07-0923101100 - Opp Iii E2 - Omm In The Er (Miller)

Front 1

How many visits to the ER have there been in the south per 2006?

Back 1

50.624 M

Front 2

How many visits to the ER in the US were for uninsured or charity?

Back 2

20.777 M uninsured
2.232 M charity

Front 3

What percent of visits to the ER in 2006 for the US were seen after PCP closed for the day?

Back 3

64%

Front 4

What % of of the pts in the ER in the US were admitted?

Back 4

13%

Front 5

What % of pts going to the ER in 2006 were seen again within 3 days resulting in a different Dx?

Back 5

3.6%

Front 6

What % of pts required immediate tx even though they came to the ER?

Back 6

16%

Front 7

Why is it economically more reasonably to practice OMM in an ER setting?

Back 7

pts report more face-time with their doc, had fewer re-visits, increased average time by 9 minutes, but pts reported feeling like they had 10 to 15 minutes more with their pts. the extra time was properly reimbursed, which made it justified.

Front 8

What types of OMM are more helpful in ER?

Back 8

virscero-somatic reflexes, chapman's points, referred pain (somato-somatic), compensatory pain at a remote location indicating somatic dysfunction

Front 9

What can one do to improve respiratory mechanics?

Back 9

improve alignment, ROM, inhalation/exhalation lesions, diaphragm mechanics with rib raising, BLT or ME to improve kyphosis, counterstrain to release thoracic cage tension

Front 10

How can one improve upper respiratory infection or congestion?

Back 10

OA release, occipital release, neck soft tissue, cervical HVLA, BLT, ME to improve drainage from head, lymphatic chest pump, pedal pump to move lymph

Front 11

How does one tx pneumonia per OMM in the ER?

Back 11

enhance movement of fluid and air through lungs: rib raising, ME on ribs, BLT, ME on thoracic, thoracic inlet, lymphatic to enhance immune response

Front 12

How does one tx cellulitis per OMM in the ER?

Back 12

body need to deliver nutrients and O2 to area of infection: enhance lymphatic flow (BOTH inlet, LE = pelvis, lumbar, UE = thorax, shoulder), remove edema, start appropriate Ab first!

Front 13

What is the complication of OMM on a cellulitis pt without appropriate antibiotics?

Back 13

septicemia by encouraging infectious agent to be better circulated along with the lymph.

Front 14

How do you tx migraines in the er with OMM?

Back 14

trigger points for migraines and tension HA by suboccipital release, cervical soft tissue, FPR or BLT on trigger points

Front 15

What is a migraine due to?

Back 15

sudden vascular dilation or contraction

Front 16

95% of disk herniations occurs at what levels?

Back 16

L4-L5 or L5-S1

Front 17

What additional symptoms, aside from Lower Back Pain, does an L5-S1 herniation usually present with?

Back 17

mimics shin splints, calf pain mimics thrombophlebitis, peroneal nerve at fibular head or tibial nerve (S1) at tarsal tunnel can be aggravated

Front 18

When is an xray initially indicated? When is an MRI or CT scan initially indicated?

Back 18

xray - should always be done on an acute injury
MRI/CT - use if neurological impairment accompanies pain

Front 19

What referred pain does psoas, illiacus, and quadratus spasm cause?

Back 19

low back pain, ipsilateral groin pain, contralateral piriformis pain

Front 20

What referred pain does a piriformis muscle spasm usually cause?

Back 20

ipsilateral buttock and post thigh pain, hip flexor and extensor pain sometimes

Front 21

What is the most common cause of lower back pain?

Back 21

psoas and quadratus spasm

Front 22

What level of proof from research has osteopathic FPR and BLT achieved for acute low back pain?

Back 22

level 2 (being second only to level 1 as best evidence)

Front 23

What level is the following: avoid intramuscular corticosteroid injections, avoid NSAIDS more than 2 days, heat for short term benefit, avoid HVLA?

Back 23

steroid: level 2
NSAIDS: level 2
Heat: level 2
avoid HVLA: level 1

Front 24

Why should we avoid HVLA in acute low back pain?

Back 24

pts report having more pain and being able to do less 2 days after manipulation. use fpr and counterstrain

Front 25

Pts most likely to benefit from spinal manipulation must meet 4/5 of what criteria?

Back 25

1. symptom duration < 16 days
2. no symptoms distal to knee
3. score < 19 on fear-avoidance measure
4. at least 1 hypomobile lumbar segment
5. at least 1 hip with > 35 degrees of internal rotation

this is known as the prediction rule (level 2)

Front 26

How can we help an ankle inversion injury with OMM in ER?

Back 26

reduce counterstrain, fix talar dysfunction, fix cuboid, fix posterior fibular head. if there is tibial torsion then look for possible strain to deltoid ligament.

Front 27

How are ankle injuries graded?

Back 27

I - partial tear of a ligament
II - incomplete tear with moderate functional impairment
III - complete tear and loss of integrity of ligament

Front 28

What position of the ankle produces a higher risk of damage to the anterior talofibular ligament?

Back 28

plantar flexion

Front 29

What two tests can be used to check for ankle stability in an acute ankle injury?

Back 29

anterior drawer test
talar tilt test

Front 30

What are the Ottawa ankle rules and how are they used?

Back 30

get a radiograph of a painful ankle if:
1. bone tenderness at A, B
2. inability to bear weight

radiograph of foot with pain to midfoot if:
1. bone tenderness at C, D
2. inability to bear weight

Front 31

What are the 4 steps of tx for an ankle injury and how is each step leveled?

Back 31

xray if tenderness at bone and unable to walk 4 steps (general/Ottawa-ish)
NSAIDS less than 7 days - level 1
OMT - level 2
RICE for 48 hours - level 2
early mobilization - level 2

Front 32

What is the Eisenhart study?

Back 32

OMT may improve the range of motion in an acute ankle injury - level 2, p = 0.02

Front 33

What is the tx for acute ankle injury?

Back 33

1. cuboid inferior, then reduce anteriorly
2. lymphatic drainage
3. proximal fibula displaced posteriorly, then reduce anteriorly
4. torsion to interosseous ligament reduced
5. CTS to fibularis and tendons

Front 34

What tx is most often used for an acute knee injury?

Back 34

million dollar knee technique

Front 35

What are Ottawa knee rules for xray of acute knee injury?

Back 35

1. age > 55
2. tenderness of fibular head
3. isolated tenderness of the patella
4. inability to flex 90 degrees
5. inability to bear weight for 4 steps (limping is ok)

Front 36

In a patient with lower back and lower extremity presentation, what should you check out regarding the foot?

Back 36

look at the footwear to see what the tread wear is as an indicator of pronation/supination

Front 37

What is flat feet and indicator of?

Back 37

chronic problem

Front 38

What is the most common foot complaint dx that you will see in the ER?

Back 38

plantar fasciitis. when a pt presents, you should be sure to check out the ankle, knee, and hip