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--- medical_student:hand [2021/02/14 17:00] – aline
+++ medical_student:hand [2025/04/11 15:09] (current) – [Team Members] haley.d
@@ Line 1: / Line 1: @@
+====== Plastic Surgery Hand/Extremity Service ======
+===== Service Pearls =====
+==== Team Members ====
+Attendings: Drs Matthew Iorio, Kia Washington, Mark Greyson, Tim Irwin\\
+PA: Claire Law, Ben Nigg, Emily Walwood\\
+Residents: This service is comprised of a Chief Resident and junior resident. There is no intern on this service. \\
+==== Reps ====
+{{:medical_student:screenshot_2024-04-06_at_15.34.57.png?600|}}
+=====Boards Collection Photo Consent=====
+{{ :medical_student:photo_consent.pdf |}}
+==== Weekday Consults ====
+  * The most junior resident on service is responsible for consults and service pagers. Amy and Ben (PA's) help to see consults when residents are in the operating room or occupied with other service/educational obligations. NB: Amy/Ben do have her own clinics and helps cover cases and clinic off-campus, so some days may not be immediately available to help.
+==== Scheduling Follow-up Appointments ====
+  * Consult patients should be added to the “Plastics Hand” shared Epic list upon receipt of the consult.
+  * If the patient will need a follow up appointment in the **Hand Clinic**, please make sure the ED puts in an order for “ambulatory referral to Hand Surgery” and specifies the attending who is on call that day. This is the same attending to whom your note should be routed. Send a staff message to: P SP AMC HAND SURGERY (pool) __and__ cc: Juli Peterson, the attending, Amy Kelso PA-C, Benjamin Nigg PA-C, etc.
+  * If the patient will need a follow up appointment in the** Plastic Surgery Clinic**, please send a staff message to: P SP AMC PLASTIC SURGERY (pool) __and__ cc: the attending, Amy Kelso, Benjamin Nigg, Kristine Padiernos.
+  * If patient is an EXTREMITY patient (Greyson/Iorio) and discharging with WV in place, please cc "Stephanie Boyd" on follow up email so that she can help coordinate any home or follow up needs.
+==== Clinic ====
+  * Gordon: Monday afternoons, Wednesday mornings, and Friday afternoons. He writes his own notes
+  * Iorio: Tuesday mornings and afternoons. Fast-paced. Amy and Ben are sometimes there to help.
+  * Washington: Wednesday afternoons. She expects help.
+  * Greyson: Wednesday mornings and afternoons. Uses his own smart phrases, make sure to familiarize yourself with them before going to clinic.
+==== Surgery ====
+  * Gordon: Monday mornings, Wednesday afternoons and Friday mornings.
+  * Iorio: Every Thursday. Mondays and Fridays may be hand cases or Plastics cases. Fast-paced. Have Preop orders and discharge orders in the night prior to facilitate turnover
+  * Washington: Mondays are split between UCH and CCNSC. Operative days off campus are covered by Amy.
+==== Consult Triage ====
+Hand Triage
+{{:medical_student:screenshot_2025-04-10_at_7.28.07_pm.png?600|}}
+==== Hand Therapy ====
+  * Hand Therapy is an integral part of any successful hand surgery both pre and post-operatively
+  * Below is a simple reference for hand therapy protocols and what the hand therapist will provide to our patients
+  * Hand Therapy Guide{{ :medical_student:what_is_hand_therapy_-_resource_for_cu_residents_2.23.21.docx |}}
 ===== Postoperative Protocols =====
-====Flexor Tendon Repair - Early Active Motion Protocol====
+==== Flexor Tendon Repair - Early Active Motion Protocol ====
 __Immediate Post-Operative Period:__
@@ Line 93: / Line 140: @@
   - Know how to perform a digital block and a hematoma block\\
-**Infections**
+==== Infections ====
   * Obtain a detailed history (including rapidity of onset and progression)
   * Examine for fluctuance
@@ Line 104: / Line 151: @@
   *- //1L of NS irrigation with 60cc syringe and luer lock irrigation shield attachment//
   *- //Bucket//\\
+==== Lacerations ====
-**Lacerations**
   * Ask about the mechanism
   * Make sure tetanus is up to date
@@ Line 123: / Line 170: @@
   *- //Suture tray: Hemastat, Needle Driver, Forceps, Scissors (Plastics Minor Set from OR is ideal)//\\
   *- //Xeroform, 2 inch Kling wrap, Kerlix, Coban//\\
+==== Hand/Wrist Fractures/Dislocations ====
-**Hand/Wrist Fractures/Dislocations**\\
   *For distal radius fractures: Determine if there is an acute carpal tunnel syndrome, meaning, is there numbness in the distribution of the median nerve (thumb, index, long, and radial border of the ring finger)?
   *Discuss with ED their ability/availability to perform conscious sedation if needed
@@ Line 140: / Line 187: @@
   *- //1L of NS irrigation with 60cc syringe, luer lock irrigation shield attachment, & bucket if open fracture//\\
   *- //Arm Elevation Pillow from OR (blue foam pillow; need to send OR a patient sticker and go pick it up from the OR desk)//\\
+==== Amputations ====
-**Amputations**
   *Determine the time and mechanism of the injury
   *Make sure tetanus is up to date