range (since learner always tends to grip harder and harder to hit the ball further)
I really have run out stuff to write, so this week, I will share some knowledge (related to physiotherapy) which I’ve learnt from golf.
During golf swing, momentum comes from your wrist, elbow, shoulder, torso and pelvic. Technically, if you have a greater ROM of these joints, you should be able to hit the ball further.
Few years ago, when Tiger Wood lost the US Open, he employed a physiotherapist to enhance his performance. The physio had developed some thoracic rotation AROM and stability exercise for Wood and he claimed Wood’s thoracic ROM has improved by 15% after treatment. Interestingly, Wood had won the US title for the next 2 years (Believe it or not?)
I was talking to one of the pros in Wembley golf course; he told me many novices tend to grip the golf club too hard and a small proportion of them will develop trigger fingers. His advice to prevent trigger finger is to educate novices to release grip after 10-15 swings when they are practising at the driving range (since learner always tends to grip harder and harder to hit the ball further)
Tuesday 16 October 2007
Osteoporosis
Hi all,
Last week, I read an article, published by Osteoporosis Australia, on osteoporotic prevention. It contains some useful information and I will share some of them with you guys this week.
1)Approximate every 8 minutes, someone is admitted to an Australian hospital with an osteoporotic fracture
2)A 10% loss of bone mass in the vertebrae can double the risk of vertebrae fracture, and a 10% loss of bone mass in hip can result in a 2.5 times greater risk of hip fracture
3)A Medicare rebate is now available (from April 1,2007) for BMD testing(DXA Scan) for all women and men aged 70 or above
4)From April 1,2007, people who aged 70 or above with a BMD T-score equal or lesser and -3 can receive treatment for osteoporosis on the PBS( w/o having sustained a fracture)
5)Protos and Bon Viva are the two new first-line medication for fighting osteoporosis
Last week, I read an article, published by Osteoporosis Australia, on osteoporotic prevention. It contains some useful information and I will share some of them with you guys this week.
1)Approximate every 8 minutes, someone is admitted to an Australian hospital with an osteoporotic fracture
2)A 10% loss of bone mass in the vertebrae can double the risk of vertebrae fracture, and a 10% loss of bone mass in hip can result in a 2.5 times greater risk of hip fracture
3)A Medicare rebate is now available (from April 1,2007) for BMD testing(DXA Scan) for all women and men aged 70 or above
4)From April 1,2007, people who aged 70 or above with a BMD T-score equal or lesser and -3 can receive treatment for osteoporosis on the PBS( w/o having sustained a fracture)
5)Protos and Bon Viva are the two new first-line medication for fighting osteoporosis
Thursday 11 October 2007
chronic pain
I would like to share with you the experience i had during my last week of prac in musculo outpatients. My final Ax pt was a 19 yo female who presented with bilateral non-specific hip pain. as i couldnt access the medical records, all i had to go on was a dr's referral saying hip pain / bursitis / tendonitis - which wasn't particularly helpful!! turns out we couldnt diagnose it any better, as every joint, muscle and stability test i did came back positive - even palpating in regions unrelated to her hips had her almost in tears. i had a long discussion with my supervisor about her as we couldnt identify a specific problem to treat - alot of our findings contradicted each other.
My supervisor explained how even very young pts can have a chronic pain presentation and the resulting widespread sensitivity throughout the body. We shouldnt expect that those with chronic pain are generally middle aged with LBP... it can occur in anyone with a varying range of pathologies, and is something to always be aware of.
With our pt we ended up starting her in hydro for a few sessions to try and get her trusting us and reduce her acute pain, with the goal of getting her to walk for at least 5 mins pain-free.
My supervisor explained how even very young pts can have a chronic pain presentation and the resulting widespread sensitivity throughout the body. We shouldnt expect that those with chronic pain are generally middle aged with LBP... it can occur in anyone with a varying range of pathologies, and is something to always be aware of.
With our pt we ended up starting her in hydro for a few sessions to try and get her trusting us and reduce her acute pain, with the goal of getting her to walk for at least 5 mins pain-free.
Tuesday 9 October 2007
Cervicogenic Headache
Hi all,
I had a patient with cervicogenic (CG) headache during my country placement, her clinical presentation was classic and since PCR exam is just around the corner (CG headache has been in the exam for the last few years), I am going to share some information with all of you on this topic.
What is CG headache?
It is a headache caused by abnormalities of the joints, muscles, fascia and neural structures of the cervical region.
Clinical Features:
1)Usually described as a constant, steady, dull ache, often unilateral but sometimes bilateral.
2)Pt may describe a tight band around the head and headaches are usually in the suboccipital region and commonly referred to the frontal, retro-orbital or temporal regions.
