Joy of acute care

Hey guys,
Wanted to let you know that my scrotal wound care ended with me doing a wound vac on him in the ICU with him in stirrups...it took me 2 hours to do it because there were 4 seperate wounds, and it kept draining....fun times. I knocked over a man's urninal on Tuesday that he had left on his tray with the lid off...that's right, I got urine all over his room. GO ME! I did get to watch a surgery on Tuesday morning which was neat. It was a TKR. Miss all of you guys. Hope it's going well.

John 0...Death +2

Lost two patients last weekend, one to CA and the other to a PE that hit him outta no where. I had been working with the two guys really close and I wasn't ready to get this kind of news, it honestly was the last thing on my mind that a patient would pass away! But, a majority of the patients here at the VA are really sick and that's the harse reality that I'm coming to realize. If only Danny was here with his amazing Differential Dx skills maybe the score would be different?

Danny +1... Death 0

So here is a little differential diagnosis quiz for you.

Patient Hx:
2 weeks status post knee scope
Complains of calf pain, does not go away in a week but is no worse
Only gets calf pain with walking, no pain in a dependent position, no pain with resisted DF/PF, skin does not feel warm to touch, no redness, homans sign negative, pain feels like it is deep, stretching doesn't make it better.

What do you do?

Outcome: We sent her to the ER on friday last week to get a dopplar done, turns out she has 3 blood clots, 2 in her calf and 1 in her lung. Pretty crazy!

Another Paslay moment

Just thought I would share yet another "forgot to put my car in park" moment I had on Thursday. Just to preface, I have only seen 3 patients thus far younger than me, including this one. So, I am almost finished with an eval with a 23 year old hockey jock when I sit down in front of him to begin explaining his HEP. I dropped my pen on the floor and as I reached down to get it I catch a glimpse of my zipper fly wide open, flappin in the breeze. I laugh at myself as I'm sitting back up, look up at him for a reaction and slyly place the towel that is in my hand in my lap. No reaction from him, so I try to act professional while I explain him the exercises....while seated. Luckily, my CI came back in the room mometarily and I stepped out and closed the trap. Ugh. I really hope he did not notice, but I'm thinking the chances are slim since it was open the whole time. It's always the little things people, I just can't seem to ever cover all the bases.

Gas and poo....I'm coming out !!!

I don't know what Presbyterian feeds and gives these patients to drink but all my patients are having some issues with their bodily functions. I am just going to tell you about the most funny patient stories. So yesterday my CI and I were getting this man (with a stroke and Parkinsons) into the standing position and I swear he wasn't standing for more than a minute when the patient said, "Oops, I just dropped in my pants." A few minutes later my CI and I looked at each other and thought to ourselves....YES YOU DID. So we had to clean him up and go to our next patient who had a brain tumor removed 2 weeks ago. So I was ambulating with her down the hall and she says, "I think I just farted" followed by "I did fart, and it was big one!". Needless to say that I am gagging at this point because I'm following behind her holding onto the gait belt. Then, today this same lady had more gas and every time I had her contract her glut med she let some more go (literally every time!!) and once again I'm standing in back. So I finally learned my lesson and started guarding in front and then she began coughing in my face. So if I don't make it back to school in March you know it is because I died from all the toxic fumes!!!

LBP or LAIR !?!

Ladies and gentlemen I'm here now to testify to the Waddell signs! I got to see a LBP pt today with another PT to view a new mobilization(it was like some Jeff Rao stuff...the dude got cavitation on his skin CRAZY). Anyways, 32 yo male with LBP that was radiating to the knee on the right side, hurt to do anything, positive straight leg test and PAVIMs. We start the treatment and wait a minute the pain is now going down the left side(red flag). So, I start looking through the guys chart while the other PT was continuing with treatment, just to see if there was any history on this dude. Two more red flags popped up...negative imaging results for injury and my man was 100% SVC(G'vmt is paying him). So I got to do Waddell's, from the sitting knee extension, rotating through the hips thing, and cervical pseudo compression. BUSTED in my books people!!! But the dude still gets to come to therapy its not like we get to kick him out, we just get to baby him along for two more sessions...kind of a let down, oh well we got a chuckle out of it.

