Empowering Patients: A Guide to Trauma Informed Care in the ED
“If nothing else, just be kind to them.”
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You’re the Dizziness Detective in the ED
A 52 year old patient sits very still in a chair at your facility’s Emergency Department, with her eyes closed and an emesis pan in arm’s reach. One glance at the chart tells you what you’ve already guessed – the patient came in with complaints of acute vertigo, the nurse recently gave her Zofran to manage nausea, and an MRI of her head has come back negative for stroke. Of course, you know that an MRI can be falsely negative for stroke in at least 12% of patients in the first 24-48 hours from symptom onset (Kattah et al., 2009). As the physical therapist assigned to the ED and renowned “dizziness detective,” you’ve been asked to help out. What do you do first?
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Take 5 – The Ottawa Knee Rules
A patient comes into the ED after twisting their knee falling off their skateboard. They are having a hard time walking and want to make sure their knee is okay so they can go to school and play soccer on their varsity high school team. What do you need to rule out? How do you know if you need imaging? And how long will all of this take? Based on the injury, how will this affect your plan of care and management of this patient?
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The Million Dollar Question
We are often asked by therapists or managers: How can we demonstrate the financial benefit of having Physical Therapy in the Emergency Department? Unfortunately, it’s complicated.
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Take 5 – Social Determinants of Health: Are You Measuring Them?
Social Determinants of Health (SDH) may be more influential over health outcomes for musculoskeletal (MSK) conditions compared to direct medical treatment.
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Take 5 – Let’s Look at Diagnostic Accuracy of the Ottawa Ankle Rule
Gomes YE, Chau M, Banwell HA, Causby RS. Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis. BMC
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Take 5 – Direct Access Physiotherapy to Help Manage Patients With Musculoskeletal Disorders in an Emergency Department: Results of a randomized controlled trial
A patient comes into the ED with back pain from an injury at home when they went to pick up a heavy box. Their pain hasn’t improved since the incident yesterday and they want to get evaluated for an injury and pain control. Which provider(s) can help them? And how can they be helped? How can we ensure the patient gets better today, one month, and three months from now?
Researching a Path to Better Care Through ED PT
I think just understanding that the ED team really wants to hear your opinion on the diagnosis and recommendations for care is a great place to start. As I alluded to before, we generally have a laid-back culture and flat hierarchy and will readily acknowledge that you have unique expertise in whatever clinical area we’ve asked for your help in. The ED environment is always really busy and we’re doing a thousand things at once, so we’ll always look like our hair is on fire – but just knowing that we see you as value added is a great mindset to come from. In terms of actual communication strategies, I would say keep it short and simple? We tend to be more interested in the punchline than the plot development/background. And then if there’s disagreement, just standard communication principles: try to understand where both parties are coming from and keep things focused on the patient.
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Take 5 – H.I.N.T.S. to Diagnose Stroke in Acute Vestibular Syndrome
You’re asked to see a patient in the ED presenting with vertigo. They are constantly dizzy, unsteady with gait, nauseous and vomiting, and reporting that their symptoms started yesterday and worsened over the course of an hour. How do you know what type of vertigo they have? And how can you rule in/out central or peripheral causes for vertigo? Has any imaging been done? Does that even matter?
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Strictly Speaking, Physical Therapists Belong in the Emergency Department
I had to demonstrate my ability to help the team through constant communication and education of our role as a therapist.
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