OMM in the ED?

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NurseyK

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So, what does our audience of DO's think?

The response I have gotten in my ER is "no way I'd actually treat the DX...what if I'm not on and they come back in?....I use it mainly as a DX adjunct (ie: somatic lesion vs. something "bad" not showing up on the "standard" exams/labs/CT/XR/etc)....I use my palp skills for procedures (central lines, Chapman points for "narrowing down" organ dysfunction, etc).

I don't know of any DO's that actually apply their skills in the ER.....it's just a shame that something I'm learning may go to waste...

Just some random thoughts...

Kat :)

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I once spoke to a DO who said that he felt he was better able to evaluate patients who had complaints of muscular pain and things like that.

I would also be interested in hearing from others on this.
 
one of my opp fellows told me that during her er rotation she a girl come in with her neck rotated to one side and locked in place. i forgot the exact medical term for it, but anyway she used muscle energy to restore normal rom for the little girl. i think there are occasions where omm can be used quite effectively. it's all dependent on the level of skill the DO has that will determine whether they would use it or not.
 
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Sounds like torticollis (sp?)

I think that a little practicality, common sense and efficiency must be used in the ED. First of all, the primary intent beyond taking care of the patient is to exclude or diagnose life-threatening illness. While OMM can function as a diagnostic adjunct, who in there right mind would rely solely on this modality in the ED. Like any physical exam skill it must be considered, weighed then incorporated according to its value. That is the true question. What is the value of OMM. I do not intend nor do I wish this string to answer that but I can say that I have not found these skills to be a regular part of my FOCUSED patient exam.
Treatment is another issue. My feeling is that OMM can be applied in the right circumstances but those circumstances appear rarely. Non-critical/benign/with little chance of anything else serious patients could be treated if the department was slow and the patient seemed amiable.
I appreciate the benefit of OMM diagnostically and therapeutically but I also appreciate every other specialists examination aids, diagnostic workup and treatment strategies and they ALL do not have a place in the ED.

Rapid patient assessment, stabilization, diagnosis (my favorite), and treatment comprise the beginnings of a medical regimen for most patients in the ED. Time counts and efficiency weighs heavily for subsequent patients.

Lastly, I have to admit that I am nervous cracking a back/neck, performing muscle energy, counterstrain.... on a patient I have no relationship with, on a patient that may not follow-up, in a medical system that does not recognize OMM as the standard of care but rather as an "alternative" treatment. All of the above sounds like a lawsiut destined to take my treehouse away.

Just my two dollars worth.
 
Sorry that I am an ignorant a$$, but what is OMM...
 
Since I am a new EM resident, I can tell you that I have used OMT in the ED...mainly fast track. Several times I have used muscle energy (using manipulation on an acute problem is asking for problems) and followed with education -exercises. This actually follows my old PT format, but all of that falls into osteopathic philosophy.
I have used a first rib manipulation after a patient came in following a car accident ...3 days previous.
You'll get a feel for it.
 
I agree with you Mr. Happy Clown Guy, I would not be doing HVLA, muscle energy, or articulatory techniques on an acute case however counterstrain can be used safely in those cases (but it takes 1.5 minutes per technique).

Has anyone else used this? (I have not personally used it, but I have witnessed it done on acute injuries and it turned down the pain fairly well).
 
PS to answer the above question, OMM is osteopathic manipulative medicine.
 
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