At 2300 on a Thursday evening in early October 2008, a 26 year old man was presented to the imaging department. Earlier in the evening the patient had been struck in the eye with a snooker cue during a violent attack at a well known drinking establishment. The patient had been requested for an orbit x ray to be performed. The supervising radiographer deemed this to be an adequate request. I supervised the radiographer in the examination as I had not previously seen the projections carried out before. ‘OM’ & ‘OM 30’.
The radiographer explained to me why this imaging set was to be performed for this injury. “A non penetrating blow to the eye may produce herniation of the orbital contents inferiorly through a blow-out fracture in the thin floor of the orbit into the maxillary sinus.” (Moore, 2006, p. 990) The radiographer also showed me the department protocols which then detailed which projections were to be performed and why. The radiograph showed no fluid level within the maxillary sinus. The patient was returned to the A & E department.
Feelings – What were you thinking and feeling The patient’s inebriated state was a relatively new situation for me to deal with. Particularly with the history leading to the patient being presented to the department. I felt there was a potential for a violent situation arising between staff and the patient, because of this I felt the need to be particularly understanding to any pain or difficulty in the patients understanding in what I wanted him to do. As the patient had been bleeding, the staff and I paid attention to cleansing the imaging room after the patient had been imaged. We found the use of gloves for this examination beneficial, in minimising contamination of ourselves and equipment.
The positioning of the patient made things awkward, he kept moving, as we need to maintain that the patient so that they only receive as low as possible dose of radiation (Prasad, 2004, p. 98), we could only expose when the positioning was correct. This involved the patient being held in the correct position, the x ray tube being prepared and the radiographer rushing behind the screen before the patient had a chance to move. This took several attempts but was a success eventually. There must be an alternative method to this technique? I have asked around but yet to learn of any.
Evaluation – What was good and bad about the experience The skull examination that I had observed previously had all been performed supine, I had been advised this aided in the stabilisation of the patient. However for this patient I was informed doing it erect was a preferred method as any fluid levels in the sinuses would be visible, which was an area that I had not thought of previously. The inebriated state of the patient was new to me, something that I felt I dealt with reasonably well. This will give me confidence in dealing with similar patients, and give me more confidence dealing with others such as children, where I continue to have a lack of confidence, due mainly to my unfamiliarity.
I would have liked to be more of a participant in the situation, due to my lack of experience in ‘skull work’ this made it very difficult, the situation has increased my skull proficiency, and since the incident I have found myself being of more use in the imaging department. I believe incident, this to be a key part in my skull knowledge development, as it opened my eyes to diverse nature of the topic.
Analysis – What sense can you make of the situation The challenging state the patient was in, made the incident testing but has given me confidence in dealing with diverse patients. I have been told that skull projections are becoming increasingly less common, so any that I can participate in will only aid in my development. The unorthodox nature of the examination (to prevent the patient moving) has made me want to find an ideal solution to prevent patients from moving. I now find myself watching other examinations that I am not part of, in an attempt to gain techniques that I can use for future situations I may find myself in.
Conclusion – What else could you have done It was difficult to ascertain how to deal with the patient, I presumed him to be fairly inebriated. I feel it was wrong for me to assume anything about patients, and maybe I should have given him the benefit of doubt and treated him the same as any other. However, alcohol does increase violent situations (www.homeoffice.gov.uk, 2007) so maybe there should always be a sense of caution whilst dealing with intoxicated patients.
I feel as though I could have looked at the subsequent patient journeys. In doing this it could aid in my understanding into processes and patient care outside of the imaging department, I can then use this to participate greater within the multidisciplinary team environment. Action Plan – If it arose again what would you do I need to get involved in as many skull examinations as possible this will increase my confidence and usefulness to the department for these examinations.
Doing more out of hours clinical work would increase my chance of working with intoxicated patients, which will improve my proficiency dealing with patients of this type, which I can use in other areas to i.e. paediatrics. There needs to be further investigation into the follow treatment of patients, currently I am working as though I am only interested within imaging. This needs to change not only to enhance my personal development, but to aid the patient care for the patients that I encounter.
Conclusion
These two reasonably normal incidents have been vital in my development toward being an autonomous practitioner. They exposed me to situations that have cemented my knowledge and aided toward my confidence in the imaging department. They have been particularly useful as I feel that I can approach others for advice, in fact by not doing this is harmful to the experience that the patient is receiving, and damaging my own personal and professional development..
References
(2007). Retrieved April 16th, 2009, from www.homeoffice.gov.uk: http://www.homeoffice.gov.uk/crime-victims/reducing-crime/alcohol-related-crime/
Carver, E., & Carver, B. (2006). Medical Imaging: Techniques, Reflection & Evaluation. Bangr: Churchill Livingstone.
Johns, C. (2000). Becoming a Reflective Practitioner. Oxford: Blackwell Science.
Johns, C., Joiner, A., & Stenning, A. (2002). Guided Reflection. Oxford: Blackwell Science.
Moore, K. L. (2006). Clinically Orientated Anatomy. Philadelphia: Lippincott Williams & Wilkins.
Prasad, K. N. (2004). Radiation protection in humans: extending the concept of as low as reasonably achievable (ALARA) from dose to biological damage. British Journal of Radiology (77).