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I forget…what did that email say? oh yeah, its at mssmem.com

Archive for the ‘Ortho’ Category

Peds Ortho Clinic

Hi Adam,

Just a quick e-mail to make things run smoother:

1. Regarding transfers from other facilities: if something is
being transferred that is thought / known to be operative, please call
the ortho resident first to ensure that we can accommodate them when
they get here. Calling will also help in the opposite way: it may not
need to be transferred if it is something that can be scheduled
electively. This will save the patient an ER visit and we can likely
just give them a clinic visit. (I’m writing this now secondary to the
fact that a type III supracondylar was transferred over here tonight,
but now the OR can not accommodate us and we can’t do the case in the
relatively timely fashion it should be done…. I am also trying to fix
this separate OR problem as well… but that is a much harder problem to
fix at the present time.)
2. Regarding peds ortho clinic: just wanted to reiterate that this
is not a walk-in clinic. Every patient seen in peds ortho clinic needs
to be run by the ortho resident in order to get there. The only time
they don’t need an official appointment is if they come during weekend
hours, but it still needs to be approved by the resident. This helps
because the resident may be able to delineate which clinic would be the
best clinic for them to go to (example: it may not just be the next
Monday … but it may be 3 Mondays away that is the better date for them
based on their injury) or they may be better off being seen by their
primary care doctor first and then they can refer them if there is still
a problem.

Thanks for your help, Adam!

Abby

Abigail Allen, MD

Director, Pediatric Orthopaedic Clinic

Written by reuben

July 8th, 2011 at 8:34 am

Admission Guidelines: Orthopedics vs. Medicine

From: Chang, Dennis [mailto:dennis.chang@mountsinai.org]
Sent: Fri 2/18/2011 5:45 PM
To: Chasan, Rachel (MSSM-Imail); Sadikot, Sean; Matloff, Jeremy (MSSM-Imail); Sachdev, Darpun (MSSM-Imail)
Cc: # DHM Hospitalists; # HMP NP (MSH)
Subject: Orthopedics Admission Guidelines

Evening,

So we met with the orthopedics department and attached are the guidelines for admission to medicine and orthopedics. A copy was given to the MAR today but if you guys could distribute this to all the MARs going forward that would be great. The orthopedics residents also received an email today. There was some confusion over the guidelines today but that was because the orthopedic residents didn’t read the guidelines thoroughly. This was cleared up today but there may be some confusion in the future. Thanks! Have a good weekend.

Dennis

Dennis Chang, MD
Co-Director, Medicine-Geriatrics Clerkship
Director of Medical Consult and Peri-Operative Services
Assistant Professor, Division of Hospital Medicine
Mount Sinai Medical Center

Orthopedic Admission Guidelines

Situations in which patient in ED with primary Ortho complaint should go to Medicine Team with Ortho Consult:
o ACUTE CHEST PAIN (for rule out MI, requiring Telemetry)
o ACUTE STROKE (Medicine or, more likely, Neurology)
o SYNCOPAL EPISODE CAUSING FALL (for rule out MI, requiring Telemetry)
o Hypertensive urgency (requiring Telemetry, IV antihypertensive drips)
o Severe ELECTROLYTE DISTRUBANCE (e.g. Hyponatremia)
o Other unstable comorbid condition (e.g. significant COPD or CHF exacerbation) not listed above

Situations in which patient in ED with primary ortho complaint should go to Ortho Team with Medicine Consult:
o ANTICOAGULATED PATIENT
o PTS NEEDING CARDIAC WORKUP PRIOR TO SURGERY
o MULTIPLE COMORBIDITIES (>5) RENAL, PULMONARY, CAD, CHF, DM, HIV – ALL OF WHICH ARE CONSIDERED STABLE AT THE TIME OF ADMISSION
Orthopedic Admission Guidelines

Written by reuben

April 22nd, 2011 at 6:01 am

Posted in Admitting,Ortho

Kyphoplasty for Compression Fractures

[The following was submitted by the anesthesia department. If neurosurgery or orthopedics are involved, make sure to discuss with them before involving another service]
The Department of Anesthesiology, Division of Pain Management is pleased to announce the availability of balloon Kyphoplasty here @ Mount Sinai.
Balloon kyphoplasty is designed to correct the angular deformity caused by vertebral compression fractures (unlike Vertebroplasty, which does not correct the deformity), significantly reduce back pain and improve patients’ ability to return to their daily activities in  patients suffering from vertebral compression fractures (VCFs) due to osteoporosis or cancer. 3,4
With over 700,000 VCFs occurring each year in the U.S., VCFs are the most common fracture caused by osteoporosis. The incidence of VCFs is higher than hip fractures and breast cancer combined. However, an estimated 2 out of 3 VCFs go undiagnosed and untreated. Vertebral compression fractures are also the most common skeletal complication of metastatic cancer with an estimated 75,000 to 100,000 cancer-related VCFs occurring annually in the U.S. Common tumors causing VCF are breast cancer, lung cancer, and prostate cancer. Left untreated, VCFs are associated with an increased risk of future fractures, chronic pain spinal deformity, and kyphosis all of which can dramatically impact your patients’ quality of life.
In the past, traditional treatment for VCFs have included bed rest, medication and back bracing. While these therapies may help to decrease a patient’s pain over time, they do not treat the deformity related to the osteoporotic fractures. 1,2 Multiple studies show balloon kyphoplasty can correct vertebral deformity, reduce back pain, significantly improving mobility and increase overall quality of life. The procedure typically takes less than one hour per treated level and can be performed as an inpatient or outpatient procedure. Most patients recover well and return to normal activities within a few days. 3,4,5
If you have VCF patients presenting with acute back pain who can benefit from balloon kyphoplasty, I would be pleased to provide a patient consult. Early VCF diagnosis can result in optimal treatment. I am committed to providing excellent patient care by utilizing the most effective and safest treatments of spinal conditions. Please feel free to contact Dr. Lawrence Epstein @ for a consult or if you would like further information at 212-241-8916 or contact the Pain service @ pager 0329 and make sure that you say that the patient has a (potential) compression fracture.
1. Ross PD. Clinical consequences of vertebral fractures. Symposium on osteoporosis. AM J Med. 1997; 103:30S-43S.
2. Silverman SL, Minshall ME, Shen W, et al, for Health-Related Quality of Life Subgroup of the Multiple Outcomes of
Raloxifene Evaluation Study. Arthritis Rheum. 2001; 44:2611-2619.
3. Ledlie JT, Renfro MB. Spine. 2006;31:57-64.
4. Garfin SR et al. Spine 2006;31:2213-2220.
5. Brunton S, Carmichael B, Gold D, et al. Vertebral compression fractures in primary care: recommendations from a
consensus panel. J Fam Pract. 2005; 54:781-788
Click here for movie.

Written by reuben

October 9th, 2010 at 11:40 pm

Posted in Ortho

Plaster Traps

Plaster traps have been installed in: the resus room sink by bed D, the pediatric treatment room, and the ortho room in UC.

Please use these sinks for your plaster needs, and avoid plaster in all other sinks.

(For those of you that don’t know- plaster builds up in plumbing and eventually causes high grade obstruction in sinks. Plaster traps solve this problem.)

Written by phil

September 7th, 2006 at 4:07 pm

Posted in Ortho