I observed the imaging MRI department with Stacy on 4/3 and 4/5 from 1:30 to 4:30. One the first day I watched imaging be done for Lumbar spine, 2 shoulders, and a brain scan. Stacy explained how they focus the image by lining up boxes over the appropriate anatomy on their computer screens. They take three view: a sagittal, coronal, and transverse view of every imaging request. One the lumbar scan Stacy enlarged the photos and showed me where the patient was having stenosis of disks L4 and L5. Both of the shoulder scans were looking for labral tears, both came back negative. The brain scan was looking at the brain vessel of a post stroke patient. The results came back with minor damage.
The second day I saw a pelvic scan, lumbar scan, knee scan, and an artery scan. The pelvic scan was really sad because it was a 16-year-old boy and they MRI came back with a large sarcoma. The lumbar scan had a disk herniation L4-L5. The knee scan was for a suspected meniscus tear, but it came back negative. That man came back to the computer area because he wanted to look at the pictures. It didn’t look like a meniscus tear. The man was describing how he is a runner and just recently he started having lateral knee pain. To me, it sounded like he might just have some IT band friction syndrome. The artery scan was interesting because they did it without contrast. This is because the GFR they inject to get the contract would have caused a reaction with the patient because he has kidney issues. However, without the contract, the test came back pretty bright, and he had no blockages.
One thing the Radiologists seemed to keep complaining about while I was there is that doctors would refer their patients, and call asking for an MRI when it wasn’t necessary. So what I learned while I was there is that MRI is just a more detailed version of an X-ray, and when I am an AT I shouldn’t refer my patients their unless it is truly necessary.
This was my first day observing in the clinic, and I followed Caitlin around. Caitlin is an LACT in an out-patient PT setting. I did not realize that athletic trainers could work in a PT clinic. The first time she introduced herself, I thought she was an AT who went to school to become an PT. What I found more interesting is that she can do just about everything all of the physical therapist can do too. The only thing she can’t do is work with patients who are covered by Medicare.
I saw three patients this day. The first was a hip replacement “pre-hab.” I came in near the end of this rehab, but basically they Caitlin was just trying to strengthen her muscle so that there is a better chance of a good surgery. They did a machine exercise called nustep. This looked like a reclined bike mixed with an elliptical, but it does steps instead of running. I thought it was an interesting machine. Then they did some hamstring stretching. After, they did a ball exercise where her feet were on the ball and she had to bridge up. Then she was done and they gave her ice.
The next patient I saw was a woman with an unknown injury, but a lot of symptoms. The PT though she may have had a mini stroke which paralyzed her on one side, but the MRI didn’t prove that. I thought it might have been some nerve root compression issue. Either way, her goal is to walk, and that is all she did for her rehab. She would stand up, walk 3 feet, then sit back down in her wheel chair, and she continued this until she made it to the exit door, then she would leave.
The last patient I saw that day was a total knee replacement rehab. She had a visionary knee replacement which is a newer method where the surgeons measure the bones to make a custom fit for the patient. I don’t remember the exact amount of time since her surgery, but if I had to guess it would probably be 6 weeks out. She did some nustep, then she walked up some real stairs. She worked on vestibular balance by closing her eye and turning her head while standing on a foam pad. Then she walked on the treadmill and was done. During this patient’s exercises I asked Caitlin what the surgeons do with the ACL and PCL since in the model she was showing me, it didn’t have the ligaments. Apparently the structure the surgeons put into the knee is secure enough that there is no anterior or posterior gliding and shifting.
The second day, I saw 4 patients and a followed Matt for the day. The first one was a shoulder surgery rehab. This one was interesting because it was actually a reverse repair, meaning instead of having a socket on the scapula and a ball joint on the humerus, it was reversed. Matt said that these typically do better than the traditional repair, but he didn’t know exactly why. She was primarily doing ROM exercises like assisted cane, and window wipers. Then Matt took her into a room and did a flexion stretch which I got to help with.
Then we saw the patients with the unknown paralysis injury, and we walked again. Although she was faster this day, she didn’t go as far as she did the day before.
Next I saw a patient with 2 total knee repairs done at different times. He did the nustep machine, then we practiced sitting to standing and then worked on some of his joint stiffness with a joint mobe and stretching.
The last patient I just briefly observed was a ACL repair on a football player. I came when he was working on leg extension, and in between reps when he was just standing there I could see the obvious lack of ROM and he had a lot of joint effusion. After he did the extension exercise, he moved onto stairs and he walked up and down them a couple of times. After that they went to do some manual stretching and then iced him.
The last day I has at the clinic it was super slow and I only saw 2 patients. Again, I was with Caitlin. The first one I observed was a middle aged man with degenerative disk disease. He had a lot of pain and decreased ROM. He did some sitting to standing exercise, then he did some window washers. After that he got some stim done on his lower back and was done. This is when I learned about the modalities, and process of how PT’s are allowed to treat their patients. Previously I thought the doctor was the end all be all. They would refer to a PT and maybe if they thought the patient needed it they could approve a modality. What really happens is the patient is referred to the PT and the PT will do an evaluation do determine a plan of care which includes length of rehab and modalities if the PT thinks It would be useful. Then they send it back to the doctor and they have to get a signature before anything can happen. I thought this was a crazy process, because I am so used to athletic trainers in a college setting being able to make all of these decisions and if there was something out of our scope, then the AT would refer. It was good for me that Caitlin explained that, because previously, I didn’t know how it worked at all.
