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medical_student:hand [2021/02/14 17:19] – alinemedical_student:hand [2025/04/11 15:09] (current) – [Team Members] haley.d
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-====== Postoperative Discharge Instructions ======+====== Plastic Surgery Hand/Extremity Service ======
  
-**Instructions for After Your Hand Surgery** +===== Service Pearls ===== 
-  *The most important thing you can do to relieve discomfort and promote the healing of your wound is to keep your hand above the level of your heart at all times.  This helps reduce some of the swelling that occurs because of the surgery.  With the swelling decreased, you will have less throbbing pain.  It also improves conditions for more rapid healing of the wound.  You will need to keep your hand elevated above your heart for at least a week or until you return for your outpatient visit. +==== Team Members ==== 
-  *In almost all cases, DO NOT use your hand for ANY activity.  This includes everything from brushing your teeth to feeding and dressing yourself.  Using your hand only worsens the swelling (which increases your pain and slows the healing process).  Unless you are specifically told to do something, you are expected **__not to use your hand at all__** until you return for evaluation during your outpatient visit.  You may be asked to wiggle your fingers after surgery, but this would NOT include performing any activity with your hand. +Attendings: Drs Matthew Iorio, Kia Washington, Mark Greyson, Tim Irwin\\ 
-  *Pain should be expected after your surgery.  How much pain a patient has varies from person to person and from procedure to procedure.  The important thing to remember is that pain is not helpful.  Experiencing pain will not improve the healing of your wound in any way.  Therefore, please take your pain medication as directed.  Take the medicine BEFORE it hurts a lot.  If you wait, the medication usually will not work very well.  Experiencing a lot of pain does not help the healing process. +PA: Claire Law, Ben Nigg, Emily Walwood\\ 
-  *If you have a hard splint or cast, please keep it on your hand in place until your return for your outpatient visit.  If you want to take a shower, use a plastic bag (a newspaper bag seems to work quite well) to cover your splint/cast.  If you have a soft dressing, you may remove it after 5 days and begin washing the wound daily with water and placing a dressing to keep the wound clean. +Residents: This service is comprised of a Chief Resident and junior resident. There is no intern on this service. \\
-  *Occasionally patients are given antibiotics to take after surgery.  This does not happen very often, but if you are given such a medicine, please take all of them exactly as directed. +
-  *In winter, when the weather is very cold, keep your hand covered to prevent it from getting cold.  This can be done by wrapping it additionally with a towel, sweater, coat or anything else that will protect it.// +
-**Elevation of the hand at night** +
-Elevating your hand at night is just as important as elevating it during the day.  As much as you can, try to keep your hand elevated above your heart.  The following pictures show one way that might work, but there are many other ways to do this (such as sleeping in a lounge chair with the hand elevated on pillows or blankets).  Use whatever works for you. +
-  +
-{{:resident:623fb5aa-0569-4852-9497-b52f84d22c62.jpeg?400|}}// +
-  +
-**Pain Control:** +
-Elevate and apply ice to your forearm for relief of throbbing pain and swelling. You may move your fingers as the splint allows. For mild to moderate pain, alternate OTC NSAIDs and Tylenol every 3 hours as instructed below. For pain not relieved, you may take XX every 4-6 hours as needed for severe pain. +
-  *8am: 500 mg Tylenol +
-  *11am: 600 mg Ibuprofen +
-  *2pm: 500 mg Tylenol +
-  *5pm: 600 mg Ibuprofen +
-  *8pm: 500 mg Tylenol// +
-  +
-  +
-**When to Call your Doctor** +
-If you experience any of the following, call your doctor: +
-  *Severe or increasing pain. +
-  *Cold, pale, or numb fingers. +
-  *A fever over 101°F. for over 4 hours, redness of your incision, or a bad odor from your dressing.  All of these symptoms might indicate an infection. +
-  +
-  +
-If you have any questions that concern you regarding your surgery or something that has happened since the surgery, do not hesitate to call.  If it is something that will keep you awake at night worrying about it, it is better to call even if it is after hours.  It might take a bit longer to get your questions answered after hours, but if it helps you to get a better night of sleep, you will benefit from the extra effort.  During regular hours, call the regular office number at 720-848-0485 and select the nurse option line.  One of the nurses will try to get back to you as soon as they possibly can.  After hours, call the main hospital at 720-848-0000 and ask for the resident on call for Hand Surgery.  Wait on the phone while the operator pages the doctor.// +
-  +
-  +
-**Other important numbers**: +
-  *Clinic appointments 720-848-0485 +
-  *Occupational Therapy 720-848-2000   +
-  +
-Prescriptions given: XX \\ +
-Next Appointment: XX+
  
-====== Postoperative Protocols ======+==== Reps ==== 
 +{{:medical_student:screenshot_2024-04-06_at_15.34.57.png?600|}}
  
-===== Flexor Tendon Repair - Early Active Motion Protocol =====+=====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 ====
  
  
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   - Know how to perform a digital block and a hematoma block\\   - Know how to perform a digital block and a hematoma block\\
  
-**Infections**+==== Infections ====
   * Obtain a detailed history (including rapidity of onset and progression)   * Obtain a detailed history (including rapidity of onset and progression)
   * Examine for fluctuance   * Examine for fluctuance
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   *- //1L of NS irrigation with 60cc syringe and luer lock irrigation shield attachment//   *- //1L of NS irrigation with 60cc syringe and luer lock irrigation shield attachment//
   *- //Bucket//\\   *- //Bucket//\\
 +==== Lacerations ====
  
-**Lacerations** 
   * Ask about the mechanism   * Ask about the mechanism
   * Make sure tetanus is up to date   * Make sure tetanus is up to date
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   *- //Suture tray: Hemastat, Needle Driver, Forceps, Scissors (Plastics Minor Set from OR is ideal)//\\   *- //Suture tray: Hemastat, Needle Driver, Forceps, Scissors (Plastics Minor Set from OR is ideal)//\\
   *- //Xeroform, 2 inch Kling wrap, Kerlix, Coban//\\   *- //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)?   *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   *Discuss with ED their ability/availability to perform conscious sedation if needed
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   *- //1L of NS irrigation with 60cc syringe, luer lock irrigation shield attachment, & bucket if open fracture//\\   *- //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)//\\   *- //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   *Determine the time and mechanism of the injury
   *Make sure tetanus is up to date   *Make sure tetanus is up to date
medical_student/hand.1613341186.txt.gz · Last modified: 2021/02/14 17:19 by aline
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