Working in Theatre and ORIF Surgery

A scan of a Weber's Category B fracture.

Stardate: 91665.06

Day three of my placement, and luckily once again I was in theatre, and I have to say I'm really enjoying it. I saw one spinal examination today on the lumbar spine, and an ORIF (Open Reduction and Internal Fixation) surgery on an ankle.

The spinal examination required little screening, and these were few and far between, which meant half of the time was spent not being able to see anything and standing around waiting to be needed. 

This led me to think of what a student radiographer needs to know before going into theatre. My general thoughts were just tips on how to feel less overwhelmed by theatre situations, as it is a whole new environment:

• know the theatre rules and the theatre culture
• make sure you're wearing the right personal protection equipment - e.g. hat, mask, lead-rubber aprons
• once the patient's skin is open, assume everything is sterile - don't touch anything except the radiography equipment and you'll be okay!
• know how to use the image intensifier (C-arm - a portable C-shaped x-ray device used for imaging during surgical procedures), or observe it being used before undertaking it yourself
• know what is needed during the procedure, if unsure, ask your supervisor
• go to the toilet before surgery - you can be in there for a really long time!
• and if you feel faint, back up to the wall and slide to the floor

The second case was one I attended almost fully unassisted by my supervisor. I felt confident enough to handle the C-arm by myself, and the only hindrance I faced was the positioning of the patient on the table, as they were a little lower down than normal, which meant a bit of the table's metal framework was unavoidably in the image, but not obscuring it. This case was the ORIF ankle case. Open Reduction is surgery to set bones, and Internal Fixation is the fixing of screws and/or plates to facilitate healing. This surgery is used when casting or splinting a fracture alone would not assist repair.

This went well and I was quite impressed at my being pro-active with getting the imaging done and feeling that I could do the examination. The patient had a Weber's fracture (ankle fracture) on the medial malleolus (inner side) of the ankle, and the plates were being placed so the bone was able to heal correctly. I was given positive feedback, and I think I'm much more confident than I was before on placement, and I'm starting to get into the hang of working within different departments.

I think this has been my favourite week so far! Now to do a quick workout, eat a cookie and watch 'An Idiot Abroad' in bed!

LLAP!

References

1. Jeremy Jones, Radiopedia.org, photograph, viewed 22 January 2014 <http://images.radiopaedia.org/images/341127/186015a2d8111ae7f0232b0fb61ab9.jpg>.

Surprise Birthday Spondylosyndesis!

An example of a post-operative multi-level cervical fusion.

Stardate: 91662.61

Overall, I have to say, today wasn't a bad birthday. I wasn't knackered upon arriving at the hospital, I'd had a decent breakfast, and I got to spend pretty much all of my day in orthopaedic theatre! I saw three cases, all of them spinal surgery, and it was great! I saw two lumbar, and a cervical spine case, and the latter was just amazing to witness. (See, I told you my posts would hopefully get more interesting!)

The patient had been suffering with a cervical spinal disc herniation between the C4 and C5 vertebrae. This is basically where a tear in the outer fibrous layer (annulus fibrosus) of the inter-vertebral disc has allowed the central jelly-like portion (nucleus pulposus) to bulge out and cause mechanical compression (pressure) upon a nerve (in this case, the spinal cord). In order to relieve this patient of their pain, surgery was undertaken, and in this case it was a spinal fusion (or spondylosyndesis). 

The type of fusion used for this particular case was ACDF (Anterior Cervical Disectomy and Fusion). This is a surgical procedure where the surgeon enters the space between the two discs through a small incision anteriorly (from the front) and to either the right or left side of the neck. The affected disc is then completely removed, and the intervertebral foramen (the channel through which the spinal cord runs) is then enlarged by a drill to allow the nerve more room. A device is placed between the two vertebrae to maintain spine alignment, and is then fixed with a 'cage' using metallic pedicle screws made from titanium. This type of surgery can take 5 hours, and although I was only in for a few of them, I saw quite a lot.

The consultant surgeon was incredibly nice and explained everything as he went along, and why he was doing it. Before we properly started he showed me some of the patient's previous MRI scans, which helped me to understand what we were actually seeing and scanning. When he'd finished doing different stages, he even encouraged me to come over and have a good look at his work, and I felt quite privileged by it, as some of the surgeons I've seen are quite offish and uninterested.

When I wasn't in theatre, I was out on mobiles, so I got to visit the ICU (Intensive Care Unit) and Oncology. I finally put into practice what I'd learnt about moving and handling (how to move yourself and patients safely), as many patients on these wards find it difficult to get into position for their x-rays. One of the elder male Oncology patients made me smile, as he was fascinated by the mobile x-ray tube, as he thought we were coming to take him back to Main X-Ray (which is about a mile away from Oncology), and he asked quite a lot of questions, and praised the technology's speed.

To finalise this post, I really had a great day in theatre, and I'm looking forward to the possibility of going tomorrow! And, I didn't faint! I knew I wouldn't!

