Introduction to Clinical Ultrasound Test #3

Describe a win/win situation

A frame of mind that constantly seeks mutual benefit in all human interactions

Cooperative instead of competitive

Based on the paradigm that there is plenty for everyone

Describe win/lose: if i win, you lose

Competitive and comparative

Part of dominant American culture

Winners happen at the expense of losers

Harmful to relationships (i.e. who’s winning in your marriage?)

Describe lose/win: I lose, you win

“I am a peacemaker, I will do anything to keep the peace“

Giving in or giving up for another to have their way

Leads to unresolved negative emotions and over-reaction to minor provocation

Describe lose/lose: getting back or getting even

Blind to the self-consequences of revenge

Purposefully creating difficulty for another

Purposefully withholding ease from another

Looking at a win as the outcome for others is irrelevant is…

completely self-focused, unconcerned with anyone else

Of the 5 possible arrangements, _____ is always the best option

win/win

often requires open communication between both parties

Describe win/win or no deal

A commitment to finding solutions that both parties feel good about

If it can’t be done, both agree to walk away from the circumstance

When no deal is an option, both parties are empowered, no one has to settle

Anything less than win/win in an interdependent reality is what?

A poor second best that will have impact in the long-term relationship

If you can’t reach a true win/win, you’re very often better off to go for no deal

What are the five dimensions of win/win?

Character, relationships, agreements, supportive systems, processes

What is integrity?

Loyalty and accountability to personal principles

A win/win character

What is maturity?

The ability to express one’s own feelings and convictions balanced with consideration for the thoughts and feeling of others

A win/win character

What is abundance mentality?

the belief that there is plenty for everyone

A win/win character

Win/win is most easily achieved when you have created a positive balance in what?

An emotional bank account

If no balance has yet been established, patiently making deposits will aid in achieving a positive outcome

Describe win/win agreements

Desired results: what is done and when

Guidelines: specific parameters within which results are completed

Resources: human, financial, technical or organizational support needed

Accountability: standards of performance, time of evaluation

Consequences: good and bad, natural and logical

Win/win is difficult to achieve when what?

There are not systems of incentive in place to support it

Describe the win/win processes

See the problem from the other point of view

Identify the key issues and concerns involved

Determine what results would constitute a fully acceptable solution

Identify possible new options to achieve results

What does ergonomics mean?

ERGON/NOMOS

work/study of natural laws

the science of designing a job to fit the individual worker

What are the goals of ergonomics?

increasing productivity, decreasing injury

What are the methods of ergonomics?

modification of products, tasks, environments

What is the book titled “Disease of Workers”

Research revolving around patients’ workplaces

Ramaszni 1713

Who is Wojciech Jastrzebowski?

Created the warsaw sundial

Wrote the 1st Constitution of Europe

1857 - The science of work, based on the truths taken from the natural science

World War II increased interest in what?

Human-machine interaction. The success of the machine depends on the operator

Post-war culture continues focus on what?

Rights of the worker

In the 1980s awareness around ___ surfaces

DMS specific pain

Shoulder pain in the scanning arm

1985 - Marveen Craig publishes survey of sonographers

What is the exhaustion cycle?

1. Busy: can’t stop now

2. Beatdown: can’t take this

3. Burnout: can’t keep going

What are some examples of physical ailments in the workplace?

Blurred vision, infections, allergies, electric shock, muscle strain, carpal tunnel

By 1995 the ____ receives increasing sonographer complaints

SDMS

In 1997 Health care trust benefit of Vancouver, Canada, in collaboration with SDMS, CSDMS and BCUS survey sonographers and found that _____ of sonographers had muskuloskeletal disorders

81%, 87%, 84%

By 2008, 81-90%

What was created in 1970 when the occupational safety and health act passed?

Occupational safety and health administration (OSHA)

What does OSHA do?

Ensures safe and healthful work conditions

Employers may be subject to criminal or civil action for violations

It is regulated by federal government, states have the right to create additional regulations

Sonographers fall under section ____ of OSHA

5b

“Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued persuant to this act that are applicable to his or her own actions and conduct“

Employers bear responsibility for ______

work environments

OSHA uses the term “work-related musculoskeletal disorder” to refer to what?

occupational injury

What is WRMSD?

Injuries of the muscles, tendons, and joints that are caused or aggravated by workplace activities

WRSMDs refer to injury that results in the following:

1. Restricted work

2. Days away from work

3. Symptoms of MSK disorders lasting >7 days

4. MSK disorders requiring treatment beyond first aid

WRMSDs account for _____ of all workplace illness

60%

_____ of sonographers have some type of WRMSD

80%

What are the conditions and results of risk factors?

