(6) OAT Surgical/Hospitalized patients Flashcards
Contraindications to OMT of surgical patient (there’s a lot)
- Surgical site >2 weeks (use indirect OMT)
- Midline abdominal incision/aortic aneurysm (do not use abdominal plexus inhibition/mesenteric release)
- Recent L hemicolectomy (do not use sigmoid release)
- Rib/spine fx, spine surgery (do not use rib raising)
- DVT (absolutely no pedal pump), LE fx, recent abd surgery
- Osseus fx, bacterial infection w/ fever >102, abscess, local infection, CA (no lymph tx)
- Upper rib fx/clavicle fx (TI release)
- Thoracotomy, chest tube, trauma (no liver/spleen pump)
Early postop - Inflammatory stage (1-3 days)
Focus on which systems?
Circulatory and pulmonary
Treatments: diaphragm release, rib raising, lymphatic pump
Early Postop - Diuresis stage (4-6 days)
Focus on which systems?
Lymphatic, GI, renal, ANS
(ensure mobility of thoracic cage and outlet bc of increased fluid flow)
Late Postop (1-3 weeks)
Focus on treating what?
Fascia/tissues, somatic dysfunction, viscerosomatic reflex
(enhance analgesia, may decrease hospital length of stay)
The goal of OMT on a hospitalized pt is to treat what kind of dysfunctions?
Dysfunctions that impede homeostatic processes such as sleep, ambulation,e ating, defecation, pain relief
Improve pts ability to cope with disease process
What systems are focused on for OMT of a hospitalized pt?
ANS
Respiratory
CV
Lymphatic
NMSK
What issues may arise with providing OMT to a hospitalized pt?
Privacy
Modesty
TV
Objects in the way
Surgical incisions/dressings
Decubitus ulcers
What positions are somatic dysfunctions normally diagnosed in for a hospitalized pt?
Supine
Lateral recumbent
Seated
*rarely use prone
What in what order is OMT provided to a hospitalized patient?
Indirect initially followed by direct
What is segmental facilitation treatment based on?
Condition and responsiveness of pt.
Reducing facilitation can be accomplished by any procedure that normalizes somatic tissues and reduces nociceptive input
What reflexes are initiated through nociception?
Viscerosomatic
Somatovisceral
Frequency of treatment of a facilitated segment for a hospitalized pt?
May need more than once daily
Underlying disease will reproduce facilitation at the segments, often quite rapidly
Treatment directed towards what tissues may have a greater effect on segmental facilitation than soft tissue techniques? Why?
Articular tissues
Joint capsules have a high concentration of nociceptors, muscle has low concentration
OMT pre-op to reduce mid-cervical SD to decrease post-op pulmonary complications is due to what reflex?
Somatosomatic reflex
(cervical SD => thoracoabdominal diaphragm - phrenic N.)
TART findings from viscerosomatic reflexes are from ____ pathologies
Visceral
Not primarily somatic dysfunctions
Pre-Op assessment for surgical risk factors
Sympathetic innervation to the head/Neck
T1-4
Sympathetic innervation to heart/lungs
T1-6
Sympathetic innervation to upper GI
T5-9
Sympathetic innervation to Small Intestine and R colon
T10-11
Sympathetic innervation to the appendix
T12
Sympathetic innervation to the L colon/pelvis
T12-L2
Sympathetic Innervation to adrenals
T5-T10
Sympathetic innervation to GU tract
T10-l2
Sympathetic innervation to Upper/Lower ureter
T10-11
T12-L2
Sympathetic innervation to the bladder
T12-L2
Sympathetic innervation to upper/Lower extremities
T2-8
T11-L2
Parasympathetic innervation to the L colon, sigmoid, rectum, lower ureters, bladder?
S2-4
A/P Esophagus chapman’s point?
A: B/l 2nd ICS
P: b/l T2
A/P Pancreas chapman’s point?
A: R 7th ICS
P: R b/w T7 and T8
Chapman’s points along the anterior R ribcage?
Liver: R 5th ICS
GB: R 6th ICS
Pancreas: R 7th ICS
Appendix: R 12th rib tip
Chapman’s points along the anterior L ribcage?
Stomach: L 5th and 6th ICS
Spleen: L 7th ICS
A/P Pylorus chapman’s point?
A: Sternal
P: R R10 at costotransverse joint
What are the 4 points of lymphatic evaluation?
What are the modified lymphatic OMTs for a hospitalized patient?
Doming the diaphragm
Pelvic diaphragm
Thoracic inlet
What is the rule of Ws and the post-op days they are associated with?
How long does it take for peristalsis to return to the SI? Right colon? L colon?
SI - 24 hrs
R colon - 48 hrs
L colon - 72 hrs
Abdominal Ganglia Inhibition
Suboccipital decompression
Cervical ganglia inhibition
Posterior abdominal diaphragmatic release: Releasing the lumbar spine/crura (BLT)
Abdominal lifts
