Monday
Today was the first day of trauma week. We went out onto the St. Luke's football field to watch a demonstration of an injury with a 16-year-old male. The football team exemplified an open-tip tibia fibula fracture. The trainer walks out onto the field calmly, careful not to alarm the audience. They check for major injuries or concussions using a Primary Assessment, where they ask questions and determine if they need gear on or surgery. The physician comes to check over everything, explain the injury to the patient, and call the ambulance. The paramedics come and take the patient to the hospital (aka the auditorium). Once they get to the trauma bay, they check vital signs and gather info for a report. He had 125/96 blood pressure, a pulse of 95, 100% oxygen stats, and respiration under 16. The doctors splint his leg and give him an IV and morphine. They do this exam called CAB, where they check your circulation, breathing, and airways. They look for malignant hem rages and set the splint in place for radiology. The doctors search for the posterior tibial pulse by using a device called a doppler. They put it into gelly, and search for the pulse in the leg. After this, they practice ABC breathing and check sensory by wiggling the patient’s toes. Then the nurses perform Hare Traction, where they go below the wound with a strap. This reduces pain from muscle spasm and improves blood flow. There are actually two types of it: Skeletal and Skin traction. The patient can be awake or sedated with hare traction. The only negative thing about hare traction is that you have to take it off for radiology. They get the report from EMS and control the bleeding. There are lots of interesting facts that come with bone fractures. Did you know that it takes 4000 newtons on a femur to break a fibula, or it takes 300 pounds to break a leg? Back to the subject of radiology, there are many modalities that are involved in this kind of injury. Modalities are used to image injuries. The doctors take the patient to the Diagnostic Radiology room used for x-raying injuries. It is always a must to try to get two photos both 90 degrees from each other. There are many different types of radiology scanners. There are portable x-ray machines, CT Scanners, Angiograms, MRI Scanners, and C-Arm scanners. To prepare for surgery, the nurses check for anything that can go wrong with injuries, like compartment syndrome where there is too much pressure on that one part of the leg. There can also be an infection of the bone or tissue, malunion, and blood clots.
Tuesday
Today was the second day of trauma week. We got to move on to the surgery part of the week where we learned about casts and types of technology used to heal a broken bone. Dr. Slauterbeck, a chairman at South Alabama, came to speak to us today about different types of bone fractures, such as aligned, shattered, tibia shaft angulated 90 degrees, 100% dislocated, displaced 50%, and distracted fractures. We also learned about different types of methods to heal bones. One way is using a plate. It is put on the side of the bone, and it loads it with pressure to where it can heal. Another way is with a rod. It is placed in the leg by the bone, and it helps align it. Another way is with an external fixator, which is put on the outside of the leg with nails drilled into the leg. It takes 1-2 weeks to heal an open wound and 3 months to completely heal. An Intramedullary nail is drilled into the bone, is not for an open fracture, and takes one hour to install. It was most likely the patient would have healed best with an intramedullary nail or an external fixator. Something really cool that we learned today was that broken bones don’t heal in outer space because they need compression to heal and with zero gravity, there isn’t any weight to compress it with.
Wednesday
Today was the third day of trauma week. Dr. Rippey, MD and CAQSM, came to talk to us about Sports-related concussions. Concussions are caused by a traumatic impact to the head. They worsen pre-existing conditions, make you lose time from work and school, lower GPAs, cause people to develop mood disorders, cause double impact syndrome, long-term symptoms and conditions, depression and anxiety. Some symptoms are headaches, abnormal eye movements, trouble focusing/balancing, fatigue, low energy, mood swings, anxiety, depression, and ringing in the ears. 2-15% risk of concussions occurs during the athletic seasons. The CDC estimates 1.6-3.8 million concussions happen annually. Sports-related concussions are 30% of all concussions happening. There are many ways to diagnose concussions, but they depend on the location of where they take place. On the sidelines, they perform SCATS, CN assessments, Reassessments, and make patients sit out of the competition/game. In the office, they perform SCATS, PCSS, Cervical and Neurological assessments, and VOMS. The treatment for concussions is resting for 24-48 hours, sub-symptom exercising, taking Tylenol/NSAIDS, staying out of school, altering your daily schedule, and possible PT referrals. There is a Process called Return to Learn, where students slowly get back into their academic and athletic activities. They recommend avoiding tests, firm guidelines, communication, and complicated activities.
Thursday
Today was the fourth day of trauma week. Elizabeth Boone came to talk to us today about physical therapy. We learned about multiple ways to assess patients in moving after surgery and a little healing. One is Straightening both legs to compare them on a scale out of 5. Another way is using the goniometer to measure the angles of joints being able to move. The bad leg of the patient measured about 95 degrees. Physical therapists also check for excessiveness, swelling, joint mobility, and a torn ACL. Some treatments used in physical therapy stimulate muscles using electrical stimulation. Other treatments include exercising or moving the injured leg or foot. Physical therapists teach patients how to use crutches, leg carts, or wheelchairs. Today was really fun because everything was hands on, and I even learned how to walk with crutches!
Friday
Today was the last day of Trauma week. Dr. Slauterbeck to talk to us about tearing our ACLs. ACL stands for Anterior Cruciate Ligament. It means that tearing a ligament allows for unnecessary motion in the knee. It is more of a risk for people whose parents tore their ACLs. Women tear their ACLs more because theirs are weaker, smaller, more flexible, and are programmed differently. Deceleration from a jump or running forward with the knee near extension, quad dominance, or combined knee motions can cause an ACL to tear or sprain. Some symptoms of a torn ACL are a wobble knee or pain. Typically, a physical therapist diagnoses it by using three tests: Anterior Lachman test, Anterior Drawer test, and the Pivet test. During an ACL surgery, a hole is drilled through the bone and ligament, a new ligament/string is pulled through, and the ligament is sewn back together. To heal and get back to normal, motion is needed. Doctors recommend standing, walking, running, and weightlifting. It typically takes 6 weeks to 1 year to heal. To prevent a torn ACL, jump in the right position and practice Norwegian hamstring curls. This week was overall a very fun, engaging learning activity!
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