I'm off to spend the remainder of my birthday relaxing in bed with my Spider-Man pillow, some bicuits and 'An Idiot Abroad' DVDs...

LLAP!

References

1. Alexios Apazidis, spineuniverse.com, photograph, viewed 21 January 2014 <http://cloud2.spineuniverse.com/sites/default/files/imagecache/inline-content/images/2012/07/25/4-months-postoperative.jpg>

Return of the Placement!

As insane as it sounds, it's slightly true.

Stardate: 91659.59

So, I'm back out on placement already, and my first day started off in a bit of a panic. Why? Well, because I thought it was okay to not check the TLD (Thermoluminescent dosimetry) I was handed before getting the train to placement. As a result, I found out I had the wrong TLD, which brought forward the looming possibility of not being able to go on placement until I had the correct one, which could take up to 3 days...

Luckily, the Radiation Supervisor and my clinical tutor said that one not having a TLD for a couple of days wouldn't be a major risk... unless something drastic happened. So I decided to risk it and get on placement anyway.

I was glad that I did. I managed to get lots of examinations for my portfolio signed off, mainly chest x-rays, because there weren't many portable examinations being requested. I saw some interesting departments like Oncology and ICU, and was glad to find out I hadn't forgotten everything since last year, which I consider to be a bonus. There were one or two situations that happened involving fainting patients and the like, but it was all good experience, and you learn from them quickly. Being in the department with other students can be helpful as looking at each others x-rays is fun, and good practice, as you get to see some pretty amazing things, and wince in unison at some painful ones.

I'm hoping that tomorrow I get to go into theatre, because tomorrow happens to be my birthday, and I want it to be interesting. I don't tend to make a big deal about them, but being the strange person I am, I think it'd be great fun to get some time in theatre to learn how the techniques are adapted to different cases. And who doesn't like a bit of gore now and then?

As for spare time, in between what little sleep I tend to get and now being out on clinical, I've started doing an online Forensic Science course, which entails studying the field using a 'Murder on the Loch' case study, while I sit happily listening to Mozart. It's fascinating, and as it's linked to what I want to do in the future, some of the material slots in nicely. It seems one has gone back into her geeky-recluse mode once more...

LLAP and the game is now most definitely on.

References

1. Sherlock and Violins, n.d. photograph, viewed 20 January 2012 <https://i.chzbgr.com/maxW500/6564377344/hBA076E54/>

Happy Belated Christmas and New Year!

This is how my Christmas and New Year holiday generally looked. Except I had piles of textbooks around me...

Stardate: 91629.78

As the title says, despite their belatedness, Happy Christmas and New Year!

Well, it has been a while since I wrote an entry, but I am putting that down to three things:

• an incredibly evil essay my year had to write for the Learning Together, Working Together module (3,000 words of pain)
• part-time work (Boxing Day sales how I loathe thee!)
• and finally fatigue and anti-social tendencies

Yes, it's true, when an essay rolls around, I tend to either disappear into the ether until it's finished, or I pretend it doesn't exist and leave it until I have around three weeks left to complete it. I managed to hole myself up in my living room with piles of textbooks and handwritten notes surrounding me, with a vast quantity of tabs in Chrome detailing journal articles open on my laptop. But, it is done and I can breathe once more. Well, this is me we're talking about, so probably not. As I'm writing this I've got a textbook on 'Comprehensive Radiographic Pathology' open next to me, with post-it notes stuck everywhere. Hey-ho.

So, how do I summarise my first semester with the University of Leeds? Overall, it was highly enjoyable and eye-opening, and I'm looking forward to some new course material to return to. I survived my first three week placement block (just about), and I feel like I learnt a great deal. I applied to be a student rep alongside another student, so the pair of us will try our best to get our cohort's concerns and thoughts heard. What else... oh yes, I definitely decided I want to become a Forensic Radiographer. We all know how I like a good challenge (or that mind-numbing boredom sets in), and I believe this will be the perfect one for me.

We received a whole year rota for our clinical placement blocks (well, the students at my placement did anyway), and I have a nice mix coming up. For my two-week January placement (on my birthday! Woe is me!) I'll be in Mobiles & Theatre in week one (hopefully I won't faint this time), and general X-ray for week two, so that'll be a nice opportunity to get the clinical experience portfolio filled in. Roll on early morning starts, cafeteria food and waiting for ages in the cold for a bus.

Semester 2 technically starts again on Monday, but it's our assessment week, and as we only had that one essay from Hell, we're hoping for an extra week off. So our real semester starts the week of my birthday, from January 20th. Which begins with two weeks of placement.

Hopefully this semester is even better than the first.

The game is on! (LLAP)

References

1. Festive Sherlock, n.d. photograph, viewed 9 January 2014 <http://31.media.tumblr.com/tumblr_mde23g8rXR1rnw4hro1_500.png>.