Thursday, February 26, 2015

Lifting Patients Too Dangerous To Be Done Safely?

A few weeks ago, I came across an article titled “Even‘Proper’ Technique Exposes Nurse’s Spines to Dangerous Forces”. Not unexpectedly, it started with the story of a nurse that was injured on the job while trying to help move a patient in the intensive care unit despite using the “proper lifting technique” taught in nursing school. The injury was quite serious, requiring several surgeries, and jeopardized her career. The article then talked about a research study that suggested it is impossible to lift patients safely with just human body mechanics. It went on listing several reasons why and also described the compressive forces that people’s spines are subjected to when lifting patients. It even noted that lifting in teams does not reduce those forces to safe levels while increasing shear forces, a force our spines are more vulnerable to. It basically concluded with the idea that we need mechanical patient lift devices throughout the hospital to make it safer, but not necessarily 100% safe, for workers to move patients around.

As I read the article, I reflected on my experiences working in the hospital, especially the times I helped move comatose patients weighing 300, 400, or more pounds. I’ll tell you, it’s definitely not easy to do, even with 4 or more people. Most healthcare professionals know what proper lifting mechanics should look like but with the way patients are located and positioned, it is not always possible to use optimal lifting mechanics. If you’re lucky, you may have a patient hoist handy but even then it’s not necessarily trivial getting a person into it in the first place. Sometimes you are able to figure out a way to use bed sheets and have enough people around to help push and pull, slowly working the patient into the best position for the actual move. Whatever the situation may be, lifting a person is nowhere near as mechanically simple as deadlifting a barbell at the gym.

So what’s the answer? I don’t know if there is a failproof solution, at least not with our current technology. Mechanical lifts will definitely help but there are limits to those. First of all, they are quite expensive so they aren’t available everywhere in the hospital. Second, they do have weight limits which some patients exceed. Finally, there is always the issue of getting the patient loaded onto the lift. Despite these problems, hopefully they’ll become more widespread so healthcare professionals can work more safely, and for longer.

Meanwhile, I strongly urge all of you to do your best to stay in good physical condition. It is your best chance of protecting yourself from serious career-ending injury. Make sure you exercise regularly. When you work out, focus on your functional strength throughout your entire kinetic chain. Substantial core strength and a strong kinetic chain will help reduce the micro-damage on your spine when lifting patients. The less damage you take, the less likely you’ll suffer a debilitating injury. DO NOT just do cardio. Cardio is not going to help you here and it can actually make things worse if you ignore strength training.

As a healthcare professional, you’re probably very busy. But for you, exercise is not a luxury. It is a necessity. Think of it as part of your job. It’s no longer just about looking good, but keeping you, your career, and your patients safe.

Thursday, February 19, 2015

How to Shovel Heavy Snow Like a Boss

My first article about shoveling snow described a technique I use to shovel faster with less stress on the back. That technique works great with lighter snow loads. We’ve been getting more snow in the Midwest recently so I wanted to go over another technique I use for heavier snow falls.

In the first technique, the back hand is tucked in front of the hip to better control the shovel. The other hand holds onto the shovel as close to the other end as is comfortable. On most snow shovels, this means the forward hand is still a distance away from the snow. While this is fine for lighter loads, it is less effective for heavier loads due to leverage issues.

To adjust for this, move the forward hand almost all the way to the snow end of the shovel and let the back hand go back behind your hips. This allows you to keep the load as close to your body as possible when lifting.

When you stand up and lift, keep the front arm straight so it acts like the hoist lines on a construction crane. This will reduce the work your smaller arms muscles need to do. On a crane, the lifting isn’t done by the hoist lines but rather by the motor that winds it up. The lines just transmit the forces to the load.

In this case, the “lifting motor” is your legs and your torso and arms transmit those forces. Your back hand functions to keep the shovel level and to steer it when you throw the snow away. When you pivot to dump the snow, you can use your hips and torso together. Since the load is essentially next to your body, twisting your torso won’t be as stressful on your body compared to the other technique where it is farther away.

This method should feel similar to lifting a box with proper form (using the legs, not the back). Your back and other core muscles just function to maintain your posture. They don’t do any lifting.

Finally, since your center of gravity is kept near your center of balance throughout the technique, you don’t have to reset your balance for each load. Essentially, you are just doing leg squats with weights. This allows you to perform each repetition more quickly.

Remember, if the snow is particularly heavy or high, shovel each spot in layers. Work all the way vertically down the snow pile before moving your forward. This technique is especially well suited for working vertically through snow since you don’t even need to move your feet for each repetition. Use this technique and you can plow throw piles of snow in record time!

Thursday, February 5, 2015

Picking the Right Cold Medicine – Part 2

In my last article, I covered how to pick cold medicines for coughs. Now, we’ll go over medications for other common cold symptoms.

Stuffy noses and sinus congestion is caused by swelling in the mucous membranes lining the nasal cavities. Besides making it harder to breathe, it can prevent drainage of excess mucous, leading to build up and painful pressure. Given enough time, germs living in this retained mucous can fester and cause sinus and ear infections.

If your symptoms are unbearable, you can consider trying a nasal decongestant. Pseudoephedrine and phenylephrine are commonly found in oral cold medicines. Both have vasoconstricting properties that shrink blood vessels and may help reduce swelling in the mucous membranes. However, they can also raise blood pressure so if you have blood pressure issues, be sure to check with your doctor first.

Research studies suggest pseudoephedrine is the more effective of the two but due to concerns of people converting it into illegal drugs, you’ll have to ask the pharmacist for it. Phenylephrine has not been shown to be more effective than placebo but if it works for you, that’s all that really matters.

You can also find nasal decongestants as topical sprays that you squirt into your nose. Oxymetazoline is a common active ingredient in these sprays. Effectiveness varies from person to person so you’ll have to try it to see if it works for you. Follow the directions and do not exceed the recommended dosage. Otherwise, you’ll have a higher chance of rebound nasal congestion when you stop using it, even after your cold is gone.

If you have a runny nose or sneeze frequently, you can try medications that contain an antihistamine. Although histamines are responsible for these symptoms when you have allergies, they have not been shown to be involved during a cold. Despite this, the older generation antihistamines used in allergy medications may help reduce symptoms in some people. If your runny nose becomes intolerable, you can consider trying an antihistamine, such as chlorpheniramine which is commonly found in OTC cold medicines.

Please keep in mind that antihistamines may make you drowsy so be careful when using them and heed the safety warnings. On the other hand, when your cold prevents you from getting enough rest at night, this side effect may be helpful. You’ll often find diphenhydramine, also known by the brand name Benadryl®, in medications marketed as night-time cold medications.

Fevers are common with bad colds and especially the flu. Since it is one of your body’s methods of fighting the germs causing your illness, you generally don’t need to treat a fever. But if the fever and accompanying chills are making you miserable, you can consider taking an antipyretic (fever reducer) such as ibuprofen or acetaminophen, the active ingredient in Tylenol®. Never give aspirin to children with fevers or suspected viral illnesses as it can potentially cause a serious and even fatal reaction known as Reye’s Syndrome.

Finally, you may have aches and pains, called myalgias, with your cold. They are generally short-lived but if they become too bothersome, you can consider taking an analgesic such as ibuprofen or acetaminophen. When taking these pain killers, make sure you follow the directions. Do not exceed the maximum daily dosage among all of medications you are taking since that can lead to serious organ damage. Also, do not drink alcohol when you are going to, or have taken, acetaminophen. This can lead to serious and even fatal liver damage.

Remember, always consult your healthcare professional if you are unsure whether a certain medication is appropriate for you.