Post-Procedural Reflection 1
I understood there were forms necessary for referral, but I wasn’t sure how to complete them and how many forms were actually necessary. My first case was a rugby/ cheerleader/ thrower who, while doing box jumps fell. She had a history of knee injuries from high school that were never resolved. After an initial evaluation, Alex felt as though she needed to see Dr. Hannula for further imaging. This was a follow-up from the imaging she had done. During the evaluation with Dr. Hannula, she explained that she was not having much pain, but the pain increased when she was walking an excessive amount. Dr. Hannula explained that she has a partially torn ACL that has scarred into her PCL for her previous injury and has torn both her menisci in her left knee. He suggested surgery; however, she was not ready for surgery and felt like it wasn’t necessary because she was not in pain. However, she wanted a brace for cheer that fit and was comfortable for her to compete in. After presenting her, I entered her evaluation with Dr. Hannula into ATS. She then completed a claim form for the brace. If there were any spots in the form, she was unable to complete I was able to look on ATS for addition information. After completion of the form I scanned in the claim form and sent to Melissa. About a week after, she met with the don-joy rep to be properly fitted for a brace, however I was not there for that experience. A couple days after, after cheering for a whole game, she started to experience a significant amount of pain. Then, after talking it over with family decided that surgery was the right route to go. I helped her fill out new patient forms that I was able to fill out a fax sheet and sent the information to Dr. Hannula’s office. Once all the forms sent a confirmation form came through the printer, I put the fax sheet and the conformation together in a folder. I had not ever used a fax machine before so that was a new experience for me. I was able to call Dr. Hannula’s office and schedule her pre-op appointment. I learned a lot from this process, using a fax machine and also communication with the doctor’s office. I was not able to be there for some of her steps throughout the whole process but understand how the process is completed. When I complete this process the next time, I will be able to complete it on my own and much more fluently. I am also excited to help her through her surgery in the near future. After her surgery she returned to school doing great, or what we thought was great. Her swelling looked good, very minimal, stitches looked great, attitude was fantastic, and she was ready to put the work in. The first day I was doing rehab with her I followed protocol and we did some stem and ice and rewrapped her knee. One major problem she was having was with school and getting up to go to class. She said that before she took her medicine, she was unable to get up, get ready, and go to class. The couple days later she came in and showed me how she had her stitched removed and I told her they looked good and keep putting work in. The very next day we received an email saying that she was withdrawn from the school and will not be returning for the remainder semester. Post-Procedural Reflection 2 A cross country/ track runner had an abnormal deformity on her medial left shin that raised for concern, additional evaluation was necessary evaluation by Dr. Hannula to diagnose her injury. She complained that she has had the deformity for years but was not really sure of when the deformity appeared. She complained it increased in size and pain of with high intensity loads and longer distances. She explained that when she would massage the mass on her leg it would decrease in size but then would reaper, but after palpation she complained of increased pain. Dr. Hannula examined the mass and was confused about the golf ball sized mass on her shin. He decided that imaging would help diagnose this odd mass. He suggested x-ray and MRI and for little while to stay away from putting a lot of pressure on it for her comfort. However, if compression helps, a wrap may be beneficial. He also asked her to stay away from massaging it, so when she came in for the X-ray and MRI it would be large and easier to see. After evaluation I assisted her with a claim from and new patient forms. After, I put the evaluation into ATS under the notes section. Then scanned her claim form in to Melissa and faxed the new patient forms to Dr. Hannula’s office. I typed up her demographics, which was a totally new thing for me, I had to type up her name, injured body part, address, social security number, phone number, primary insurance, and secondary insurance. After typing up the demographics I made a copy of her insurance card and printed of the demographics. Then faxed the information over to Dr. Hannula’s office. I did not have to call Dr. Hannula’s office to make an appointment up to this point. I feel this experience has taught me a lot for my future career. I now understand how I need to refer athletes for further evaluation. A big problem that we face every day with athletes’ is cooperation for rehab or appointments. A lot of athletes