manual theraphy healing rib fractures

[gplondon]

hi there im a gp in london and need some evidence based advice or advise from any experienced manual therphy specialist,

i have a patient who is a local paediatric physio, this physio was called out on call during the night to attend to a case of a child with old healing fractures who was in the picu ward, the patient was actually ventilated and doctors oncall thought he had an obstruction, physio oncall was called out, sats were dropping and respiratory rate increasing up to despite suctioning, the physio oncall tried suctioning and saline and when not improving and deteriorating then carried out manual theraphy with caution to try and ease the obstruction, patient improved and actually settled after this,

unfortuanlty now the physio is being pursued for gross misconduct because of his actions on the oncall night and taken to a disaplinary hearing...
he is most distraught regarding what he should do and where he should turn to for help, as a doctor we have mps legal advice he has contacted the union but is now facing disaplinary action is there any advice regarding manual theraphy with caution or any informal advice which might help his case....


unfortunatly i do not know the details of the case but was worried about how the stress of his situation was affecting him and was wondering if anyone can offer help,


thanks


gp london

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[Dr Damien]

Dear GpLondon

I am not a respiratory therapist however i wouldnt think it would be a matter of trying to find some evidence for this particular case as opposed to looking at the precautions and contraindications for the maneovres. Now i think what that therapist did was very courageous and necessary, what we are trained to do when managing a critically ill patient as first protocol is not maintain airway patency which is critical to life. Ethically i would think that he should be alright if he has the CSP backing him up. Having said that, different hospitals have different policies. The question is was there a specialist who was more qualified to handle the situation at hand? we generally do not carry out any manual chest therapy on fractured ribs old or new if we havent got any evidence that it is safe to do so. where there x rays to prove that these fractures had healed sufficiently to accomodate such maneovres?

when it comes to a life or death situation we are ethically bound to save a patient's life if we can or prolong it as much as we can unless the patient declines such input. did this therapist gain the consent of the patient's family/parents before carrying out this maneovres? was he qualified enough to have done what he did? these are the questions that would be asked... No evidence out there would back him up if he didnt gain parents consent to carry out a risky maneouvre like that. I guess at the end of day, he didnt do any harm so he probably will be let go on a warning im guessing. He will have to prove that the child's life was in danger and there wasnt any time to follow the procedures as i have asked above...for this he would need support of his peers, doctors, nurses, other physios.