Conditions: forceful exertions, awkward postures, prolonged static postures, repetitive motions, “pinch” grip, exposure to environmental factors

Results: pain, inflammation, swelling, deterioration of tendons and ligaments, spinal degeneration, muscle and joint stress

Sustained awkward poses _____

creates imbalance between stabilizing muscles and motion muscles

Repeated rotation of head, neck, or trunk ____

creates imbalance between stabilizing muscles and motion muscles

Asymmetric posture _____

spinal misalignment

Increased muscle tone or inflammation ____

compresses nerves or vasculature

Static posture and prolonged muscle activity ______

decreased circulation, decreased waste metabolism

What is tendonitis and tensosynovitis?

Inflammation of the tendon and the sheath around the tendon

What is de Quervain’s disease?

Tendonitis involving the thumb that can result from gripping the transducer

What is carpal tunnel?

Entrapment of the median nerve as it runs through the carpal bones of the wrist. This results from repeated flexion and extension of the wrist, or mechanical pressure against the wrist

What is cubital tunnel?

Entrapment of the ulnar nerve as it runs through the elbow. This can result from repeated twisting of the forearms and mechanical pressures against the elbow when you res it on the exam table while scanning

What is epicondylitis?

Inflammation of the periosteum in the area of the insertion of the biceps tendon into distal humerus. This can result from repeated twisting of the forearm

What is thoracic outlet syndrome?

Nerve entrapment can occur at different levels resulting in different symptoms

What is trigger finger?

Inflammation and swelling of the tendon sheath in a finger entraps the tendon and restricts motion of the finger

What is bursitis?

Inflammation of the shoulder bursa from repeated motion

What is rotator cuff injury?

Repeated motion results in fraying of the rotator cuffs muscle tendons. This injury increases with age and is even more prevalent when work-related stress is added. Repeated arm abduction contributes to this injury by restricting blood flow to the soft tissues of the shoulder

What is spinal degeneration?

Intervertebral disc degeneration results from bending and twisting and improper seating

What do losses to the employer encompass?

Medical costs of an injury

Cost of replacement staff

Worker’s compensation

Loss of revenue

Cost to the worker includes:

Monetary hardship

Possibility of permanent injury

Chronic pain

Loss of profession

True or false: MSDS are also the most costly of all occupational problems, accounting for the majority of worker’s compensation costs

True

$1 of every $3 of worker’s compensation costs are spent on occupational MSDS

Employers pay $15 to $20 billion per year in worker’s compensation costs for lost workdays

Mean cost per cause of upper extremity WRMSD in $8,070 versus a mean cost of $4,075 per case for all types of work-related injury

Describe the costs of ergonomics

1. Indirect costs are three to five times higher, reaching approx. $150 billion per year

2. Absenteeism, staff replacement and retraining, and loss of productivity

3. Cost of hiring temporary replacement staff is between $130,000 and $166,000 per year

4. Estimated average cost to find and hire a new sonographer is $10,000

Cost of equipping a sonographer examination room is _____ compared with the cost of a worker’s compensation injury

minimal

quality of the patient’s examination may also suffer if the sonographer is in pain while performing the examination

Accessory equipment that mitigates injury risk include what?

Height adjustable stool

• Cost is $750, reimbursement in two to three patient studies

Set of support cushions

• Cost is $250, reimbursement in one patient study

Ergonomic examination table

• Cost is $7400, reimbursement from 2 days’ work

Work-related injuries must be reported immediately to who?

Occupational health or risk management departments

Injuries should be recorded on OSHA logs

Failure to do so may result in the denial of claims

Describe ergonomically designed machines

Increased mobility, with brakes

Control panel and monitor on swivel

Height adjustable

Easy access control

Voice comman

Slim and lighter transducers

Describe administrative controls

Scheduling: decrease exam type repetition, mini breaks, allow for reasonable scan time

Supply proper materials: textured gloves, properly designed rooms, adjustable ancillary equipment

Describe PPE/Professional controls

Posture, exercise, scan ergonomically

Describe motion awareness

Wrist flexion and extension, twisting your neck, abduction of your scanning arm, transducer cable management, trunk twisting, reaching, exercise

Describe bad ergonomics

Asymmetric forces are exerted on the spine when more weight is placed on one side of the body than the other. The head must be turned to view the monitor, resulting in a twisted neck

Describe bad ergonomics in sonography

Cord around shoulders

Leaning from the waist

Reaching over patient unsupported

Describe good ergonomics in sonography

Straight spine

Supported scanning arm

Monitor facing sonographer

Examples of proper equipment

A height adjustable stool

A set of support cushions

An ergonomic exam table

Provide a general definition of health and safety techniques

Keeping yourself and your patients healthy and/or sage while you care for them

What are the general foundations of biomechanics?

Base of support, center of gravity, mobility and stability muscles

What is base of support?

The foundation on which the body rests

Upside down trapezoid, feet slightly apart and feet pointed out slightly

What is center of gravity?

