Acute Neurosurgery Physiotherapy

[sarahkelly]

I am a Physio student and have just found out that my next placement is on an acute neurosurgery ward, and I litearally have no idea what to expect. If anyone know anything about what I should expect (even if just a word) please let me know as I have a few days off now and need to focus my studying.
It will be my first and last neuro placement so I want to get a lot out of it.
Thank you

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[gcoe]

Hi sarah

It may seem quite a scary area but actually neurosurgery is very orderly and is generally very protocol-orieted. Your physio should help you with identifying what needs to be done and you should get plenty of guidance - particularly with the post surgical patients. A real main thing to remember is that these patients are often acutely ill and as you are dealing with the most delicate and easily damaged system that is of paramount importance - do no harm so if in doubt ask for help.

It may be helpul to read up about the conditions you are likely to see. Lindsay and bone's "neurology and neurosurgery illustrated" is an excellent intro text as it presents each condition/ surgical procedure on a page. You could look up the various tpes of brain haemorrhage, tumours, spinal surgery etc the imaging techniques just to get familiar withbsome of the more common presentations and procedures

You are actually very fortunate to have this experience as most students around the world don't get a chance in their education. Best of luck with the placement.

[radhika28071985]

HI Dear !!
There`s nothing to get worried about .. being a student it ias a great opportunity to get a posting in the neurosurgical wards ..
I was the incharge physiotherapist for the neuro surgical ICU for 2 yrs and trust me u need not worry .. it is just the matter of presence of mind and how well you know to tackle a conditions physio theraputically ..
In neuro surgical patients kindly ask the surgeon before mobilizing the patient .. and go through the neuro case sheet totally .. You Can take the surgeon if the patient needs little more duration of rest or can be mobilized .. if yes , take some additional help as per the patient condition , assess the mm.strength before you get the patient out of the bed..
You can check for the lung fields ,as most for them need chest physio due to prolonged bed rest and unconscious state ( in some cases ).. Here you can learn and read about suctioning, chest physio and techniques that help in increasing lung capacities (spirometer )
If told to mobilise the patient , 1st check the patients static stability on bed in sitting and standing , only then go ahead with the mobilisation.
I think this should be good enough ..
ALL the best
Radhika

[badlybruised]

Hiya

I would just like to reiterate what your other 2 replies have said; neurosurgery is a great placement to get, and you will easily develop respiratory, neuro and msk skills.

I would def recommend phoning the unit to determine exactly what they see; for example the unit I worked on the ICU patients were seen by the respiratory team, and the neurosurg unit had 'level 3' beds (a bit like HDU) and the normal ward beds.

There were a variety of conditions including spinal cord injury (traumatic and tumours), elective spinal surgery, brain tumours, brain haemorrhages, traumatic brain injury, deep brain stimulation. A lot of these patients were multi-trauma and therefore you also get to see orthopaedic injuries and patients with respiratory issues (e.g. low GCS, tracheostomies etc) as well.

What I woud say is don't bog yourself down too much with the specific conditions, as there are loads. I think you need to be aware of them, but you will develop specific detailed knowledge as you see the patient. Just ensure you can do good solid musculoskeletal and neuro assessments, as you need to understand what you see to be able to problem solve, plan and set goals etc.

I hope you enjoy it.

:-)

[sarahkelly]

Hi there,
Thanks for the advice, it is a good placement (good mix of resp, neuro, msk, ortho..)and I'm been working hard, just a few things I dont' get:
1. Why do we as physio's need to monitor fluid balance as in how does it affect how we treat a patient?
2. Why do TBI patients tend ot get hypertonia?
3. On reading ABG's type 1 & 2 resp. failure aside, how do you treat metabolic alkalosis, resp acidosis etc.?
Cheers,
Sarah

[PTGrad]

What to expect? Don't worry you'll gonna love it. It's the most challenging area of Rehab Medicine. Just be particular with your Vital Signs...Know them by heart and try to focus. Remember, stay calm. Patients in these areas are more mentally and emotionally challenging so be quick to judge. Your encouragements, choice of words even your tone of voice matters in the recovery of the patient(s). So, goodluck. Hope you'll learn to love neuro, just like I did...

[junior_physiotherapist]

Hi There,

In Summary:

Although the body strives to maintain normal pH levels,
Sometimes causes of an acid-base imbalance can not be corrected…
So, the renal and respiratory systems can offset the ill effects of a fluctuating pH.

COMPENSATIONS,

Arterial blood gas values are frequently influenced by the ability or inability of the respiratory muscles to ventilate the lungs

Many of the specific interventions to improve abnormal ABG finding involve improving the following:
Biomechanics of breathing
Airway diameter
Alveolar ventilation and oxygenation
Pulmonary hygiene

Besides ABG’s :
Observation of the patients;
Skin color
Degree of respiratory distress
Breathing patterns
Auscultation of the patients lungs;
Provides important information about:
Biomechanics of breathing
Airway diameter
Alveolar ventilation and
oxygenation

Which may direct therapeutic intervention to rapidly improve a patients status before arterial blood gases deteriorate


Hope this could help!

[junior_physiotherapist]

Remember!!

CHART REVIEW FOR A PATIENT
ON PT PROGRAM:
Review latest doctor’s orders:
labs, tests, procedures, meds, etc

Review progress notes since last PT treatment:
any changes in patient’s status

Review results of latest labs, radiology tests, etc

Check the chart again before you see the patient
if significant time has elapsed since your last review

Speak with the nurse before seeing the patient…
plan for the day

ICU patients can have a change in status quickly….
it may not be documented yet and
only the nurse may know!

PRECAUTIONS TO PT:

Pending test or lab results
Need for a brace
Clarification of order
DVT, PE
Blood transfusions
Mental status
Weaning from the vent
Chest pain
Change in vitals
Plan for surgery, post-op
Increase or decrease in body temperature
Difficulty breathing
Dialysis