Y3S2W1: Preparing for Lift-off.

On the last weekend of the semester break, I took a physio friend (peer) into the Emergency Department at Dunedin Hospital. He messaged me just before I begun work asking whether I could offer him a lift to the hospital as he had experienced severe pain on the left side of his chest and it wasn't going away. I told him to ring for an ambulance, and that I would message him upon finishing work to check in with him (I suspected that he wouldn't call for an ambulance - I was right). Upon arrival to his flat, my friend was shallow breathing, couldn't breathe in deeply (limited by pain on inspiration), adopted a hunched/forward leaning posture (even when walking and sitting) and had pain up to this left shoulder... he had been this way (after a sudden onset) for an hour or so. At ED, his vitals were taken showing a 158bpm resting pulse, then an ECG was taken, IV line placed, blood work (D-dimer test) taken... finally an xray was taken. Diagnosis? Spontaneous Pneumothorax: 80% collapse of the left superior lung lobe due to air outside of the lung, between the lung and the chest wall. Treatment? Conservatively monitor i.e. have patient practice full breathing, supplementary oxygen and manage pain with medication. Outcome? After no change on Sat or Sun (x2 x-rays later), the decision was made to surgically remove the air to re-inflate the lung. He was discharged Sunday afternoon and attended lectures on Monday. "Just getting ahead on my respiratory physio for second semester" - friend with pneumothorax.

I was again at the sport injury clinic on Sunday before semester two began for a netball tournament. Luckily for the teams, there were very few injuries. In other sporting news over the weekend... the Highlanders won the Super15 rugby final against Wellington's Hurricanes! There was a parade at 12pm up the main street for them on Monday! Ooootaaaagoooo!!!

Two days following the highlanders touch down, we were at an info evening to begin our prep for lift off (4th year placements). In forth year, students are scattered around the South Island and Southern and Eastern regions of the North Island: Timaru, Dunedin, Invercargill, Christchurch, Nelson, Wellington, Hutt Valley, Palmerston North, Hawks Bay and possibly some places in between. We've got a couple of weeks to decide where we want to be next year. We rank our preferred choices and hope we get either our first or second pick. Third year is the last year our cohort will be all together (then we'll see each other at graduation and possibly some class reunions 50 odd years down the track). I'll discuss these placement locations and major physio opportunities in depth next year.

Our placement allocations for semester two (of this current year) are out. I've been placed at Unipol in MSK setting for these next three weeks. Later this semester I will be placed at Dunedin Hospital on the 7th floor (cardiorespiratory ward). The MSK placement at Unipol has been fairly relaxed this week. We've had one patient through the door - I got to type out the notes for the objective assessment. I'm looking forward to having a patient of my own (hopefully next week). Otherwise we looked at ways in which we can adapt our manip techniques, the application of 'dry needling', discussed shoulder assessment and muscular control of intrinsic muscles of the foot (and management for bunions).

So, we've only got two papers this semester... PHTY354 Rehabilitation Science and PHTY355 Clinical Practice... I imagine the workload will be similar to first semester. Here is next week's timetable.

PHTY354 Cardiorespiratory: We completed a cardiorespiratory assessment on our peers in a mock patient situation. The assessment included measuring chest movement and auscultating - a good referesher from last years respiratory modules. In lectures we discussed assessment findings (like specks of blood or colour of sputum, auscultatory sounds throughout the breathing cycle), respiratory conditions and types of respiratory failure, and practised prioritising patients in terms of severity based on their blood gasses (PaO2, PaCO2), fraction of inspired air (FiO2), forced expiratory volume in one sec (FEV1) & forced vital capacity (FVC).

PHTY354 Integrated Studies: We began the week with mechanisms and theories of pain and ended the week discussing chronic pain and some questionnaires that can be used in particular situations e.g. as it relates to work, ability to cope with pain, or to assess different components of the patient's pain experience. In between, we had a lab which involved clinically assessing different regions which modulate pain (from the periphery to the brain, and the synapses in between), e.g. the 'descending endogenous opioid inhibitory system'. To test this example, we used a conditioned pain modulation (CPM) technique (i.e. pain inhibits pain technique) - this involved putting a blood pressure cuff on an arm, inflating it to 240mmHg and measuring the pressure tolerated in a patients knee (measured with an algometer). A similar test was done using exercise instead of the blood pressure cuff... The pressure at which pain was first elicited was greater when using these two methods. My pre-exercise pressure tolerance was 11kgs and post-exercise tolerance was 21.4kg on my quadricep. This is important to consider if you find yourself in a horror movie situation: when running around an abandoned house to escape a sociopathic villain, be sure to run fast to a) not be caught and, b) have a high tolerance to physical torture should you be caught.

Integrated studies and cardiorespiratory will overlap in a few weeks time for the purpose of an assignment. For this assignment, we will need a daily count of steps taken (pedometer) across a one week period. So far I've averaged around 8,000 steps per day. I imagine that this will reduce across the weekend. Talking about assignments, I have got around to starting my EBP (evidence based practice) assignment. It involves selecting a case you've experienced from your clinical practice, describing it and an outcome measure used. We then dip into the research to find out what the evidence says about the outcome measure and add in our commentary about the findings and how it relates to the clinical case.
 

The Saturday night was spend with a good bunch of my physio friends roasting marshmallows over a bonfire at Long Beach.