Friday, September 23, 2011

Anatomy Guy is Awesome

A former student sent me this link called, quite simply, Anatomy Guy.  Simply put, I love it!  Once you get the past the old school green screen effect, which reminds me of Mystery Science Theater 3000, (possibly one of the best shows of all time) the content is superb. 

The site breaks down into specific body regions, of which you can see actual cadaver tissue (an absolute bonus if your ATEP doesn't have a gross anatomy lab).  I think this is great for students at any level, as he breaks down each region into several categories:
Dissection Prep
Dissection Review
Surgical Subspecialties

In addition, they offer several shorter videos on specific injuries, injuries to regions, and special categories.  This is a great site which I think can really enhance studying and further understanding of basic anatomy, structure and function.  Check it out!

Oh, and here's another MST3K vid to carry you through the weekend. For those who don't know, the basic premise of the show was to take a horrible B movie and make fun of it.   Sorry I couldn't resist.

Tuesday, September 20, 2011

Taping: Skill or Art?

"Taping is an ART."
"You will learn the skill of taping."
I have been greeted with both of those when learning various taping techniques at workshops/courses etc.  I think the truth lies somewhere in between.  Either way, we must be adept at it in order to perform our job.  Truth is, when an athlete is injured, how many times has a coach or athlete said, "Can't you just tape it up?"  It is perhaps as synonymous with athletic training as any other task we perform, and rightfully so.  We should be good at it, if not the best.
I've even heard colleagues state "Taping is dead.  Braces are the way to go."  I'm not so convinced.  Many athletes still prefer taping to bracing, and since we are a service based profession, I believe taping is here to stay.  What it will continue to do, much like everything else, is change and evolve (hello Kinesio taping!)
That said, here is a basic closed basket weave for an ankle, perhaps the most common taping technique regularly applied.  A classic, very diverse and useful:

Here is a variation; just a couple of tweaks, but the basic premise remains the same.

Some basic points on ankle taping:
1.  Avoid continuous tape; this often provides pressure and not necessarily support.  Shorter strips tend to hold up well.
2.  As a colleague down the hall says every day "Taping is your signature.  Make it look good."
3.  Be wary of the 5th metatarsal; don't tape to tightly over it, but don't stay behind it either.  It's a spot that is easily aggravated.
4.  Every ATC has their own "style" of taping; as long as the ankle mortise is receiving adequate support, then variations are OK.  Basically, if the tape is performing it's intended function, then it shouldn't matter at what specific point you apply your heel lock, figure eight, etc. It's OK to be different, but be efficient!

So who out there exclusively tapes?  Exclusively braces?  Tell us why, I'd sure be interested in hearing your thoughts.  

Wednesday, September 14, 2011

Combative Patient Restraint During Spine Boarding

One of the tasks assigned to AT educators is to properly instruct aspiring ATC's on the logistics of spine boarding (back boarding) of patients.  I have found that students respond readily to repeated rehearsal of the tasks associated with efficient and timely spine boarding.  However, the difficulty often lies within the patient themselves.  What to do when a patient is non-compliant or combative? When students practice in simulation, the assumption is that the patient is either unconscious or conscious and will automatically comply with verbal communication from the medical staff.  It has been my professional experience that this is not always the case.  If the athlete is unconscious and becomes alert midway through the process, they may be confused and, understandably, resist personnel who are attempting to do their job.  If they have suffered a head injury, or in the classic "fight or flight" mechanism, their reactions may be in complete contrast to the compliant patient we all envision when anticipating performing the act of spine boarding.  So what to do?  Well, in this case, go to the experts.  EMS personnel spine board more patients than most, if not any other health care profession.  And they do so in a variety of challenging and not so ideal environments. 
Question my students have posed after mock scenarios:  Do I restrain a combative patient who attempts to resist the immobilization process mid-way through?

My response: GREAT question. 
So we turn to Firehouse Magazine, and an interesting article found here. 
Take Home Points:
1.There are 4 methods of restraint:  Verbal, Non-Verbal, Physical & Chemical.  Use Verbal and Non Verbal as your first choice.  When those fail, physical restraint may be necessary.
2.Have four people ready to control each limb (this shouldn't account for everyone, though).
3. Use necessary, but not excessive force.

Mike Weaver writes in this article that much like firefighters training again and again for fires (which occur relatively infrequently when compared proportionately to training exercises), personnel can become more adept at handling challenging cases when they present.  He suggests this same logic be applied to spine boarding the combative patient.  Some take home points here:
1. Position the patient to your advantage: Holding them in a "T" position (arms abducted and elbows extended to 90 degrees, legs straight) takes mechanical advantage away from the patient.
2. Acceptable minimum number of trained personnel should be six persons.
3. Don't "crowd" the patient.  Give some space.

Some general rules I teach students to follow:
1. Don't assume that because you know all of your athletes, that they will automatically respond to you in a positive manner.
2.  Maintain a calm demeanor and constant eye contact with the patient (best if done by person at head position).
3.  Don't take it personally; they are in physical distress, and perhaps psychological distress.  Remain calm and in control.
4.  Remember, at sporting events, it's likely family and friends are in the direct vicinity.  Do your job, but be professional about it, in both physical and verbal commands.
5.  Use your verbal commands, and negotiate with the athlete.  Remember that excessive force at the head can actually increase severity of the injury; potentially catastrophically. Your struggle to hold the head and neck down may actually hurt them more.
6.  Know your equipment.  Every spine board and buckle/strap system is different, and there are many variations currently utilized.  Familiarize yourself with these wherever you go.

Great food for thought, a true gray area. Feel free to share your thoughts!

Wednesday, September 7, 2011

New Shoulder Pads Allow Easier Access for ATC's.

Back in June, Riddell unveiled a new product called the RipKord (TM) Shoulder Pad Release System. This year, the Chicago Bears will be the first NFL team to use them.  A common difficulty for ATC's is that we practice helmet and facemask removal constantly, but removal of the shoulder pads usually presents a significant problem:  How do we remove them while also trying to simultaneously remove shoulder pads AND limit cervical spine motion?  Beyond that, any significant torso injury needs to be accessed while trying to minimize athlete movement.  This is an interesting twist on the old design.  Below is a great video which depicts how the pads are removed utilizing the new system..

Similar to other shoulder pad removal systems, it begins much the same with removal of straps under the arms, around the torso, as well as the chest string.  The beauty of this design is that you then pull the "rip chord", the pads are then slid down the torso to each side, and then pulled away from the body.  A stroke of genius.    Let's hope this catches on, as it will make emergency management much more fluid. 

Tuesday, September 6, 2011

Fitting your shoes online? No Way!

Runners World has a new online tool which  fascinates me.  Not that I think it's a great idea to substitute a visit to your local running store and be fitted by an actual expert, but the idea is intriguing.  Check it out here and try it for yourself.  If you know your foot type well, it can indeed be very useful.  For the beginner, I would recommend seeing a specialist prior to solely relying on this tool.  The main upside is it can be a nice tool to educate your athletes with, and get them invested in the notion of being in the right shoe.

To learn more about terms and conditions prevalent to runners, check out this link.

When I input my own data, the shoes varied a bit.  I currently run in a pair of Brooks (pictured above) which I love, but the recommendations were primarily Adidas, which tend not to fit me well at all as they run narrow on my feet.  The fact that they recommend shoe types which won't necessarily account for how a specific brand fits speaks to the tools limitations.  But, it's fun to play with.  Enjoy.