OMT in the ED

[Cowboy DO]

I tried doing a search for this but i didnt find anything.

My question is, and this is mainly for Quinn and other DO's (but feel free to chime in if you have any opinions):

What is OMT's place in the ED? Do you use it much? Do you even have time to?
Also for those of you in allopathic programs, are you allowed/encouraged/or discouraged to use it?

Just curious because I like to do it and, although I certainly don?t believe OMM is gods gift to medicine, I think some of it would be useful occasionally.

---

Members don't see this ad.

 

[nadeem]

I think there was an article in JAOA or DO journal a couple of months back on that topic. I'm not sure which month though....

Ahmed MS-4 CCOM
PGY-1 MWU-CCOM EM

 

[DrQuinn]

Originally posted by nadeem
I think there was an article in JAOA or DO journal a couple of months back on that topic. I'm not sure which month though....

Ahmed MS-4 CCOM
PGY-1 MWU-CCOM EM

There were two recent articles "revolving" around EM in the DO journals. One was based on EM resident training in the DO EDs, and asked if the attendings felt they were "hampered down" teaching. (to extremely paraphrase).

The second article talked about use of OMT in the ED. Obviously, those DOs that trained in DO EM residencies tended to use more OMT than others.

I, however, have not used OMT on a patient in the ED, um, ever.

I will do some HVLA and soft tissue stuff on the nurses and ancillary staff, though.

Q, DO

 

[kungfufishing]

isnt OMT some mnemonic for "flexeril and ibuprofen"
I dont mean that.
I havent used OMT in the ED, and I havent ever seen it used, either. Still nice stuff to know.

 

[Cowboy DO]

Quinn & KFfishing, why would you say you havent used it? Not enough time, no indications to, or you just dont think it'd be that effective? Im only curious.

I've read one of those articles but I'm more interested about OMM in allopathic residencies.

 

[Chris_Topher]

Definitely not enough time to do a structural exam and treatment. I don't have time to see my patients as it is!

 

[DrQuinn]

Originally posted by Cowboy DO
Quinn & KFfishing, why would you say you havent used it? Not enough time, no indications to, or you just dont think it'd be that effective? Im only curious.

I've read one of those articles but I'm more interested about OMM in allopathic residencies.

I don't use it, because I don't feel its indicated in the ED in my patient population. I'm trying to practice EBM.

Q, DO

 

[Cowboy DO]

Fair enough. I'm also not trying to be a prick, I honestly dont know and the last thing i want is a debate on the efficacies of omm, but isnt a lot of medicine in current use not EBM?

 

[mikecwru]

Originally posted by Cowboy DO
I tried doing a search for this but i didnt find anything.

My question is, and this is mainly for Quinn and other DO's (but feel free to chime in if you have any opinions):

What is OMT's place in the ED? Do you use it much? Do you even have time to?
Also for those of you in allopathic programs, are you allowed/encouraged/or discouraged to use it?

Just curious because I like to do it and, although I certainly don?t believe OMM is gods gift to medicine, I think some of it would be useful occasionally.

Quinn oftens uses OMT in place of intubation drugs.

mike

 

[DrQuinn]

Originally posted by Cowboy DO
Fair enough. I'm also not trying to be a prick, I honestly dont know and the last thing i want is a debate on the efficacies of omm, but isnt a lot of medicine in current use not EBM?

Thankfully, EM is more and more evidenced based.

My background is a bit different than most... I worked as a medmal defense paralegal throughout medical school, and having done most of the research for the defense team, I know that if one had a bad outcome (or even a "unsightly" outcome) from OMT, your ass would be grass. Seriously, in today's world of lawyers, one would stand absolutely NO CHANCE.

"So, Dr. MikeCWRU, you've heard that cracking necks before intubating allows better visualizations of the cords, as well as relieving chronic neck pain, is that correct?"

"Yes Mr. Lawyer, I was taught by Quinn, DO about OMT use in the ED. I figured the gentleman who comes in every other week for pain pills might benefit from OMT, so I gave him an adjustment. I didnt' give much thought to the fact that he could feign a permanent injury and blame it on my manipulation."

"I rest my case."

In a recent literature search, 66% of all adverse outcomes of osteopathic manipulation resulted in CVAs, I think I'll stay away.

Q, DO

 

[ribsandbbqbeef]

If DO's don't do anything different in EM than MDs, then why go to DO school & learn the extra stuff on manipulation when one could go straight into an MD program and concentrate on learning the stuff they will use?

Just curious. I don't know anything about DO training. Would appreciate it if you could enlighten me.

 

[DocWagner]

I will say I have used OMT on occasion. VERY rarely.
Since I was a PT prior to med school, it is difficult to weed out where and when I learned certain orthopedic techniques, but I honestly believe there is a larger emphasis on orthopedic exam in DO programs...which should allow for a broader differential. In general, it should be emphasized, large and very busy ED's are not ideal for the practice OMT in emergency medicine...urgent cares are perhaps a better match.
I do remember a funny thing though. The wife of a DO resident from the local osteopathic EM program was brought into our ED (allopathic EM hospital). She had arm pain blah blah blah.
Oddly enough, I gave her the diagnosis of Thoracic Outlet Syndrome and showed the Osteopathic EM resident how to perform the manipulative treatment...and I am in the allopathic residency. Funny.