(6) OAT Surgical/Hospitalized patients

Question 1

Contraindications to OMT of surgical patient (there’s a lot)

Answer 1

1. Surgical site >2 weeks (use indirect OMT)
2. Midline abdominal incision/aortic aneurysm (do not use abdominal plexus inhibition/mesenteric release)
3. Recent L hemicolectomy (do not use sigmoid release)
4. Rib/spine fx, spine surgery (do not use rib raising)
5. DVT (absolutely no pedal pump), LE fx, recent abd surgery
6. Osseus fx, bacterial infection w/ fever >102, abscess, local infection, CA (no lymph tx)
7. Upper rib fx/clavicle fx (TI release)
8. Thoracotomy, chest tube, trauma (no liver/spleen pump)

Question 2

Early postop - Inflammatory stage (1-3 days)

Focus on which systems?

Answer 2

Circulatory and pulmonary

Treatments: diaphragm release, rib raising, lymphatic pump

Question 3

Early Postop - Diuresis stage (4-6 days)

Focus on which systems?

Answer 3

Lymphatic, GI, renal, ANS

(ensure mobility of thoracic cage and outlet bc of increased fluid flow)

Question 4

Late Postop (1-3 weeks)

Focus on treating what?

Answer 4

Fascia/tissues, somatic dysfunction, viscerosomatic reflex

(enhance analgesia, may decrease hospital length of stay)

Question 5

The goal of OMT on a hospitalized pt is to treat what kind of dysfunctions?

Answer 5

Dysfunctions that impede homeostatic processes such as sleep, ambulation,e ating, defecation, pain relief

Improve pts ability to cope with disease process

Question 6

What systems are focused on for OMT of a hospitalized pt?

Answer 6

ANS

Respiratory

CV

Lymphatic

NMSK

Question 7

What issues may arise with providing OMT to a hospitalized pt?

Answer 7

Privacy

Modesty

TV

Objects in the way

Surgical incisions/dressings

Decubitus ulcers

Question 8

What positions are somatic dysfunctions normally diagnosed in for a hospitalized pt?

Answer 8

Supine

Lateral recumbent

Seated

*rarely use prone

Question 9

What in what order is OMT provided to a hospitalized patient?

Answer 9

Indirect initially followed by direct

Question 10

What is segmental facilitation treatment based on?

Answer 10

Condition and responsiveness of pt.

Reducing facilitation can be accomplished by any procedure that normalizes somatic tissues and reduces nociceptive input

Question 11

What reflexes are initiated through nociception?

Answer 11

Viscerosomatic

Somatovisceral

Question 12

Frequency of treatment of a facilitated segment for a hospitalized pt?

Answer 12

May need more than once daily

Underlying disease will reproduce facilitation at the segments, often quite rapidly

Question 13

Treatment directed towards what tissues may have a greater effect on segmental facilitation than soft tissue techniques? Why?

Answer 13

Articular tissues

Joint capsules have a high concentration of nociceptors, muscle has low concentration

Question 14

OMT pre-op to reduce mid-cervical SD to decrease post-op pulmonary complications is due to what reflex?

Answer 14

Somatosomatic reflex

(cervical SD => thoracoabdominal diaphragm - phrenic N.)

Question 15

TART findings from viscerosomatic reflexes are from ____ pathologies

Answer 15

Visceral

Not primarily somatic dysfunctions

Question 16

Pre-Op assessment for surgical risk factors

Answer 16

Question 17

Sympathetic innervation to the head/Neck

Answer 17

T1-4

Question 18

Sympathetic innervation to heart/lungs

Answer 18

T1-6

Question 19

Sympathetic innervation to upper GI

Answer 19

T5-9

Question 20

Sympathetic innervation to Small Intestine and R colon

Answer 20

T10-11

Question 21

Sympathetic innervation to the appendix

Answer 21

T12

Question 22

Sympathetic innervation to the L colon/pelvis

Answer 22

T12-L2

Question 23

Sympathetic Innervation to adrenals

Answer 23

T5-T10

Question 24

Sympathetic innervation to GU tract

Answer 24

T10-l2

Question 25

Sympathetic innervation to Upper/Lower ureter

Answer 25

T10-11 T12-L2

Question 26

Sympathetic innervation to the bladder

Answer 26

T12-L2

Question 27

Sympathetic innervation to upper/Lower extremities

Answer 27

T2-8 T11-L2

Question 28

Parasympathetic innervation to the L colon, sigmoid, rectum, lower ureters, bladder?

Answer 28

S2-4

Question 29

A/P Esophagus chapman's point?

Answer 29

A: B/l 2nd ICS P: b/l T2

Question 30

A/P Pancreas chapman's point?

Answer 30

A: R 7th ICS P: R b/w T7 and T8

Question 31

Chapman's points along the anterior R ribcage?

Answer 31

Liver: R 5th ICS GB: R 6th ICS Pancreas: R 7th ICS Appendix: R 12th rib tip

Question 32

Chapman's points along the anterior L ribcage?

Answer 32

Stomach: L 5th and 6th ICS Spleen: L 7th ICS

Question 33

A/P Pylorus chapman's point?

Answer 33

A: Sternal P: R R10 at costotransverse joint

Question 34

What are the 4 points of lymphatic evaluation?

Answer 34

Question 35

What are the modified lymphatic OMTs for a hospitalized patient?

Answer 35

Doming the diaphragm Pelvic diaphragm Thoracic inlet

Question 36

What is the rule of Ws and the post-op days they are associated with?

Answer 36

Question 37

How long does it take for peristalsis to return to the SI? Right colon? L colon?

Answer 37

SI - 24 hrs R colon - 48 hrs L colon - 72 hrs

Question 38

Abdominal Ganglia Inhibition

Answer 38

Question 39

Suboccipital decompression

Answer 39

Question 40

Cervical ganglia inhibition

Answer 40

Question 41

Posterior abdominal diaphragmatic release: Releasing the lumbar spine/crura (BLT)

Answer 41

Question 42

Abdominal lifts

Answer 42