become very lazy and do not want to walk from their rooms to the clinic, which is a very large problem we face every day with athletes. Post-Procedural Reflection 3 A rugby player while playing was tackled improperly and his tibia and fibula dislocation with fibula fracture and anterior compartment syndrome. He was rushed to the hospital and had emergency surgery. His injury happened about three months ago from 2/11; he was in the recovery process but was using a walker and was not able to put body weight on his leg. Joe and I wanted him to see Dr. Hannula to check on his progress, make sure he was on track for recovery, and see if we could start to move forward with weight bearing. I was able to present him to Dr. Hannula and he felt that he was doing very well and should start putting body weight on his leg to reeducate in walking with a normal gait. He did however want to see how his alignment was, requesting for an x-ray. The USA rugby club has a claim form for rugby athletes that were injured while playing rugby, it helps with paying medical bills. I was able to instruct and assist him with filling out the forms. After completing the forms, I typed out his demographics and was able to fax them to Dr. Hannula’s clinic. I later came to find out the next day, the athlete informed Joe and I that he had seen an Orthopedic at home and had x-rays done right before returning to school. We were able to get ahold of those x-rays and get them to Dr. Hannula, he agreed with his earlier decision with starting the process to weight barring. From this experience I learned that history is important and to communicate with your athletes, checking to see if they had seen any other doctors or been to any other clinics. I have experienced this a lot over the course of the semester, many of my athletes had also gone to have another to have another opinion without telling us when they did it. I do think this case prepared me for my future career as well as for my BOC. I think one of the biggest challenges an AT faces is communication with athletes. In some cases, athletes forget to communicate things or can even withhold information. I was able to follow this athlete throughout his whole recovery process over the course of the semester and was there during his major milestones. He worked extremely hard to recover and had great progress every single day in the clinic. He not only put the work in inside the clinic but also outside of the clinic. If we mentioned working out outside of rehab he was always prepared for the challenge and I would even see him doing things outside out of our recommendations. Post-Procedural Reflection 4 My last patient referral was another rugby player. During the game the previous weekend he complained of a pop in his medial knee while being tackled during a play. I was able to do his initial evaluation and present it to Joe. He complained of a lot of pain and had a very altered gait while walking and felt like his knee was very loose. Upon evaluation I noted medium amount of swelling and extreme tenderness over his MCL. He had an increased amount of pain with flexion compared bilaterally. I performed many special tests on his knee to test other complexes other than the ACL while doing anterior drawer and Lachman’s he complained of being uncomfortable but valgus test being the test that created the most amount of pain. He was very lax compared bilaterally and I then expressed my concerned about the MCL to Joe that thought he needed to go see Dr. Hannula to have an MRI done. Joe quickly agreed with me. I instructed him on filling out a claim form and as the USA rugby claim form, since it happened at a rugby game. He had never been to see Dr. Hannula, so I also had him fill out new patient forms. After receiving his new patient forms, I was able to quickly type up him demographics. I then called Dr. Hannula’s office and tried to find the earliest appointment we could get for this athlete, but at this time he was already out of the clinic. I was able to get ahold of him and figure out his schedule then called his office back, I was able to get him in that day, luckily someone had cancelled. After scheduling his appointment, I faxed him new patient forms and demographics over to his office and he was able to get to his appointment later that day. The next day after his appointment he came in to do rehab and he explained to me that Dr. Hannula was not very concerned about his knee, he suggested an MRI but was not extremely worried and felt like it was not torn. So, him did not get an MRI and started doing rehab to strengthen his knee. After a couple times of rehab, I never saw him back in the clinic again. The process for this referral was very fast and it was all done in the same day, it took a couple hours, but I was very happy to get it all done so fast. I feel like a challenge I have faces with not only this patient with any others as well is communication and work ethic. This athlete did not want to put the work in to strengthen his knee as I had wished, however I, as an AT cannot force an athlete to come in and do rehab. I feel all of these referrals have prepared me for the future of being an athletic trainer.
