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Ortho for dummies?

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double elle

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Hi all -
I need to come across a little book that gives me the down and dirty about ortho for moonlighting.
Ortho made ridiculously simple?
Ortho for dummies?
Have no idea if those even exist, but would like something like that!

Details on splinting, etc.
I've looked at wheeless online, but I hate how you have to click to different things all the time.
any suggestions?
 

moquito_17

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First off, where are you moonlighting that you are needing to do orthopaedics? Are you just splinting ankle sprains or are you setting fractures?

If you are in the primary care setting I would recommend Essentials of Musculoskeletal Care by the AAOS (American Academy of Orthopaedic Surgeons). Walter Greene is the Editor.

If you are in the ER, I would recommend Handbook of Fractures by Koval and Zuckerman. It’s the blue book that all the second-year ortho residents have in their pockets.

Hope this helps,
 

double elle

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Simply, basic care in the ER. Kid comes in...arm pain...fracture...
Nursing home fall, broken hip...
What is my role prior to the surgeon seeing these patients, etc.
I will check out those 2 books - thanks for the suggestions.
 

moquito_17

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Before you call the surgeon, you should do do the H&P, get the relevant films and look over them yourself. Knowing the right films to order and having them done before you call is huge. You would be amazed how many ER docs call and say: "This kid fell on his shoulder and now has pain. What do you think?"

If you can do basic splinting for ankle sprains and other minor injuries you'll be fine. Be sure to know the Ottawa Ankle Rules and other ‘high-yield’ ER musculoskeletal topics. Do not miss compartment syndromes. This can be devastating. You should also be able to recognize the more serious injuries and be familiar with common fractures (DR, peds forearm, hip frx, etc.) Unless you're doing a lot of casting, I would stay away from that. Casting can be tricky for people who don't do it often, and depending on the injury, it can be dangerous if not properly split.

Hope you enjoy the ER,
 

dry dre

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double elle said:
Hi all -
I need to come across a....

If you have the means to do so, take a couple nights call with an ortho resident. In exchange for your help (that will certainly be much appreciated) you will likely get a good dose of instruction on how to describe fractures (ie over the phone) as well as how to apply splints. In all reality, these two skills are what you really will be lacking and which you most need to have while moonlighting. The average resident with a PACS nearby can show you a variety of fractures (hips, wrists, ankles) and help you learn to describe what's going on.

If you can do the following you will be leaps and bounds ahead of the average moonlighter who calls a trauma center:
O) Decribe the mechanism
A) name the bone(s) involved
B) describe the fracture type (e.g. open/closed, displaced/non-displaced, comminuted/non-comminuted, intra-articular/non intra-articular, transverse/oblique/spiral)
C) Describe VASCULAR STATUS (i.e. intact, equal to uninjured side)
D) Describe SENSORY NEUROLOGIC STATUS of the affected limb (e.g. 2-point intact, parasthesia)
E) Describe MOTOR NEUROLOGIC STATUS of the affected limb (5/5, 4/5, etc)
F) Decribe range of motion (e.g. intact full active (Pt can do alone) range of motion, ROM limited by pain, no active ROM)
G) Decribe tender/non-tender to palpation
H) Characterize compartments hard/soft

Hand injuries, well, just send the patient on with $75 (that you "earned" that hour) for the local ortho resident who will accept your headache/nightmare.

If all else fails, when calling an accepting orthopod, ask "what should I do to make sure that the patient is stabilized overnight/for transport." Any reasonable orthopod (i.e. most) would be happy to help direct a referring physician who is eager to help the patient.
 

moquito_17

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So Dr. Dre, when some ER TempMD calls you and says :

"Um, Hi Dr. Dre, I wanted to tell you about this patient...... Neuro WHAT status?......His compartments?.......... What do you mean? ...........Um well, i guess his leg is ok. ......um..........hmmmm.......good point.......ok.....um...... Hang on.......Um he got scruunched under a pile of bricks, so I dont know....... Um he feels sorta ok i guess......... I dont know......... We gave him a lot of morphine......What do you mean by soft?....."

Because I hear this all the time.

