I was at an orthopedic outpatient placement when I was asked to conduct a treatment session on a patient who was day one post TKR. This patient was approx 50 years old and i spent a fair amount of time reading her notes, establishing her pre-op status, which was independant, living at home. She had no major relevant PMHx and she had a general anaesthetic during her op and had no risk of motor block and there were no unusual post op precautions, she was FWB. Her Hb was 90, the limit to standing a patient at this facility was 80. So fully prepared I went into to stand the patient. After assessing both legs strength, which was surprisingly good and Knee ROM which was almost 50 degrees, with no quads lag we decided to stand the patient. The patient was almost able to reach a sitting position by herself and standing was no trouble at all.
Once the patient got to standing with a pulpit frame she was feeling really good so we tried marching on the spot. I had my knee blocking her knee through the frame and she managed three steps before the operated leg suddenly gave way. I managed to block the knee to stop it from collapsing completely and we put her back on the bed. As we went back to the bed her leg appeared to be fully externally rotated and she was in severe amounts of pain. It appeared that her prosthesis had been compromised. As any student would probably react, I was certain that she had done something terrible and it was because of something that I had missed!!! My supervisor immediately contacted the intern who ordered an xray to check the condition of the prothesis. Throughout the process the supervisor and intern were extremely reassuring to the patient but i couldnt think of anything to say, I was just so worried for the patient. After we left the room my supervisor took me aside to debrief, she said first of all that I had checked everthing I could have and if the TKR had indeed failed that there was nothing we could have done differently. She also reinforced that all of the permanent staff were so prepared to react to the situation that it has happened before and will happen again and not to let it upset me.
As it turns out the patients TKR was fine and it was probably just pain inhibition which caused her to collapse. The experience was actually helpful as it helped me to realise that we cant be perfect and control stiuations, these things will happen even if we have done all possible preparation and taken all precautions.
Subscribe to:
Post Comments (Atom)
2 comments:
That sounds like a scary situation to be in. if that were me in your position i would immediately start to think that i had missed out on something important/ done something wrong - i think at this stage we just dont have the self confidence in ourselves and the skills we have. i think its great how the supervisor took time out to debrief you and go over everything that happened, i would think that would restore your confidence. hopefully you were able to continue to treat this patient during your placement and do it with confidence.
Ill second that, I think just putting the pt to bed and contacting the intern is really the only thing you can do, and youve done well. I would be pretty shaken up by that, thinking that it was my bad, but i guess things like that will happen and having confidence in ourselves that we have done everything we can is important. I think as students due to out lack of exerience we tend to blame ourselves first haha
Post a Comment