The week started with two of the acute physiotherapy team members on unplanned sick leave. This somewhat stretched physiotherapy resources. Tuesday and Wednesday were a little different on the wards too (normal physio staffing resumed) - the junior doctors had their strike against the DHBs for better working conditions.
I saw a variety of conditions this week, so I'll briefly mention them here.
There was a patient in ICU who had had a cardiac arrest. The patient was intubated and suction was performed to stimulate a cough and remove secretions. As this patient's status improved, they were extubated and put on airvo (high flow oxygen device). The supervising physiotherapist encouraged vibrations with deep breathing and oral suction (having checked the CXR, chest x-ray). The nurse also showed me how we collect sputum samples using suction. Physiotherapy encouraged movement of arms and legs, then sitting etc too. Patient comfort is obviously very important; one thing I learned this week was about identifying other means of ensuring the patient is comfortable. One aspect I overlooked was addressing the patient's dry mouth by using water from a sponge on a stick (I'm sure it has a proper name) - these are good tips and ticks that I hadn't thought of. Having a cold wet flannel on the forhead is another trick that can make a patient feel more comfortable.
Another thing I learned this week was: when a member of the MDT request for you to see a patient, particularly for a mobility review, you need to make your own informed decision about whether you need to see the patient, and what you will do / offer for the patient, and then justify or inform the MDT about your decision... it may well be that all the information they need about a patient's mobility is described by the hospital level residential care facility that the patient resides in, in the patient notes already. All that is needed is for the patient to confirm this information and a wheelchair to be brought up (...because the residential service didn't send it in with the patient).
Bird flu? Parrot fever? Psittacosis? This was the suspected diagnosis for a chest infection for another patient I saw this week. Other than the odd [potential] source of infection, the main reason I'm mentioning this case is because the physiotherapist performed 'induced sputum' to (as the name suggests) get a sputum sample for laboratories to examine. The process involves hypertonic saline (9%) in a nebuliser and the ACBT (active cycle of breathing techniques i.e. deep breathing, huffing and a cough or two) to be performed. The patient breathes in these vaporised droplets for about 20min to moisten secretions and produce a productive cough.
Mountain biking is a dangerous sport. We've had two patients with injuries sustained from mountain biking this week. The first patient had a contusion of the lung and a concussion, the second patient had fractures of their first six ribs, clavicle and scapular. Yikes! After an orthopaedic sling was fitted, I encouraged them to use a towel or wall to brace against to take deep breaths and cough to manage their pain and gave advice about returning to mountain biking.
The whitebait are running ?swimming and the seasonal tramper will be gearing up for another year in the wilderness (labour day / long weekend this week). A word of warning, be careful with gas canisters. We had a patient with burns to their hands, chest and face following an incident earlier in the week. As there were no burns to the airways or grafts needed, I encouraged deep breathing through incentive spirometry (given they had lower blood SpO2, probably pain related), and gentle hand/finger range of motion exercises.
In an interesting experiment with a patient who lacked touch sensation and was not able to voluntarily walk as a consequence of a back injury, but had reflexes intact, good muscle definition after weeks post-injury, could get themselves into standing and use a cross-trainer at home (not to mention, unremarkable imaging)... a physio had a genius idea of tieing each of the patient's feet to a high walking frame with a theraband and pushing them down a ramp to get a gait pattern / walking movement going. Of course, there were plenty of hands on board to ensure the patient's safety. The set-up showed potential as the patient was able to continue stepping on the flat surface having gained momentum.
The last interesting case of the week involved a patient who had a tibial plateau fracture. There were a few unexpected post-surgical events that delayed their recovery. Anyway, the short story is the team is trying to get his knee straight. A range of motion brace was trialed and found to be a nuisance for the nurses to put on and off, so there was a collaboration between a few physio team members, and a thermoplastic brace was made to encourage knee extension. I was fortunate to watch the designing and making of the thermoplastic device.
It's Labour weekend, so I'll get an extra day to get my portfolio up to date!
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