Off early today!

So this week is already much faster paced for me than last, and it's only Tuesday. I've been given more responsibilities--treatments, solo evaluations, documentation, POCs, etc.  Monday morning I did the wound care on a HUGE sacral bedsore. Seriously, it was 13cm x 8cm and 4cm deep, with tunneling around ~50% between 3-5 cm deep! It was the largest wound I've ever seen. I was a bit iffy at first, especially after I read the chart and saw that the patient had newly diagnosed osteomyelitis AND Hepatitis C!  The PT that did her wound care the previous treatment day had accidentally gotten cut during the debridment and so they had to check her and the patient. Turns out the patient tested positive! Luckily the PT did not, still she will have to be re-checked throughout the next few months as a precaution.  Anywho, so yea I did a Cell Mist treatment, which is just a painless, non contact ultrasound device that uses either a saline or antibiotic mist.   It is the only noncontact ultrasound device cleared by the FDA with an indication to “promote wound healing”.  It uses sound waves directed into the wound bed to active cell stimulation in order to encourage re-vascularization, and can moisten the avascular tissue so we can cleanse and debride it. After that was done I got to pack the wound with Dakin soaked kerlix. Literally had half my hand stuffed into her wound in order to pack it fully. Crazy! Sounds kind of gross in hindsight.....but during I was just thinking "Whoa!"  :) 

So far patients haven't been that difficult to manage. Was worried about one of our regulars that found out he had TB.....AFTER we'd been working closely with him for the week! Now we have to wear these special duck-like masks before going into his room. My CI didn't seem too concerned, she felt as if our chances of having contracted it prior to his actual diagnosis wasn't likely.

Been seeing a lot of heart patients--Bypass, MI, CHF, transplant candidates, etc. So all we really need to do is educate regarding precautions/restrictions, then walk them to improve cardiovascular endurance and conditioning.   Today, though one of my evals was a patient that had uncontrolled Diabetes leading to peripheral vascular disease, which eventually developed into gangrene on his R foot (obviously this pt wasn't paying attention to his feet for a while!) He ended up have every toe except his great toe removed yesterday and a femoral-popliteal bypass graft. He was in pretty bad shape when I saw him this morning. Lots of pain. And his incisions weren't dressed very well.  Thus....a lot of blood everywhere when he transferred from the bed to the bedside chair. Another one of our patients is a bilateral amputee, below knee on R and got an above knee amputation. Hoping we get to see him tomorrow. Never dealt with an amputee this acutely!  I mean I know it has to be rough on the patient and I would never wish strife like that on anyone. But it will also be challenging for me as the therapist, thus my excitement.