The second patient I saw was the football player with the ACL repair. He was really tired, and there were no significant changes.
I thought going to the PT clinic was very interesting. This was probably my favorite observation I have done so far. Now that I know athletic trainers can work in a PT clinic, this opens up more possibilities that I didn’t know were available previously. My preferred setting would be with performing arts, or a collegiate athletic level. However, this is not an opportunity I would disregard. I think it would be good experience right out of college, but I really want to travel which is why I would prefer the other two positions over a clinical setting.
The first day I went I was there for an hour and a half. I only saw 2 patients. The first patient was a lady with venous ulcers. They unwrapped the previous bandaged took some measurements and a picture to track the healing process then they cleaned the wound and re dressed it. The nurses used 3 types of compression wraps. They said this is important because if they don’t compress they will get a huge swelling lump that will look like a mushroom and hang over the bandage. This is because the patients with the venous ulcers have poor circulation and the blood will just stagnate in the area. The second patient I saw was an elderly man with a severe bed sore on his butt and on his heels. This was the worst wound I had saw during my time. He had exposed bone and the sore was 6 cm deep. The patient says he lays in bed all day alone. The only time he gets out of the bed is when his daughter comes by about once a day. I wasn’t able to stay to watch them dress this wound.
The second time I went I was there for 5 and a half hours, so I was able to see many patients. The first patient I saw was a lady who was missing the tip of her great toe. She said she was unsure of how it happened, but it happened while she was in the Virgin Islands. She received treatment there before she flew home to get treatment at JMH. This was the strangest thing I have ever seen in my entire life. She wasn’t missing any bone, she was just missing the fatty tip of her toe, but bone was exposed. The nurse suspected some kind of bone infection. The nurse and the doctor were struggling with this lady’s paper work. It seemed like she had a lot of strange treatments that didn’t make sense. They talked about how she is a good candidate for the hyperbaric chamber and they recommended getting her in as soon as possible, along with another treatment to help the bone inflection. However, this lady wanted to postpone all these treatments for a week later because she wanted to go back to the virgin island to finish her vacation. Needless to say, the doctor and nurse were not very happy. Eventually, they cleaned and dressed her toe and sent her down stairs for other testing. Next I saw 2 more venous ulcers. They did the same thing as when I saw them on the first day. I also saw a diabetic foot which was healed. They just trimmed the callus off the patient’s foot. Finally, the last thing I saw was a pediatric bed sore on a disabled child. This was an interesting case. It was a 12-year-old boy who had just finished getting hip replacement surgery because his hips kept dislocating. For some strange reason he had developed bed sores on his legs and heel. They suspect it is because of some kind of medication they had him on. The parents seemed to take really good care of the boy so it was definitely not from just lying in bed all the time. This was the first time this family was in the wound care center so they had to do extensive documentation. Eventually after getting all the information they needed, they cleaned his sores and lightly dressed him.
Overall, I thought everything was interesting. However, this opportunity to observe truly only showed me that I do not want to work in that kind of setting. More power to those Nurses and Doctors who do it every day, but it’s not the job for me.
The first time I was there, it was a slow night. I was there for 2 hours and I only saw 2 patients, along with watching triage for a while. I saw a 5th digit dislocation and fracture. She got X-rays done and then later had a digital block. The nurses also splinted her. This patient also had tachycardia. The nurses took her BP 3 times. First was 232/135, second was 222/118 and they gave her some medication to try to reduce the heart rate, the third was 210/118. I thought this was strange because this lady looked perfectly fine.
The second patient I saw was a young girl with a greenstick fracture. The nurses splinted her and let her go.
The second time I went was a very busy night. I was there for 3 hours and saw lots of patients. Again I started in triage and watched some patients come in. The PA also let us look at some X-rays. He played a game with where I had to say what was wrong with the picture, if there was a problem. Then I followed a nurse around, which is when it got really crazy. I saw a lady who was having breathing problem so bad her face was cyanotic; I saw a lady come in complaint of 10/10 abdominal pain, but she had a hysterectomy; I saw an intensely drunk man who fell of his bicycle; I saw a young girl with a spider bite spreading up her leg; I saw a child with pneumonia, and I help restrict her movement while we forced fed her medicine; I saw a baby with a suspected concussion; and finally I helped fit crutches for a girl with an ankle sprain. I didn’t see the conclusion for any of those patients, but it was still really cool to see that much in one night.
The final night I was there for 3 hours again. I was in triage for most of the night. Most of the patients coming in were having strep throat and flu symptoms. It was a pretty slow night. I stayed in triage until a lady who fell and was having ankle problems came in. I followed her for the rest of the night, and talked to her a bit. I was asking her some questions just so I could guess what might be wrong with her ankle. It was severely swollen, but by the mechanism I didn’t think it was fractured. I told the patient about all of the things AT would do instead of how they do it at the hospital. The nurse did an x-ray eventually. Then this lady sat there in intense pain for an hour. We both thought they had forgotten about her. It was about time for me to go, so I went to find her X-rays just so I would know if I was right or not. She didn’t have a fracture and the doctor said she probably just had some type of sprain. I wish I could have done some special test to figure out everything. Even though I was a slow night, it was still pretty cool.
Overall I enjoyed my emergency care observations. It’s interesting to see what happens when a patient gets to the ER. I wish I could have seen more things I was familiar with, but even if I didn’t know a lot about something, the nurses and PA’s were nice enough to explain it while we were running in between rooms.