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When we first learned about the AAU tournament, I was very excited but also very nervous. We have all done our own thing in the clinic with a preceptor right by but have never really been on our own. This is truly the last step we will be taking before out professional careers really takes off. I remember the seniors experiencing this tournament last year but was unaware that they were performing everything during the tournament on their own. I think that all of us were very impressed with being able to be on our own.
While developing the risk management plan the largest challenge we all faced was, not knowing what needed to be done and not citing everything that we took out of our P&P or off of other national websites. Another problem we faced was the work getting down, a problem that every group faces and is the division of the work. With that problem, we ended up working on the manual up until the day before we left for the tournament when it should have been done a week prior. I loved experiencing the tournament, it was a lot of fun and I hope to do it in the future as an athletic trainer. I enjoyed it most because of how fast paced it was, I was on my toes the whole time while in either gym. It was also very different than what I am used to, from the population and the sport. I have experienced wresting before with high school but the population in the AAU tournament was elementary ages 5-12, very different from high school because the weight classes started at 40 pounds. In the tournament our roles were extremely important, we were the medical staff/ first responder to the accident, so we were forced to stay on our toes and be prepared for blood, c-spine, dislocation, fracture, or anything that happened on our matts. I had two experiences that stood out to me most, the first one with a little boy that had a nose bleed. I was not the first one to him, but I was there to help, the little boy was bleeding more than I had ever seen, dripping out of his nose and his mouth. I was there to hand gauze then quickly changed to attempt to help stop the bleeding as well. We went through 1 minute and 50 seconds, two nose plugs full of blood, so many gauze pads before we were able to get the bleeding to slow down. The whole time while were trying to help the boy his coaches were yelling at us and trying to tell us what to do. We were able to get a plug in without filling and then put a piece of gauze under the plug and powerflexed the gauze to his face to stay in place, 4 seconds later the boy was coming back out and ran out of time before we could stop the bleeding again. This experience stood out to me because he was the longest nose bleed of the tournament and that I have ever experienced. Another encounter that I experienced alone was a boy who got kneed in the chest, complaining out difficulty breathing. I ran up to his immediately worried about a broken rib with a puncture underneath. I started to look at his chest and noticed a deformity over his sternum, then I palpated around to determine if it were was something to worry about, I decided to call over Mike. He determined there wasn’t anything major to worry about. He also said that if anything would have punctured, he would have been in severe pain and unable to move at all. After I went to get him some ice for his chest I noticed he was holding a paper towel to his head, I was confused and asked him about it and when he took the towel off I noticed the boy had a red raised circle just above his hairline near his ear. I decided to go get Mike to take a look at it, I explained that I was sure it was tinea capitis and as we walked over the boy’s father asked to talk to Mike on the side. I was a little confused, he then walked back over and said we were going over to the ATR. He then started to exam the boy’s chest listening to his lungs and heart which sounded good and had not problems. He then looked at his head and confirmed my suspicion. The boy flew down from New York for the tournament and his father said that he did not have the mark during skin checks on Friday, so Mike said to make sure it was covered at all times but if his symptoms increase and he had a hard time breathing that he will not be allowed to wrestle on Sunday. After the boy and his father left, I asked what the father talked to him about and he told him that his son had SVT when he was very young and almost died. SVT, supraventricular tachycardia, is a condition where the heart is abnormally fast and out of a normal rhythm, so after his dad talked to Mike, he decided to do a full evaluation to double check that everything was normal. I learned from this experience about how important past medical history is. During the wrestling tournament knowing PMH is nearly impossible because we did not know which team was on each matt at what time. To prepare for the tournament I would have packed my pack totally different. On Friday, I had a normal pack with just some extra nose plugs but after being at the tournament quickly learned I did not need all the tape that was in my pack. By the end of Sunday all I had in my pack were bandages, gloves, gauze, and hemorrhoid creme. I also learned to help stop bleeding hemorrhoid, a vasoconstrictor, can stop the bleeding faster. Each day I felt like I restocked on gloves and gauze three or four times, I never had enough. On our risk management plan the only time we should have changed is dealing with coaches and parents appropriately, even though they are children wrestling the parents/ coaches get more involved and care more about winning then the health of their child. Many times, I walked on the matt and the child wouldn’t even look at me because the coaches were in their faces screaming that they were okay. Also, just because a child is crying doesn’t mean there really is something wrong with them. Additionally, having a different pain scale or some other form to understand their pain would have been better because I think at such a young age, they do not really understand pain. The event really prepared me for being a professional soon and how to deal with the same or similar events as well as possibly working this event in the future as an AT. I love being on my toes and am prepared for anything to be thrown at me. I had a magnificent time shadowing Dr. Handy. He taught me lots of things that I would not know having not during a rotation with him. I was able to complete over 23 hours with him and wish I could do many more. I was able to experience many things that I may never see in my profession. I was a completely different environment for me, compared to being at a college of high school. 90% of his patients were over the age of 50. During my rotation I noticed that more than half of the patients had COPD or diabetes or both.
