And eat lots of RICE. Brown or white?
Rice?
Ortho injuries
- Thread starter Veneficus
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Rice?
mycrofft
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Rest Ice Compression Elevation
I think compression helps stop bleeding and third-spacing of fluids locally.
I think compression helps stop bleeding and third-spacing of fluids locally.
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Bingo.
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For your patients that aren't athletes, and you're seeing them within a few minutes of injury, take an extra 5 minutes and teach then what they need to do to wrap the injury and use ice. In effect, teach them RICE. If you're not seeing them that quickly post injury, RICE may still work, but it won't be as effective. It's not a difficult concept and it does work... add in meds for pain control, ace wrap for compression and elevation for drainage of edema... and things should be OK. The really important thing is to teach them RICE and to get on to doing this as soon as possible post injury. It makes a huge difference in post injury recovery time and how long it takes them to return to a functional status.
AnthonyM83
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Not to create too much of a tangent, but we even forget that even concussions can leave physical soft-tissue damage that isn't apparent with traditional imaging...they too can have lasting effects.
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True. It is because of this that sporting bodies have become a LOT more strict about when an athlete can return to practice, let alone play, after a concussion. The problem with those new rules is that being removed from competition is a strong motivator to NOT report concussion symptoms...
Now back to our regularly scheduled program...<_<
For professional athletes I would think the risk/consequences of concussion are work related hazards.
I would imagine it is a far larger problem in "amateur" sports or youth sports.
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The problem with "amateur" sports is that the athlete really want to play and they know they stand a good chance of being pulled out for half or the entire season if they're concussed. Therefore, they have an incentive to NOT report symptoms of concussion. Their teammates also want to keep the team together, and if one of them gets pulled out because of a concussion, that can't happen, so they also work together to hide symptoms of concussion if they see it in a teammate. This does happen quite a bit... unfortunately, and is difficult to detect/root out.
mycrofft
Still crazy but elsewhere
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Sports/entertainment medicine, patient and provider, is worth its own forum. Include rugbyites, jockeys, motocross, circus...I am excluding explicit combat exhibitions here because the point is to cause or simulate bodily harm.
abckidsmom
Dances with Patients
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And adventure racing.
. As I sit here stretching while wearing my tough mudder tshirt and working out on duty.
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While sports/competition stuff does almost deserve it's own forum, the applications from that field can help out here too. Granted some of the stuff is a bit time consuming if you have more patients to attend to, but you may see some improvement in patient outcome by simply doing certain things or initiating some things in the field before the patient arrives in the ED for further evaluation.
Somehow, that doesn't surprise me. (Said respectfully
)One of my mentors in life and medicine is a cranky old veterinarian who practices large animal medicine, almost exclusively dairy. (I grew up on a family dairy farm.) He is incredibly intelligent, an excellent clinician, and one of the wisest people I know. He's one of those people that is able to correlate the theory of medicine with the practical aspect of medicine.
Anyways, there is an old adage in veterinary medicine: "No animal should die without the benefit of steroids."
Basically, when the animal is sick and you don't know why, or you do know why and don't think you can save them, just give them the steroids. At least you will make them feel better, and many times he's turned an animal around that he thought was going to die, and didn't really know why he saved them (other than the steroids).
We keep dexamethasone in stock, and use a LOT of it on our cows.
So, there's a lot of validity to what you are saying.
Tigger
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Dex is used fairly extensively at my sports medicine gig via iontophoresis and it does wonders for reducing pain and improving ROM in a lot of muscoskeletal injuries.
I could not agree more, the two years I've spent working for an ice hockey program have made me a much better provider on the ambulance, even if it never quite changes my treatment plan. Just to have the knowledge of what's going on is helpful enough.
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Using the knowledge from that background while evaluating patients and devising treatment plans as a medic has yet to serve me wrong... as long as I remember the limitations as to what I can do and work within that.
It's the nursing stuff that has me all discombobulated simply because I have to remember what my scope is while in clinicals vs. what I know how (and why) to do things that are above that authorized scope. Fortunately, I haven't exceeded that... I have zero desire to get bounced out of the program.:blink:
And Dex does work pretty well from what I've seen (way back when) and iontophoreses does get it where it needs to go... though I seem to remember also delivering it via a combo iontophoresis and ultrasound...
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Tigger
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I'm sure as a medic you find the additional education to be much more useful. The sad thing about being a basic is that there is so little room to go above and beyond. I'll happily do a knee exam on someone that fell and felt something go pop, but there's not much I can do with those findings and I can forget about telling the ER that I suspect a meniscus tear or something like that. Oh well, one more reason to get more formalized education.
I'm also not an ATC, I intern at a school that can't even offer an AT degree, so much of what I learn is done OTJ. What I would do for all the education that ATCs get as opposed to the piecemeal strategy that I currently have going...
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I do (and did) find that the education I got was extremely useful in my career as an EMT and Paramedic. In particular, outside of learning how to use the BVM, Oral Airways, and Oxygen administration, I learned absolutely NOTHING new. I could have learned those three things and passed the written and skills exams nearly blindfolded. I still needed to work on some organizational stuff as it related to EMS, but the knowledge was easily way beyond EMT. If I'd learned ACLS, PHTLS, PALS... that kind of stuff, I probably could have passed the NREMTP exam upon graduation from College.
I'm not saying that my Paramedic education sucked, rather that my ATC education was actually quite good. As I settled into my roles as an EMT and later, a Paramedic, I found that I was making patient care decisions based on both sets of education and devising care plans that generally happened to match protocol because I knew the protocols and what I had available to use.
I'm not an ATC, though I did get all the education that an ATC does get. Through a series of unhappy events, I was unable to get signed off for NATABOC testing... That being said, I learned a LOT. As a medic and as a Basic, I have found that when dealing with injuries that I'm very used to dealing with, I can ask all the questions, do some limited examination (because some stuff just isn't taught in P school, so...) and relay the findings in report. I used to tell people that I speak multiple languages: English, ATC, Athlete, Coach, Athletic Director, Parent, Paramedic, and Doc (primarily Sports Med/Ortho)...
As to telling the ED what you suspect, there are ways to tell the receiving MD exactly what you suspect without overtly saying it and potentially getting in trouble for making a field diagnosis above and beyond say, "knee pain."
mycrofft
Still crazy but elsewhere
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I repeatedly wonder what effect on the "normal" course of recovery there is of steroids or NSAIDS.
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My gut tells me that steroids can suppress inflammation too much, and NSAIDS, in too big of a dose can do the same thing. IMHO, some inflammation is necessary for the body to conduct it's repair processes, but too much can slow that process down, and if you suppress inflammation too much, the same result happens too.
I think a lot of the repair effects with some suppression of inflammation comes from a lot of physical therapy and whatnot...
Kind of esoteric and such, but it's just... some observations I made a few years ago but haven't been able to really follow up on this in any sort of a meaningful way.
Tigger
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The only time we look at going to steroids is when there is no other way to reduce the inflammation to allow PT to take place, and I agree that is where most of the repair takes place. It's fairly rare that a good course of NSAIDs cannot knock to inflammation to workable levels, but again these are only observations and the use of our own "best practice" that might be subject to some further review.
mycrofft
Still crazy but elsewhere
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Re-reading this, I remember the facial fx's I mentioned far above. Steroids seemed to help there. I have seen where weekend warrior types use OTC NSAIDS at Rx strength to suppress pain and probably go on to further aggravate injury (ditto warehouse workers and athletes).