PS:
Jacquelyne, I believe those types of wounds are called "Tweener Sores" nasty!! You should ask your CI for clarification as to where the "Tweener" starts and stops, maybe its in the O'sullivan book?

too many bm's to count.....

even though it's only tuesday, poop has already become the theme of the week!  i think i had 3 patients yesterday and 2 today either have a bm while we were in the room or ask to be transferred to the bedside commode and then do their business while we're still there getting everything put back together!  add in all the women that just lift their gowns up to wipe their faces or ask you to check and make sure they aren't getting a rash "down there", and the men that seem to have no qualms about their business hanging out.....it's been a fairly traumatizing experience!  besides the lack of modesty we've encountered, my CI and our other student pt rachel (who's from iowa too, crazy), have been tackling those ortho evals like pros.  we switched teams this week and are now seeing thr's, tkr's, hip fx's, lum and cerv fusions, etc, etc.  i've seen/done enough ankle pumps, quad sets, heel slides, and straight leg raises to last a lifetime.  after 3 evals on my own today, the kinks are starting to get worked out!  i hope everybody is having a great time at their sites, miss you guys!!

Wound Care....

Hey guys! I definitely need to get into PT shape. Each day it's harder and harder to get out of bed because my legs are so tired! On friday, I thought it was going to be a slow day. My CI has been out of town so I've been seeing a couple patients on my own and then following another PT. We were doing paperwork when Kim got a phone call from a surgeon who was actually in the middle of his procedure in the OR. He asked if she would be willing to come into the OR and help him. He wanted her opinion about a potential wound care pt. She let me go with her which was pretty awesome. I got to scrub up! I was not prepared for what I was about to see....We walked in to find a middle aged man with his feet in stirrups. It was a scrotal wound! It was the biggest thing I've ever seen...the wound! It extended from his scrotum all the way to his butt and was probably 8-10 inches wide. The PT I was with put a wound vac on him. I did a lot of handing her stuff and no touching. It was intense. Anyways...it's been going pretty good overall. I definitely miss all of you. FYI: wound care is not for me....

humbling moment.

So....... I LEGITIMATELY lost to my ASIA D C6 SCI patient in Wii Balance today. a humbling experience to say the least.

I'm hungry all day

Hi kids!!!! Is it weird that I miss school? I really thought I would never say that. So I'm at Sports and Spine in Plano with Danny, and we pretty much own the place. JK, no but really. My CI, Kendra, is the coolest CI ever. I think we would be bff's if she didn't have to be my boss-man. Oh, and yeah, I know what everyone means about the getting into "PT Shape". Dang, I didn't know that if I wanted to work at Tom Domino's clinic that I would have to eat peas 2X/day and run 5 miles plus "lift" everyday at lunch. Seriously though, all of the guys work-out like pretty much every day. I on the other hand glance at the clock every ten minutes to see if it is lunch-time yet. I freaking starve there! When you wake up at 5 am to get to Plano by 6:45, you kinda want to eat your hand. So yeah, I love it there though. I haven't done anything too embarrassing yet...but hence I said "yet". Take care. I miss you guys!

Diff Diag

So, seeing a lady in her 60's with back and leg pain who can barely walk and has a positive Babinski bilaterally and a serious Marie Fioux bilaterally. When sitting or lying she will involunarily flex up one LE, especially if stretching. It started 2 years ago and she saw a neurologist recently that said she was FINE! My CI called her PCP who just wanted to refer her back to the same neurologist. Thankfully, the patient insisted on an MRI which she should get this week or next. Kinda scared to hear what they find.

Then, seeing a sweet little lady with M.S. post laminectomy who told me on Tues that she finally got her bladder back that morning....didn't know it wasn't there to begin with but yay! Then on Thursday when we see her she says she has bad back pain and "numbness in her seat, inside and out." So, being the curious george I am , when I was stretching her I asked how well her baldder was doing since Tuesday...we've bonded...and she says not as well. Then I ask her about her numbness again and she describes it as being in the area a saddle would be. And to top it off, she's never had this problem before. Mention it to my CI who basically says lets wait to see if it is consistent for a few days. I'm like, is this a Red Flag call the docotor moment or a Red Flag rush to the ER moment, or a yellow flag let's wait and watch it moment??!

Reminder, I'm in an outpatient clinic. Differential Diag is haunting me.

Paslay

awkard moment....what Dr. P. Smith did not warn us about

okay.. so today I was helping an elderly man do exercises .. and I had to teach him glut sets. So I explain to him how to do them and he starts to do the exercise. He then says... this reminds me of my honeymoon!!!!!!!!!! I just sorta laughed and said oh.. ok... I could feel my face get so red!! Anyways my clinical is going well.. I did my first full eval today and it could have gone WAY better.... but practice makes perfect I guess.. :) miss all of yall!!!

My first...

