Friday 7th September 2007 Podiatry Clinics

I was told that Fridays traditionally are a quiet day in regard to Pre Booked appointments and Clinics.

There was a wave of M.I.U. Patients throughout the day with a variety of injuries, some fractures some not. This was to be a day where I was to develop my skills at plain film imaging, the great thing with a hospital like this is you never know what patients will be walking through the door and what prospective injurie they may appear with. Very simillar to an A/E department but you have alittle more time to think about positioning, and exposure factors something I have never really concentrated on until coming to work here.

From the M.I.U patiants there were two I shall discuss two;

The first had presented on the request slip with ?# Proximal phalanx or Querry Fracture of the proximal phalanx, what the slip did not say was very large open wound. The patient had severed the tendon and the incision had passed through, this incision wa so large that it ended I would assume at the distal radius right across the palmer aspect of the hand.

This was the first time I had to think about the exposure to blood and protecting myself and the room from and more importantly the patinet from any infection, before even taking the image.

All the relevant cleaning measure were implemeented and the patint went back ti M.I.U. it turned out there was an fractured distal, and proximal fractures with the middle phalanx being displaced on the 2nd metacarpal following by a dislocation of the 1st Metacrapal at the MCP Joint. This patient was refferred to clinic at the large city hospital nearby.

I had learnt that by taking my time and really thinking about situation before carrying out any part of imaging or positioing will help me keep my composure and acquire a diagnostic image.

The second patient was admitted after a fall at home, the patinet had been lay for three days on her side unable to move, after being found by her neighbour the paramedics rushed her to us for immediate imaging before possibly being sent to the City Hospital. The need for smaller community hopsitals are vital in caring fpr patients with urgency when a longer ambulance ride to a City Hospital is not suitable.

The request slip required AP and Hztl Beam Hip Left and Left Knee and Ankle, additionally there was a request for left Shoulder and Wrist, quite a checklist of images all related to the fall.

The only problem was the patients size and the problem of her being on a chair and not a trolley.

This was to be the first time I had attempted to use a Hoist (under a lot of Supervision), and was asked how I would adapt the traditional techniques around this patient, it was quite interesting to be asked and to attempt what I had suggested (only if it were correct though), the shoulder AP and Lateral, and the Wrist images were done in the chair.

After leraning how you set up a hoist I was allowed to help in placing it under the patient, this was not satisfactory as the patients hevaily swollen knees would not move and any movement around this area resulted in discomfort.

We eventually managed to lower the table to chair hieght and slide the patinet across onto the table top, using an old 35/43 cassette as the sliding board wouldnt withhold the pressure, an all new version of adapted techniques!!

Eveentually the images were acquired and there fractures so the patient was refferred to the City Hospital for further treatment.

All in all an extremely hard week with a variety of cases and a lot of learning, its amazing to think that Radiography used to be so intensive when away from the patient, the image acquisistion is actually the easier bit.

Oh well Weekends upon us and another week about to begin, and too be honest im looking forward to going back.