One of the first patients during my rotation I saw was an older woman with type II diabetes and COPD, she never smoked however had asthma that progressed into COPD. Dr. Handy then explained to me that most of the patients I will meet have type II diabetes. I meet a very interesting man with an autoimmune disorder where he suffers from a burning tongue and jaw. He had been seen by many different doctors. He had a hard time with many of the doctors and spend a lot of time talking to us about how doctors need to work hard and understand their patients. At the end of the appointment when Dr. Handy asked if he had any other concerns, and he lifted up his shirt and said yes, this spot has worried him. After Dr. Handy looked at the spot he immediately determined it was a squamous cell that needs to be removed. However, I was not on his rotation during that time, so I was not able to see him remove it. On the last day of my first week I meet an older man with rheumatoid arthritis experiencing severe shoulder pain, Dr. Handy decided to use a steroid shot in both AC joints. I was able to comfort the patient while Dr. Handy was giving the shots. Then walked into the last appointment of the day, to meet a woman who had just had a colonoscopy done, six years late. Dr. Handy had been pushing this woman for many years to have it done however she refused. She had it done a couple days before she met with Dr. Handy, he explained to her that the images they took did not look good and there was a potential for cancer. A couple days later I conformed with him that it was cancer. My final day with Dr. Handy was a completely different than ever anything I had ever done before. I was able to go do home visits, I was able to meet four patients from the age of 40 all the way up to 93 years old that were unable or unwilling to travel to Dr. Handy’s office. The patients were all very different from weight to gender to ability to communicate. Two of the patients weighed over 500 pounds and were both unable to move around their houses, one man and one woman. The man was on a road to recovery and had already lost over 300 pounds. The woman however was gaining weight and explained to me that she did not care, nor did she believe in doctors. The that stood out to me the most was the third patient was a 78-year-old woman with Alzheimer’s and prereferral vascular disease who had her left leg amputated and no pulse in her right leg with her pinky toe and fourth toe black. Dr. Handy made sure to all her prescriptions were filled. I asked about her toes and amputations about her toes, he told me that if they do amputations it leaves an open sore where as if they let the toes die on their own they will just fall off. The most exciting patient I was able to meet during my time with Dr. Handy was an older woman with a possible urinary tract infection, however she was unable to supply a urinary sample. She felt like she was about to burst, however could not use the restroom in public places. Dr. Handy knew he needed a urine sample, so he decided to use a catheter. I was able to assist with the insertion of the catheter. Dr Hannula saw four patients tonight, all four being new patients. I assisted with three of the patients.