My patient couldn't lift his leg, do heel slides, or ab/adduction because of pain but the chart didn't say anything about LE issues...so my mind starts to do the algorithms and problem solving to figure out where the "pain generator" is. That's when I looked down and saw....SCROTAL EDEMA!!! Dr. Querry never taught us the "WHY" of this one. Thank you, that is all...whoa

Sincerely,
Scarred for Life

Love the hustla'

"My agility dog is better than your honor student" and "Hustler 4 life...hustlin' since birth." Is anybody else jealous that they don't own shirts that say such thought provoking quotes?....I'm just saying. I freakin love the patients I work with.

Whats up Everyone...

Week 1:
Let me start out by saying that I had the hardest time remembering my gmail password so that I could participate in the blogging....
Diabetic toes, amputated limbs, MRSA, lymphedema x 2, filled wound vac, dementia, abdominal abcesses, tons of ackward intoductions to doctors, and on top of it all I dumped a pitcher of ice water on the other guy in my patient's room(funny but embarrassing). Got to do a wound care round with the nurses on Friday...wow its three older ladies with guts of steel who take care of all wounds in the main building. I think Julie called ahead and mentioned how much I like to look at stage 4 sacral pressure ulcers and puss dripping chronic diabetic heels right before lunch time. For some reason the nurses thought that this would be the perfect appetizer! On top of it all I seem to caught between a orthopedic conflict with the Physical Therapist's and Kinesiotherapist's, yes KT!?! They see all the ortho pts and do not like student PT's looking over their shoulders to see their hip/knee/ankle pts or touching their goniometers, and playing with the modalities...BIG NO NO!. But, so far the VA has been pretty cool and very different experience, the facilities are pretty up to date, and clinic has everything a car, kitchen, bedroom, and driving similator. Did I mention that I get my own desk with computer and swivel chair.....HOLLA!

PT Shape

Paslay! I agree, all the PT's I have met stay in really good shape. Guess there is no going down hill for us!!

All good here

I'm at Cooper and Bush Outpatient in Benbrook. People it takes me 8 minutes to get there, 10 with traffic! It is a much needed change in commuting for me. My CI, Van Bush, rocks my socks off. He is a great teacher and fits my learning style fabulously, although I get quizzed a lot, only some of which I have an acceptable answer. I work 11 hours Mon - Thurs and get Fridays off. We see a little bit of everything, most of which is pre-surgery, so we get to play the "where is the pain really coming from" game more than "here's your protocol" game, which is challenging, but fun. Learning a ton and getting a workout....does anyone else feel like they need to get into PT shape?!

Paslay

haha no he didn't think I was her twin but I almost told him the story of how we all dressed up like the faculty...but this man is a retired pediatrician and he talks non-stop....i literally can not get two words in before he starts another story, so I decided not to get him started lol

You're treating Joney Pony's patient?!  Sweet!  Does he/she think you're her twin??  I miss that Joney Pony, shoot, I miss all our bosses.  I'm sad Charlene is leaving!!  And that Billy Crawford...who IS that man?!  He is such an odd cat!  lol  But it's all good.  Nate, you have to expound upon this sexual harassment you are being subjected to!  lol  you can't just lay the hook and leave!!  Speaking of getting some action on the job though, we have this adorable (and when I say adorable, I mean I have tried on multiple occasions to smuggle this kid out under my scrubs and give Baby Mexico a last name of Booth) kid, and when you transfer him from his wheelchair to the mat, he either kisses your cheek or macks on your neck.  lol  He's pretty cute.  On that note I will also add that so far, my CI and I have had only one patient whose first language is English.  She is a native speaker, so she gets a lot of the Spanish speaking eval/treats, which is intimidating and a blessing at the same time.  Hope everyone had a sensational first week! Keep on bloggin biatches!!  lol j/k  Hugs and wubs!

Oh the vestibular....

So I'm at Matrix Rehab in Plano and really enjoying it. My CI, Judy is really patient with me and she is doing a great job with easing me into treating by myself. Basically, each day she sees every type of ortho issue we have ever learned about in PT school which makes reviewing difficult after work. If that isn't overwhelming enough, the icing on the cake is that she likes to do hand therapy, TMJ and vestibular of all things! I must say that I did get kinda giddy when I saw a patient have nystagmus during the Dix Hallpike. Just fyi, the BBQ Spit is really called the Epley Maneuver. Yeah, all I could remember was that we called it the BBQ spit.... Another PT that works there is a former student of UTSW and actually verbalized to me that Blau was his favorite teacher! Tid bits of random info I know but that's what I got so far....and J Can, I am the massage queen these days. Girl, it wears me out!