Pig's Feet

So much has transpired since I last posted.  Hopefully, I can sum it up okay.  

Starting with I & D.  Incision and drainage.  One of the annual lecturers brought pig's feet to class.  He had previously implanted a home made oatmealish substance and injected it under the skin. This made the foot look rather edematous. We then practice local anesthesia blockade techniques, such as 'round' and 'square.'  This is the initial 'poke' and 'burn' that patients will feel prior to becoming numb.  Another technique that many physicians use is a 'pinwheel' style (there are other names for it as well,) the needle is inserted into the skin, give a little lidocaine (most common local anesthetic used, but there are others)  to create a wheal and while the needle is still under the skin proceed to go in a circle.  In and out, injecting medicine, but never completely withdrawing the needle. Any technique should work as long as you overlap the previous dose. 

Side note: Some physicians don't even numb up their patients for such procedures.  Another reason to do this is for major hang nails, ya he showed us a video on how to remove one.  That kinda wigged me out a bit. 

Providing time for the numbing effect to kick in, with a 10 blade, puncture the center of the nodule or papule.  The technique we were taught was to cut away first to prevent any pus spray in our direction. Now, once the full length has been cut, time to squeeze.  You got it, all that pus has to be extracted. 

I won't go into anymore detail, I believe you have the idea.  The doctor leading the class showed us some videos on how to perform all the proper techniques.  One included draining a pus-filled pocket in the oropharynx, just superior to the tonsils. Crazy!

Let me continue with the pigs feet stories: 

These friendly feet were our practice buddies for suture class!  O, yeah!  

We had purchased suture practice kits and had be attempting our knot tying skills prior to the course.  With a rope, none the less. 

 The kit provided a CD filled with step-by-step videos, which were extremely helpful.  It taught us two-handed and then one handed styles. This is a one handed square knot repeated.  It then taught how to perform the same knot by way of instruments.  My personal opinion, it's much easier and quicker.  

We, as a class spent a Saturday morning and with the help from local proctors, we lacerated the pig's feet and sutured them up. 

It was a great class, but I forgot to snap a shot of all my fancy work afterwards.  We practiced subcutaneous, continuous and interrupted suturing. There is certainly an art to it.  How and where to place sutures is depended upon the location of the laceration and depth. 

 It reminded me of scouts, practicing the knots repeatedly, just over and over (Thank you to all of who pushed me to obtain the Eagle Scout award.)  Also, the more I can get my hands on instruments, I more comfortable I feel.  I am definitely a 'hands-on' type of student. 

More 'hands-on' courses: 

This was a quick skills class on joint injections, say for steroid injections.  Also, here I am attempting a subpatellar arthrocentesis. If a patient has fluid build up within there joint, it can be removed and then cultured for possible infection. (I know I don't have any gloves on…oops!)

One last skills class we did was FAST.  Focused Assessment with Sonography for Trauma.  A local ER doctor came to educate us on how to perform an quick abdominal scan, including the heart and the bladder with use of ultrasound. 

(Sorry if the video doesn't work properly!)  The video is a transthoracic echocardiogram of my heart.  It's not one of the normal studies done in a FAST exam, but it was fun to do.  (You can see the left atrium and ventricle, including the mitral valve rather well.  Also, the aortic valves leading into the ascending aorta.  The right ventricle is noticeable, but don't as well.)

The major point of the FAST exam is to look for any fluid.  For example, fluid may become stasis between the right kidney and the liver:

Of such is mine.  It takes awhile getting use to the odd-ultrasound images, but once you know what you're looking for it becomes relative easy. (The liver is the left of the screen.  Look for the upper black area, which is a rib shadow and then follow it to the right. You'll see a small, porous object, then a line and then that odd shaped-oval at an angle is the kidney.)

One last one:  Splinting.  

This was a fun class.  I use to work in some Insta-care facilities back in UT and I was able to perform most of these splints already.  However, I just never got familiar with the names and the reasoning.  Now I know.