3)Usually gradual onset
4)Pt often wakes with a headache that may improve in the day
5)May be present for days, weeks or even months
6)May be a Hx of acute trauma ie whiplash injury, MVA or repetitive trauma ie work or sporting activity
7)Often associated with neck pain or stiffness and us. Agg by neck or head mvmts such as repetitive jolting (travelling on car/bus)
8)Can also be assoc with light-headedness, dizziness, tinnitus
9)Pt also us. presents with poor posture: rounded shoulders, poked chin resulting in weakness of DNF’s
10)Stress is often also assoc
Note: Different types of headache can co-exist
I have gathered the above information from a few different sources and I am aware of some clinical features mentioned do not match with what we’ve learnt in Uni, feel free to give me some comments, I will pay a penny for your thought.
I had a patient with cervicogenic (CG) headache during my country placement, her clinical presentation was classic and since PCR exam is just around the corner (CG headache has been in the exam for the last few years), I am going to share some information with all of you on this topic.
What is CG headache?
It is a headache caused by abnormalities of the joints, muscles, fascia and neural structures of the cervical region.
Clinical Features:
1)Usually described as a constant, steady, dull ache, often unilateral but sometimes bilateral.
2)Pt may describe a tight band around the head and headaches are usually in the suboccipital region and commonly referred to the frontal, retro-orbital or temporal regions.
3)Usually gradual onset
4)Pt often wakes with a headache that may improve in the day
5)May be present for days, weeks or even months
6)May be a Hx of acute trauma ie whiplash injury, MVA or repetitive trauma ie work or sporting activity
7)Often associated with neck pain or stiffness and us. Agg by neck or head mvmts such as repetitive jolting (travelling on car/bus)
8)Can also be assoc with light-headedness, dizziness, tinnitus
9)Pt also us. presents with poor posture: rounded shoulders, poked chin resulting in weakness of DNF’s
10)Stress is often also assoc
Note: Different types of headache can co-exist
I have gathered the above information from a few different sources and I am aware of some clinical features mentioned do not match with what we’ve learnt in Uni, feel free to give me some comments, I will pay a penny for your thought.
Monday 8 October 2007
$$$
I am currently on my rural placement at a private practice. The placement has been excellent and it is such a great opportunity to practice musculoskeletal assessment and treatment. My days are pretty booked up with 8-13 patients a day which is great. The patients are however paying full price to see me- so the same price as the other physios (some have been practicing physio for 40+ years). At the start I was quite uncomfortable about this. However as the prac has gone on I have realized a few things:
- lots of my patients are veterans affairs so they don’t pay any way
- lots have workers comp so they don’t pay either
- most have private health so they only pay a small amount
- and finally, that people come to physio expecting to pay for the service they are receiving
After realizing the above I now don’t feel so bad!
- lots of my patients are veterans affairs so they don’t pay any way
- lots have workers comp so they don’t pay either
- most have private health so they only pay a small amount
- and finally, that people come to physio expecting to pay for the service they are receiving
After realizing the above I now don’t feel so bad!
Wednesday 3 October 2007
Ethical Dilemma
When I was on my country placement, one of my patients was a 70 years old male who had a head injury (subdural haematoma) secondary to a fall in the community.
When I took over his case (in a restorative ward), he was already 38 weeks down the track. From his previous medical entries, this patient had been documented as ‘unfriendly’, ‘uncooperative’, ‘stubborn’ and ‘verbally expressive’.
In his first physiotherapy session with me, he was unwilling to participate and the only thing he wanted was to kick or punch me. I wasn’t quite sure what to do so I went back to consult my supervisor.
My supervisor went to see the patient with me and she suggested since patient was not doing anything apart from kicking or punching, I might have to integrate these two movements into his session. For example: If I want him to do active knee extension in sitting, I have to ask him to ‘kick my hand’.
To be honest, this method worked for that patient yet I was thinking: Would this encourage patient to develop an aggressive manner towards other medical staff? Is it an appropriate method to treat your patient while hospital has emphasized on the importance of ‘zero-tolerance’ policy.
When I took over his case (in a restorative ward), he was already 38 weeks down the track. From his previous medical entries, this patient had been documented as ‘unfriendly’, ‘uncooperative’, ‘stubborn’ and ‘verbally expressive’.
In his first physiotherapy session with me, he was unwilling to participate and the only thing he wanted was to kick or punch me. I wasn’t quite sure what to do so I went back to consult my supervisor.
My supervisor went to see the patient with me and she suggested since patient was not doing anything apart from kicking or punching, I might have to integrate these two movements into his session. For example: If I want him to do active knee extension in sitting, I have to ask him to ‘kick my hand’.
