SPORTS MEDICINE & ANESTHESIA ROTATIONS

ROTATION #7: SPORTS MEDICINE

 Sports medicine is a specialty of orthopedics and primarily done as outpatient treatment.  

 CLINICS

I was able to work with doctors who specialize in different areas of the body such as the shoulder, hand/elbow and knee. I saw new patients who were referred by their family physicians inquiring about possible surgical treatment. Here are a few things I saw

Arthritic shoulder, elbow
Rotator cuff tears
Acromioclavicular dislocations
Anterior cruciate ligament tear
Medial/lateral meniscal tear

Dupuytren's contracture
Rheumatoid arthritis
Osteoarthritis
Non-union of scaphoid
Scaphoid fracture
Fibula fracture
Humeral fracture
Biceps tendonitis
Wrist fusion
Carpal tunnel

OR

Observed/assisted by retracting, holding the camera or holding the limb in proper position. I saw...

ACL repair
Meniscectomy of knee
Rotator cuff repair
Anterior stabilization
Shoulder/knee/elbow arthroscopy
Removal of foreign body in elbow


ROTATION #8: ANESTHESIA

Anesthesia was fun. During the rotation there was some extra down time which allowed me time to complete my capstone project. During this rotation I took advantage of any teachings that was offered to the med students. I was able to go to the CSLF (Clinical learning and simulation facility) and was taught some skills on intubation and fun scenarios. 

OR

Observed anesthesia and did some intubations as well as Bag-valve-mask ventilation. Yes the first time I tried intubating I placed it in the esophagus :P 

PAC (pre anesthesia clinic)

I was able to take a focussed history for anesthesia. I learned the most during these clinics. It is important to ask...

  1. Past surgeries and if there were any reactions to the anesthetics used. Family history of anesthesia problems

  2. Respiratory concerns. Including asthma and sleep apnea. For undiagnosed sleep apnea you ask patients if they stop breathing at night, snore and if they feel rested in the morning. If they sleep in the same room with their partner you can ask their partner if they notice any changes in breathing when sleeping. Risk factors include obesity.

 

  3. Cardiac concerns

  4. Ask if they have false teeth

 

  5. Past Medical History – ex. HTN, diabetes, medications, allergies etc. 

  6. Physical Exam – you look at their mouth opening and determine the mallampati score (pic bellow), as well as thyromental distance, TMJ subluxation and neck flexion/extension.

In the textbook they describe a difficult airway using the acronym BONES: Beard, Obesity & Obstetrics, No teeth, Elderly, Sleep apnea

PACU (post-anesthesia care unit)

Observed nurses on what is involved in caring for patients after surgery. This includes communication with the anesthetist on the surgery and the medications that were given as well as relevant risks such as sleep apnea. Patients vitals are recorded every 15 min for the first 2 hours then (q = every) q30 min for 2 hours, q1hr for 4 hours then q4hr for 4 hrs then q12hr. Most patients stay between 1.5 hr – half a day. To leave the PACU the patient must be at the level of consciousness pre-operatively, pain tolerable (3-4/10), vital signs are in 20% range of pre-op vitals, no obvious complications, nausea managed and normal thermic temperature >36 degrees Celsius. 

The nurses are very knowledgeable on giving the proper medications to control pain for the patient as it changes after surgery. The possible choices are morphine, meperidine (for shivering), fentanyl, hydromorphone, toradol, Tylenol #3, and naproxen. For nausea and vomiting the choices include metoclopramide, gravol and odansetron.

APS (Acute pain service)

Rounded on patients on the ward in the morning. Observed what the nurse assesses to manage pain and what medications are used. 

PAIN CLINIC 

Observed a resident take histories and physicals for outpatient chronic pain management.

April went by quickly and now I'm currently in internal medicine: S – I’ll let you know how it goes. Two days in and I’m already overwhelmed but I’m really liking it so far. 

On a side note I can officially say that I know how to swim! I've been taking lessons from a friend and after 2 months I can float, do the front crawl, back crawl, elementary and breast stroke. :)