Sister Fox

Safety belts? Something I must have missed! For sure, the Huggas should be in direct contact with the patient. The way to prevent burns (??) is to set a correct temperature!

NO!!! Jiminy cricket! I have to add the story about the houseman (junior doctor) who had his finger included in a transfixion suture and was too polite/timid to say anything! True - I was there!

I'm curious - here in the UK, OHNs are required to maintain all medical records of employees as strictly confidential - that is, not for the eyes of any member of the management. All management gets after a pre-employment medical is a paper stating that this person is either "FIT" or "UNFIT" for the proposed job. Nothing more, certainly they never get sight of the forms the individual has filled in. Any issues considered pertinent to be revealed to the management require the employee's written consent beforehand but they are at liberty to withhold that consent if they choose to though that would probably mean they wouldn't be offered the job. The only time medical issues can be discussed with the management is when a manager has referred an employee for a sickness absence review and even then, we may only discuss the condition(s) causing the absence. Thus, if a person has absence due to back pain problems and depression, then that is all we discuss.

Gosh, you get involved with first-aiding? I've been doing Occy Health for 14 years and never got involved with accidents or such - well, only the really serious ones that required triaging and resus. The rest was always dealt with by the first aiders who are pretty hot stuff. Mind you, I am talking about firms that only have the nurses working 1-3 days a week and the factory runs 24/7 so it makes no sense to have a different protocol for just a couple of days each week. Most of what I do is annual health checks for people in hazardous areas; noise, fumes, chemicals and so on, plus fork lift and HGV drivers. These medicals usually comprise BP, weight, eye test, spirometry and audiometry. We do pre-employment and termination medicals and give the occasional drop in advice which generally should really go to their GP. We also counsel for stress when required and offer help with health care issues like checking breasts and testicles, smoking or alcohol problems. On occasions we might need to administer vaccines like Hep B or flu but that's about it. One needs to have a pretty comprehensive knowledge of hazardous substances and environments and company protocols and laws relating to them, (here called the EU six pack!) also sickness absences. Well, that's how it works in the UK, anyway.

What's a practicum? Don't think we have such a thing in the UK (unless they snuck it in since I retired!)

Welcome to Ortho! Fat, especially in TKRs, is a fact of life! In 50 yrs I never found anything that would eliminate it! You just get used to it over time. You might be misreading their looks. Remember they are having the same problem too!

Try telling that to the anaesthetic staff! Hear, hear, Scrubby! There are always occasions when there is no-one else able to do this particular case for a variety of reasons. And I've always felt that someone who has to be so cut and dried about what is good practice has to be lacking a little in versatility like lateral thinking! I worked to what was safe and best all the time but does everything need to be written down in black and white, for pity's sake? What? Who ever said any such thing? Then you are most fortunate, my friend. I had an occasion when, having worked an eight hour late shift, I was on call for the night and ended up being scrubbed up from 10.30pm until 5am with a complex trauma case. Being the on-call for the orthopaedic theatre, there was no-one to relieve either me or the surgeon. We were both extremely grateful that the floor nurses brought us in drinks and wine gums from time to time. And by that you assume it doesn't with us?

I always passed by hand but received it back in a kidney dish. I was pretty strict when teaching that the scrub should always pass with the back of the blade to the palm, place the scalpel handle in between the forefinger and thumb of the surgeon's outstretched hand and, once he had 'ownership' of it, to take her hand away in an upwards arc away from the back of the blade. It sounds cumbersome in words but can be done quite swiftly and is about as safe as you can get under the circumstances. I lost count of the times I was cut and stuck with things over the years. Even got my thumb pad transfixed with a Steinmann pin once but I don't suppose many of you remember them!

Well, if people still insist on sending instruments and bedpans to the laundry, what makes you think they are fastidious enough to be into recycling!

Bless you - what a horrid atmosphere to be working in. But the others are right. And those people are nit-picking at you because they are jealous! Be proud of yourself, what you have achieved and don't let them rob you of your self-confidence like this. Is there no-one there you can talk to? I'm not familiar with the US OR hierarchy and don't know what a traveller is, but there must be someone even if it's only the hospital chaplain! Or you can always come and vent on here!

Oh this gave me such a belly laugh! Seems the US and the UK aren't so different after all, even if what we call the OR does sound like something from Broadway! I can only reply with a story of my own but it won't be as succinct as you guys! I was theatre manager, on call with 2 other members of staff. We had a strict protocol during on calls, only one patient in the department at a a time. We'd get around this by sending for the next patient while the first one was in recovery (we had to do recovery too!). Often as not, the first one would be awake enough to send back as the second one arrived and everyone would be happy (including me). This Sunday evening, we had an appendix on the table. Been going for about 30 mins when ortho registrar came to book a case. 12 yr old girl, dislocated a hip when she fell out of tree that afternoon. He wants to do a closed reduction. Now this chap, Sam, is Iranian (say no more!). I've always got along with Sam extremely well but this weekend he was standing in for his absent senior and a little, well, proud of himself that he was SENIOR reg that weekend. So I tell him the appendix will probably be finished about 6.30pm, give or take, and all being well he can follow on. Well all was not well as the lassie having her appendix removed decided she wasn't going to wake up very quickly from her anaesthetic. 6.20pm and up comes Sam and starts pacing up and down the corridor, demanding to know where his patient is - you know the routine. I try to explain but he throws a tantrum and decides that he will do this case in the ER. I then made the big mistake of saying to him "Don't be daft - suppose you need to open her up?" whereupon he goes incandescent and storms out shouting that he's the surgeon and I'm not to tell him how to operate, etc., etc. By this time the other patient is awake and going back to the ward but he won't climb down and leaves anyway. We all go home. About 9pm, a very subdued Sam is on the phone. Can we please come back as, when he tried to reduce the dislocated hip, the corner of the acetabulum hooked into the epiphyseal plate and flicked the epiphysis off the femur like the top off a beer bottle! Poor girl. We got back in, me expecting to find the consultant (senior surgeon) there too but no boss man. When I ask Sam he says he's perfectly capable of doing this himself! Well, as luck (and an awful lot of prayer from me) would have it, just as we were draping, there was a call from the ward. Father had just remembered that his employment private health cover also applies to his children and was it too late for him to go private? Boss man comes in and tears strips off Sam for even trying to do the closed reduction on his own, much less the open one! Patient is saved a botched surgery and all is well. But I learned never to call a non-English surgeon "daft" even when they were!

It's been a few years since I actually worked in theatre (4 actually!) but when we got extra items out, the packet was fixed to a clipboard kept especially for that purpose and kept on top of any trays for said extras. Items were then counted to the packets and trays. Easy!

And here's some educational websites that might help! hemiarthroplasty Total Hip Replacement Plus there's heaps of vids on YouTube!

Oh these acronyms! Bane of life! If you'd Googled Austin Moore, you might have had better luck! Okay: Insertion of an Austin Moore prosthesis is more correctly known as a hemi-arthroplasty and is performed for fractured necks of femur of the subcapital variety, meaning those in which the head has been deprived of a blood supply and begun to suffer avascular necrosis (death from no blood supply). A total hip replacement is performed on hips destroyed by osteo-arthritis and therefore both the femoral head and the acetabulum have to be replaced. Hope this has helped!

Yes, I do remember that but thanks for the reminder.