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.
Tuesday, 9 October 2007
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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