On my cardiopulmonary placement on a ward, I had several opportunities to go down to ICU to treat patients (organised by our supervisor to give us an exposure to a wide range of cardio patitients). On our first encounter in ICU, the other student and I, with our Curtin tutor, treated a patient who had been in ICU for many weeks with renal, liver (etc) trouble, and had been intubated several times. The previous day, the patient was able to sit over the edge of the bed and cooperated with treatment, however his nurse reported to us that he was not as well today but to go ahead with physio treatment. As we bagan to speak to the patient it became aparrent that treatment would be limited to "chest physio" in modifications of supine.
During our treatment the patient desaturated on rolling onto his left, but recovered quickly on repositioning. At the end of our treatment the medical team was using the patient's notes so we said that we would come back after lunch to write in them. We came back after lunch to be informed by one of the physios that the patient had passed away, as the patient and their family decided against re-intubation. Our initial response was 'oh gosh wht did we do?' We were reassured by the physio that our treatment was fine, but in hindsight if they knew that he that close to slipping away physio treatment would have been witheld.
I do not think we were to know how close the end was for this patient, and although we felt terrible, we did not do anything wrong. If I ecountered this situation again, I feel I have a better understanding of how quickly patients can change, and would ask the medical team directly what they feel the best course of action to be.
Tuesday, December 2, 2008
If something smells fishy...
Whilst on a clinical placement in an inpatient setting, I, together with my supervisor, assessed and treated a patient who had vestibular symptoms. Symptoms reported included dizziness, spontaneous nystagmus (usually in the middle of the night) and nausea. Assessments and investigations done by the neuro (medical) team could not ascertain a diagnosis or cause of the symptoms, and the patient’s mother was becoming somewhat frustrated and worried, almost catastrophising, making it increasingly difficult to reassure her.
In out physio assessment and treatment, we noticed that the patient’s symptoms did not always correlate with findings of our examination. Yes, the patient showed vestibular dysfunction, but some tests that should (according to reports of what brings about his symptoms) have elicited some of his symptoms. I also noticed that the patient’s account of their symptoms also depended on whether their mother was in the room with us or not.
We established that there was some vestibular involvement, so proceeded to treat with desensitizing exercises. We also discussed our concerns with the medical team, who revealed that they had similar concerns and referred the patient for a psych consult.
From this I learnt that if you feel something is not quite right, it is best to consult with other members of the team, as they may have noticed similar things, or they may be able to explain to you why something was noticeable. I took this experience and applied it to a couple of other situations where I felt that I person’s social situation may be influencing their medical presentation.
In out physio assessment and treatment, we noticed that the patient’s symptoms did not always correlate with findings of our examination. Yes, the patient showed vestibular dysfunction, but some tests that should (according to reports of what brings about his symptoms) have elicited some of his symptoms. I also noticed that the patient’s account of their symptoms also depended on whether their mother was in the room with us or not.
We established that there was some vestibular involvement, so proceeded to treat with desensitizing exercises. We also discussed our concerns with the medical team, who revealed that they had similar concerns and referred the patient for a psych consult.
From this I learnt that if you feel something is not quite right, it is best to consult with other members of the team, as they may have noticed similar things, or they may be able to explain to you why something was noticeable. I took this experience and applied it to a couple of other situations where I felt that I person’s social situation may be influencing their medical presentation.
Monday, December 1, 2008
Effective Coomunication
Hi Guys
Whilst on my ortho inpatients clinic one of my patients had had a bilateral TKR, he had had a troponin rise and therefore instructions from the medical team were not to get him out of bed. Unfortunatley the patient had not been informed of this troponin rise or its implications by the doctors. When i went to go and treat him he beccame quite upset at me and was asking why he hadnt been up out of bed and if i knew what i was doing. I almost opened my mouth and told him he hadnt gotten out of bed due to his troponin rise however luckily i didnt as my supervisor arrived, and explained to me that i am not in a position to tell the patient that, and it has to come from the RMO. However this patients blood pressure was going through the roof as he had worked himself into such a state as to why he wasnt getting out of bed.
This situation was resolved by paging the RMO and getting him to come down and explain the situation to the patient. However i hope the RMO realised that by not informing the patient of his change in condition, that the patient became highly stressed and anxious which probably put even more strain in his heart. If i was in this situation again, i would follow the same actions. I never knew before this situation that we werent allowed to disclose certain things to the patient unless the doctors had told them first and this is what i learnt from this situation
Whilst on my ortho inpatients clinic one of my patients had had a bilateral TKR, he had had a troponin rise and therefore instructions from the medical team were not to get him out of bed. Unfortunatley the patient had not been informed of this troponin rise or its implications by the doctors. When i went to go and treat him he beccame quite upset at me and was asking why he hadnt been up out of bed and if i knew what i was doing. I almost opened my mouth and told him he hadnt gotten out of bed due to his troponin rise however luckily i didnt as my supervisor arrived, and explained to me that i am not in a position to tell the patient that, and it has to come from the RMO. However this patients blood pressure was going through the roof as he had worked himself into such a state as to why he wasnt getting out of bed.
This situation was resolved by paging the RMO and getting him to come down and explain the situation to the patient. However i hope the RMO realised that by not informing the patient of his change in condition, that the patient became highly stressed and anxious which probably put even more strain in his heart. If i was in this situation again, i would follow the same actions. I never knew before this situation that we werent allowed to disclose certain things to the patient unless the doctors had told them first and this is what i learnt from this situation
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