To be honest, this method worked for that patient yet I was thinking: Would this encourage patient to develop an aggressive manner towards other medical staff? Is it an appropriate method to treat your patient while hospital has emphasized on the importance of ‘zero-tolerance’ policy.
Monday 1 October 2007
Working Hours
Hey everyone,
Currently I am on my rural placement which I am really enjoying- except that I am doing 8-5 everyday with only a half hour lunch break (8.5 hours a day). I normally don’t mind if I have to do extra hours to catch up on extra notes or what ever but I often finish my work early but my supervisor makes me stay until 5. I read the unit outline and it states that we do 37.5 hours a week normally on a rural placement which should be 7.5 hours a day and I am doing 8.5 hours a day- which adds up over a week! My supervisor is not the easiest person to approach so should I let her know or just stick it out for the next 3 weeks?
Currently I am on my rural placement which I am really enjoying- except that I am doing 8-5 everyday with only a half hour lunch break (8.5 hours a day). I normally don’t mind if I have to do extra hours to catch up on extra notes or what ever but I often finish my work early but my supervisor makes me stay until 5. I read the unit outline and it states that we do 37.5 hours a week normally on a rural placement which should be 7.5 hours a day and I am doing 8.5 hours a day- which adds up over a week! My supervisor is not the easiest person to approach so should I let her know or just stick it out for the next 3 weeks?
Ward round
During my current placement, I have been warned by one of the physios that certain consultant doesn't like physio to stay with the patient if he was doing a ward round and the physio is in the middle of the treatment session.
I understand that the consultant and the team want to have an uninterrupted ward round. But I could not see how I could disrupt the ward round if i was just standing on the side listening quietly, as I feel it is quite important for me to know the most up-to-date plan from the medical team.
I have a brief discussion about this with my supervisor and she suggested that sometimes the pt can be overwhelmed by the number of wardround team members. So it may be considerate for us to stand behind the curtain / door and have a listen.
My supervisor's advice has made me to think from the pt's perspective, rather than disliking the consultant's "rule".
I understand that the consultant and the team want to have an uninterrupted ward round. But I could not see how I could disrupt the ward round if i was just standing on the side listening quietly, as I feel it is quite important for me to know the most up-to-date plan from the medical team.
I have a brief discussion about this with my supervisor and she suggested that sometimes the pt can be overwhelmed by the number of wardround team members. So it may be considerate for us to stand behind the curtain / door and have a listen.
My supervisor's advice has made me to think from the pt's perspective, rather than disliking the consultant's "rule".
when physio is not indicated
Hi all,
Currently im on prac in an intensive care unit. We have a patient who is a 22 y.o male with a closed head injury and multiple fractures. At the scene of the accident, he had no pulse, required CPR for 20 mins and had a GCS of 5/15. As a result he has a sub arachnoid hemorrhage. He is currently ventilated and sedated but the medical staff are having difficulty controlling his rising ICP ( he sits at about 23, normal being under 10!) After suctioning him via his ETT, his ICP rose to 28.This is an example of a patient were physio may not be indicated. Even though the suction was productive of a moderate amount of yellow/green sputum and being intubated/sedated etc, it is a possibility that this patient could (or may already has) developed chest complications. However, this is where we need to be able to look at the overall presentation of the patient, and not treat them purely as a 'cardio' pt as for him, the number one thing on his problem list is his neurological status. We need to recognise that our treatment already indicated that it may have a detrimental effect on his number one problem (raising ICP) and even though the condition of his chest is important, his neuro status is of greater concern. Physio at the present is not indicated however the pt will be monitored and when more neurologically stable, we will intervene.
Currently im on prac in an intensive care unit. We have a patient who is a 22 y.o male with a closed head injury and multiple fractures. At the scene of the accident, he had no pulse, required CPR for 20 mins and had a GCS of 5/15. As a result he has a sub arachnoid hemorrhage. He is currently ventilated and sedated but the medical staff are having difficulty controlling his rising ICP ( he sits at about 23, normal being under 10!) After suctioning him via his ETT, his ICP rose to 28.This is an example of a patient were physio may not be indicated. Even though the suction was productive of a moderate amount of yellow/green sputum and being intubated/sedated etc, it is a possibility that this patient could (or may already has) developed chest complications. However, this is where we need to be able to look at the overall presentation of the patient, and not treat them purely as a 'cardio' pt as for him, the number one thing on his problem list is his neurological status. We need to recognise that our treatment already indicated that it may have a detrimental effect on his number one problem (raising ICP) and even though the condition of his chest is important, his neuro status is of greater concern. Physio at the present is not indicated however the pt will be monitored and when more neurologically stable, we will intervene.
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