The point around which all parts of your body are balanced

You will be better balanced when your center of gravity is low to the ground

Where are mobility and stability muscles found?

Mobility: found in the limbs, long white tendons, cross joints

Stability: found in the torso, large expanse of red muscle, provide postural support

Moving and lifting heavy objects should come from the power of engaged _____ muscles

stability

Describe the four levels of patient assistance (no physical help)

Independent: 100% independent, timely, safely, consistently

Modified independent: independent with increased time or assistive device

Supervision: physically independent but needs checks for completion

Stand by assistance (SBA): able to do task, but needs cueing, setup or don orthosis, always within arm’s reach

Describe the five levels of patient assistance (physical help)

Contact Guard Assist (CGA): keep a hand on for loss of balance at all times

Minimal Assist: assisting with mobility or task 1-25% of the time. The patient does most of the work

Moderate Assist: assisting mobility or task 26-50% of the time. The patient and staff do equal parts of the work

Maximal Assist: assisting with mobility or task 51-74% of the time. The staff does most of the work

Dependent: total assist 75-100% of the time

Rigidity may be used to assist with some transfers. _____ makes a transfer more difficult

Flaccidity

What are the principles of lifting?

1. Let the patients do as much WORK as possible

2. Communicate with the patient

3. Check the chart

4. Minimize hazards

5. Go slow

6. Use proper body mechanics

7. Only perform within the known limits of your physical abilities: get help if you need it

Describe biomechanics for patient transfers

1. Get in close and at eye level with the client

2. Get wide, get low, squat, don’t bend

3. Never twist your body when you lift. Twisting puts dangerous amounts of torque on your lower back, keep your feet and shoulders pointing in the same direction!

What is orthostatic hypotension?

A drop in blood pressure when a person stands upright too quickly from a sitting or supine position

What are fractures?

Fractures of the lower extremities or pelvic girdle, including the hips, increase patient need for transfer assistance

What are weight bearing restrictions?

Patients may be on weight bearing restrictions depending upon their clinical condition

What is a spinal injury?

Any injury to the vertebrae or spinal cord could require stabilization before transfer

What is a fall risk?

Inpatients who have a history of falling, or meet certain criteria are noted to be at increased risk for a fall and require assistance to move

What is homeostasis?

The relative constancy in the internal environment of the body that is naturally maintained by adaptive responses that promote healthy survival

Vital signs are measured as a quantification of the patient’s ability to maintain homeostasis (OBJECTIVE)

What are primary homeostatic mechanisms?

Heartbeat

Blood pressure: a measure of the force exerted by blood on the arterial walls during contraction and relaxation, measured in systole and diastole

Body temp: a measurement of the degree of heat of the deep tissues of the human body (normally 98.6 or 37)

Respiratory rate: responsible for delivering oxygen to the patient and eliminating carbon dioxide, inspiration and expiration make up the respiratory phase and are controlled by the diaphragm

Electrolyte balance

What are the three aspects of thermoregulation?

Diaphoresis: peripheral vasodilation and sweating

Ventilation: respiratory function of removing excess heat

Heat preservation: peripheral vasoconstriction and shivering

What are the five types of body temperature measurements?

Oral, axillary, tympanic, temporal, rectal

What is hyperthermia?

Temp >99.5

Induced by illness or head injury

Marked by increased cellular metabolism

Increased consumption of oxygen places greater demand on cardiovascular system

What is hypothermia?

Rare

Secondary to cold exposure or hypothalamus injury

May be medically induced to decrease metabolic demands during heart surgery

What is a normal respiratory rate?

Adult = 12-20 breaths per minute

Child = 20-30 breaths per minute

Normal respiratory rate is counted by…

observing chest movement (visually: hand on chest)

What are the three parts of respiratory quality?

rate, depth, pattern

What is a pulse oximeter?

A non-invasive device used to provide ongoing assessment of the hemoglobin oxygen saturation of arterial blood and the patient’s pulse rate

Normal reading: 95-100%

What is a pulse?

Refers to the beating of the heart as reflected in the arterial blood pressure variation that happens from beat to beat (beats per minute)

The pulse rates reflect the rapidity of each heart contraction

Normal adult: 60-100 bpm

Normal child: 70-120 bpm

What is a normal bp?

120/80mmHg

What is a bp of an adult with hypertension?

140/90mmHg

What constitutes an emergency?

Any situation in which there is a sudden change in medical status of a patient that necessitates immediate attention and action

What are the medical imaging professional’s role in an emergency?

Preserve life, avoid further harm to the patient, obtain appropriate medical assistance as quickly as possible, recognize emergency situation and initiate emergency measures

What are emergency priorities?

Ensure open airway, control bleeding, take measures to prevent or treat shock, attend to wounds or fractures, provide emotional support, continually re-evaluate and follow up appropriately