I'm happy if the ER doc does a H&P and ordered films. I'll take it from there...
 

dry dre

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moquito_17 said:
So Dr. Dre, when some ER TempMD calls you and says :

"Um, Hi Dr. Dre, I wanted to tell you about this patient...... Neuro WHAT status?......His compartments?.......... What do you mean? ...........Um well, i guess his leg is ok. ......um..........hmmmm.......good point.......ok.....um...... Hang on.......Um he got scruunched under a pile of bricks, so I dont know....... Um he feels sorta ok i guess......... I dont know......... We gave him a lot of morphine......What do you mean by soft?....."

Because I hear this all the time.

I'm happy if the ER doc does a H&P and ordered films. I'll take it from there...

Some assumptions...

I assumed that the OP was asking about info for a moonlighter in a hospital without an orthopaedist in the building.

I assume that the above post is coming from either a non-orthopaedist, or from a resident at a low-volume program.

The suggestions that I offered could help any physician in the care of any patient with an orthopaedic complaint. Moreover, having the above information on hand when calling the orthopod will be of assistance in helping him/her assist in the patient's plan of care.

A good telephone exchange can ensure that proper stabilization is employed (e.g. prior to transfer) and that proper radiologic studies have been ordered (e.g. if in the building, before I come down). This helps to provide better and faster care. Then again, I'm not Superman and our department is very busy.
 

moquito_17

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dry dre said:
Some assumptions...

I assumed that the OP was asking about info for a moonlighter in a hospital without an orthopaedist in the building.

I assume that the above post is coming from either a non-orthopaedist, or from a resident at a low-volume program.

The suggestions that I offered could help any physician in the care of any patient with an orthopaedic complaint. Moreover, having the above information on hand when calling the orthopod will be of assistance in helping him/her assist in the patient's plan of care.

A good telephone exchange can ensure that proper stabilization is employed (e.g. prior to transfer) and that proper radiologic studies have been ordered (e.g. if in the building, before I come down). This helps to provide better and faster care. Then again, I'm not Superman and our department is very busy.

Your assumptions are wrong.

High volume program or not, the expectation that the ER doc is going to do the entire orthopaedic exam and evaluation is ridiculous. That is not their training. A cursory exam and evaluation with basic films is expected, but they aren’t going to know how to do the complete exam and evaluation. Expecting them to do so, I think, is unrealistic. All I expect is that they will do the best that they are able within their training and ask for help and be open guidance. I don't think that is unreasonable.

Besides--how many times have you gotten to the ED and the ER resident's assesment or exam is way off? I got a call once from a resident who had a lady with 'hip pain' since her 'minor car accident' 8 hours ago and 'her film 'just didnt look right''. Turned out she had an acetabular frx and was dislocated. No joke.
 

dry dre

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moquito_17 said:
Your assumptions are wrong.

High volume program or not, the expectation that the ER doc is going to do the entire orthopaedic exam and evaluation is ridiculous. That is not their training. A cursory exam and evaluation with basic films is expected, but they aren’t going to know how to do the complete exam and evaluation. Expecting them to do so, I think, is unrealistic. All I expect is that they will do the best that they are able within their training and ask for help and be open guidance. I don't think that is unreasonable.

Besides--how many times have you gotten to the ED and the ER resident's assesment or exam is way off? I got a call once from a resident who had a lady with 'hip pain' since her 'minor car accident' 8 hours ago and 'her film 'just didnt look right''. Turned out she had an acetabular frx and was dislocated. No joke.

We all specialize in different areas of medicine and thus forget/never learn what occurs in other disciplines.

Any professional physician would be remiss if they didn't take the time to help their counterpart workup and diagnose disease that regularly presents in the scope of the counterpart's practice.

On a practical level, the orthopaedic knowledge-base of your EM colleagues helps or hurts you, in residency and much more in real life. I don't know what kind of orthopaedist (or other specialist for that matter) wants to come in to the hospital for every orthopaedic complaint at any hour for their entire career. "Take an H&P and call me in" is nonsense in the real-world. It helps neither the patient nor the specialist.

A desirable private practice includes a strong EM department who can work up/tee-up your orthopaedic complaints. They have to learn these skills some time/some place. If this doesn't make sense to you, it will someday...hopefully. Personally, I'd rather help them learn now than at age 56 at 3AM.
 
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