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e-stim burns
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e-stim burns - August 31, 2004 10:33:00 AM
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angiew
Posts: 11
Joined: September 3, 2002
From: O'Fallon, IL, USA
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I recently had an incident in the clinic where a patient believes that he was burned after an electrical stimulation treatment. It was the second time the patient had received IFC with ice with no problems after the first time. He had no redness when the e-stim pads were removed after the second treatment, however, he had two small red areas the next day. Several days later, the burns had progressed from first degree to second degree even though no additional treatment had been given. I have never burned anyone with e-stim and am puzzled by his presentation. I did contact the Dr. and the patient saw the Dr. who was very upset with me. Does anyone have any experience with e-stim burns or have any ideas why he was not burned until more than 12 hours after treatment?
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Re: e-stim burns - August 31, 2004 11:45:00 AM
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OAK
Posts: 184
Joined: September 1, 2003
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It's happened to me a few times, there can be a bit of a delay in the reaction. It may be caused by improper electrode contact. I highly doubt any major damage was done.
The patient's Doctor seems to be adding on to the problem by "giving in" to the patients concern.
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Re: e-stim burns - August 31, 2004 12:13:00 PM
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Dr.Wagner
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From: Indianapolis
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The key to this is documentation of both the procedure and the exam after the procedure. When I was a PT, documentation of daily treatments was fairly lax, I can tell you in the environment of today, documentation of "patient tolerated treatment well and without incident" is the least you need to put on your chart.
If you have NO documentation regarding the procedure, then you have no leg to stand on. If it isn't written down, then it didn't happen.
It is very likely a bit of bad luck.
I for one had a burn with Ionto years ago.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: e-stim burns - August 31, 2004 2:13:00 PM
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angiew
Posts: 11
Joined: September 3, 2002
From: O'Fallon, IL, USA
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It was documented that there was no redness after treatment. When I saw the patient for the first time after the burn, I also documented the patient's account of when the burns appeared and the location of the burns. The Dr. did contact me after he had seen the patient and did not seem to understand what IFC was and the purpose behind it. I chose this treatment to assist in reducing the pain and swelling the patient was getting post exercise. My supervisor suggested writing a letter to the referring Dr. and apologizing again and explaining the rationale behind my treatment choice.
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Re: e-stim burns - August 31, 2004 2:36:00 PM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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burns most likely from poor contact or cheap non-buffered electrodes causing acidic build-up. They are somewhat common, hence the reason they pulled those ab ones off the shelf, everyone was getting nasty burns from the poor contact. I kind of think if you treat it like, well, too bad, we learned, no biggie, then the patient usually goes along with that, if you freak out and start having them sign things, etc, they usually can sense something went wrong and start getting litigious on you.
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Re: e-stim burns - September 1, 2004 12:09:00 PM
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OAK
Posts: 184
Joined: September 1, 2003
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I have a question about the documentation. I have never gone to court so I don't know exactly how things work. In this case, if the patient reports to me the next day that they were "burned" from the IFC treatment and I document everything they say, did not I just do myself in? I now have produced written proof of the incident.
Would I be better off legaly if I did not document the burn? Please correct me if I'm wrong!
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Re: e-stim burns - September 1, 2004 12:12:00 PM
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OAK
Posts: 184
Joined: September 1, 2003
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Also, if I document that the patient was fine after treatment, would this hold up in court? Are all these chart notes a waste of time?
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Re: e-stim burns - September 1, 2004 4:36:00 PM
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hmgross
Posts: 292
Joined: February 28, 2003
From: Minnesota
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I would be hesitant to use e-stim and ice at the same time. The ice would decrease skin sensation and make it difficult for the patient to tell you if the stim is too intense. I actually don't do many modalities, but when I do, I try to stick to one thing at a time, otherwise it is hard to tell what is helping and what isn't. And I wouldn't dodge the issue by not documenting it--who knows, the patient may have taken a photo. I took a photo of a patient's low back (with his permission) and put the date and time on at one initial eval where the patient had obvious burn/scars from a home heating pad. I certainly didn't want to get blamed for that!
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Holly Gross PT
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Re: e-stim burns - September 1, 2004 7:38:00 PM
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Mrxmixer
Posts: 4
Joined: August 15, 2004
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You may also want to contact the Electrode mfg and the mfg of the E-stim unit....may have a bad lot of electrodes...They should stand behind their product if all recommended parameters were applied....
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Re: e-stim burns - September 18, 2004 10:24:00 AM
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ptdan23
Posts: 224
Joined: November 6, 2003
From: Orlando, FL
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I use e-stim and ice together all the time and have never had an incident where a pt was burned.
Was the pt diabetic or neurologically impaired in any way?
I agree w/ others and the fact that the doc didn't help back you up and automatically accused you of wrongdoing is just wrong!
Dan, PT.
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