During your 10-week surgery rotation, you have 3 weeks of specialty rotations, including Anesthesia and 2 other specialties of your choice. Since I am interested in Pediatrics, I chose to do them in ENT and Orthopaedics since they are the most frequently consulted surgical specialties by Pediatrics. And while they are as different as night and day, I had a blast learning about each and had the opportunity to appreciate the rewards of both specialties.
This week, I have been on Ortho with my awesome first-year medical student Hannah. Today, we attended our scheduled casting class at the faculty medical offices (FMO) across the street from the medical center. The Ortho tech Maggie taught us how to properly place different types of splints and casts, and then we got to practice doing them on each other. Aside from having such a good time making arm casts on each other (and then signing them), we learned the importance of making proper splints and casts so that they will not further harm the patients. These are some of the techniques we learned:
Sugar-Tong Forearm Splint: Splints are used in the Emergency Department to stabilize non-emergency injuries until a consult service like Orthopaedics can come evaluate them. A sugar-tong forearm splint is often used for distal radial or ulnar fractures.
Hannah is wrapping the splint with an Ace bandage while making sure my elbow is flexed at 90 degrees.
Collar-and-Cuff Sling: A collar-and-cuff sling is used to immobilize the ipsilateral arm in a humoral fracture. The sling provides traction for proper alignment of the arm.
Hannah demonstrates a properly placed collar-and-cuff sling.
Forearm Cast: We practiced casting using fiberglass material which hardens pretty quickly. Some important things to keep in mind are proper positioning of the arm and wrist to ensure that the whole arm is supported by the cast, as well as making sure that you don’t wrap the fiberglass too tightly to prevent something as limb-threatening as compartment syndrome. If a patient complains of pain with a cast on, it must be removed immediately!
First, make sure you put a towel on the patient’s lap and that the caster puts on GLOVES! You don’t ever want to touch wet fiberglass with your bare hands! Then, put a measured stocking on the patient’s arm. (Note: the left arm is in a radial gutter splint)
Next, wrap the arm with web roll from the distal elbow to the palmar crease.
Then, dunk the fiberglass cast roll into a bucket of warm water to activate the fiberglass, gently squeeze some of the excess water, then wrap the arm with the fiberglass cast starting at the wrist. After you have wrapped the cast, you will rub the cast down with the palm of your hands. The cast will get warm and will harden over a few minutes.
As soon as that cast dries, sign away! (Note: the tech casted my right arm first, then Hannah casted the left. At one point, both arms were casted!)
I’m glad I don’t really have a fractured arm under that cast!
Hannah seems happy with the work I did!
And that was our day. If you never considered rotating through Ortho, hope you will because you will learn a lot of practical and relevant things! Hope everyone is staying cool despite the heat!