The first patient I assisted with had been having persistent shoulder pain for over two years. When beginning the evaluation I learned they had been experiencing some instability throughout some activities. They complained mostly of anterior shoulder pain that radiated down into the hand. They couldn’t really think of any particular MOI, however upon palpation they were extremely hyperflexable. A lot of their family had experienced hyperflexability, however it was something they had never had any problems with before. I had the patient do AROM and they had no pain however external rotation was about 85 degrees on both sides. Upon PROM they had some pain pass that point of AROM. When Dr. Hannula began the evaluation he first asked what one major problem that most people have with shoulders, instability. He then did load and shift, taking the shoulder out about 60% and the sulcus sign, which showed a major gap, positive for inferior instability. Due to the laxity of both shoulders Dr Hannula was not very worried about any tear, just the patient need to strengthen the joint to strengthen the joint. The second patient had dislocated their finger during practice, Alex relocated the finger during practice. The patient was not complain of major pain just some pain when making a fist. I first began with palpation, however there was no deformity I could feel. I next did valves and varus stress tests, both were possible for pain in that joint. Dr. Hannula put stress on the finger checking for a possible fracture after rolling that out he was not too worried about the patient wearing a splint he just suggested them buddy taping for practice or games. The third patient had been hit during a game yesterday. They had been hit in the thigh by another players head/ shoulder. The patient was complaining of severe pain in the medial knee and lateral quad. Upon palpation they did not have any deformities, however was extremely tender. After doing AROM of the knee and hip it was very appreciate that they were very uncomfortable. When shifting the patella lateral and medial they were extremely apprehensive to the motion. Dr. Hannula was very worried due to the amount of pain they were in about a possible fear fracture, however after performing the tap test and squeeze test of the pelvis the worry went down. He also did a apprehension test for the patella and decided the patient may have subluxed the patella and has a quad contusion. September 10, 2018
Dr. Hannula saw 6 patients two follow-ups and four new injuries, I assisted with two patients. The first patient had torn their ACL a year and a half ago during a game and had surgery last October. They wear a brace during all practices and games, however during their last game while going for the ball planted and heard a pop, their knee was extremely swollen. Dr. Hannula evaluated the patient and was confused as to who the patient had a such a good stop on their knee while doing Lachman’s test. I was also able to do Lachman’s and feel the stop and the laxiety of the knee compared bilaterally. I was also able to jump in on a follow up to help take a stitch out of a patient's leg. Dr. Hannula first showed Sam and I how to do it, then let us take the remaining stitches out. The second patient I assisted with had been having some pain in their shoulder while throwing. Dr. Hannula first began with ROM, the patient had an extreme amount of external rotation of both arms compared bilaterally, however the amount of internal rotation is where the patient was having trouble. Dr. Hannula went through many tests, with only a couple resulting with pain. A couple tests in particular the patient had the most pain, Anterior apprehension, Jobe relocation and surprise. They had a very hard time staying on the table while Dr. Hannula was doing those tests. Dr. Hannula said they need to work on the stability of the shoulder because the posterior capsule was very tight and causing anterior pain. Monday September 3, 2018
Dr Hannula saw six patients, however I only assisted with five. First patient was a new patient, they had been having knee pain since the beginning of preseason and their AT from high school had diagnosed the pain with patellar tendinitis. The pain became very severe while cutting and going up stairs. Dr Hannula observed the patient walking then their Q angle, before diagnosing with patellofemoral pain syndrome. The second patient that I assisted with was seen for medial and lateral ankle pain 3 weeks after spraining their ankle in a game. They had been doing working on strengthening the ankle over the last 2 weeks and showed very good progression. The third patient was a follow up, ACL tear. The fourth patient was a post operational follow up looking for approval for progression. Lastly the fifth patient was an athlete who has hyperextended their elbow in practice then again in a game. Dr Hannula began to supinate and pronate their wrist and quickly noticed that biceps brachii was on contracting on the left arm. He then began with the hook test on the uninjured side, which was easily done. Then allowed in the complete the test on the injured side which was positive. Feeling a positive test on an actual person versus testing them without the injury is two completely different things. Having a positive hook test was an awesome experience because now I know the difference and what I should be looking for. Our Prezi presentation, presented on April 20, 2018
https://prezi.com/view/NOH9hnkoQPp71zsSnzE2/ |
AuthorMeg Greene Archives |