1. OMM in Acute Care David C. Mason, DO, FACOFP Chair Department of OMM TCOM TOMA/TxACOFP Saturday June 23, 8-9am

2. Session Description This one hour discussion will identify opportunities to apply Osteopathic Principles and Practices in the Acute Care Setting. Cases will be used to illustrate OMM concepts and manipulative treatment plans. The current literature supporting the use of OMT in this setting will be reviewed.

3. Learning Objectives Recognize opportunities to incorporate OPP into acute care setting. Develop skills to provide OMM to patients who present with acute medical problems. Review the literature that supports the use of OMT in the acute care setting.

4. Conditions OMT is used for By DO’s 151 different conditions Low Back Pain Headache/cephalgia Undiff. musculoskeletal SD. Neck pain Cervical strain Sinusitis Undiff. strain Thoracic strain Top 15 Cervical body region Lumbar strain Thoracic body region Undiff. Sprain Lumbar body region URI Fibromyalgia Shirley M. Johnson, PhD MPH MSW, Margot E. Kurtz, PhD Conditions and Diagnoses for which osteopathic primary care physicians and specialists use Osteopathic Manipulative Treatment JAOA Vol 102 No 10 October 2002 P 527-40.

5. OMT in ED Overview Peer Reviewed Clinical Research – Ankle Sprains – Non-Traumatic Acute Neck Pain Clinical Journal Review or Text Book – Low Back Pain – Torticolis – Chest Pain – Asthma – Sinusitis – Cephalgia – Nosebleeds/URI – Abdominal/Pelvic Pain Michael Mesisca, Keasha Hoffman, Gregory Fenati and Raymond Hruby Osteopathic Manipulative Treatment in the Emergency Department: a Two Dimensional Curriculum The AAO Journal Volume 20, issue 1 March 2010 P 23-31

6. USE of OMT in ED Percent using some OMT Ray 55% Spaeth 49% Johnson 55.6% Obstacles to Using OMT Insufficient Time Physician not comfortable with Skills Patients unfamiliar with OMT Lack of formal OMT guidelines Liability Concerns Michael Mesisca, Keasha Hoffman, Gregory Fenati and Raymond Hruby Osteopathic Manipulative Treatment in the Emergency Department: a Two Dimensional Curriculum The AAO Journal Volume 20, issue 1 March 2010 P 23-31

7. TIME for OMT Think osteopathically Integrate Management Efficiency

8. Incorporation of OMM Incorporate Osteopathic Tenets into every encounter Recall Autonomic Nervous System Review Biomechanics Incorporate Osteopathic treatment plan into every patient encounter

9. Acute Ankle Injuries Randomized Treatment(N=28) and Control groups(N=27) Demonstrated statistic significance for improvement in edema and pain and a trend towards improved ROM immediately 73 percent returned for followup Demonstrated statistic significance for improved ROM at one week followup Anita W. Eisenhart, DO Theodore J. Gaeta, DO, MPH David Yens, PhD Osteopathic Manipulative Treatment in the Emergency Department for Patients with Acute Ankle Injuries JAOA Vol 103 No 9 September 2003 p 417-21

10. Treatment Protocol Evaluate and treat Fibular Head dysfunction, Tibial torsions, Soft tissue including Fibularis longus and brevis, Cubiod bone, counterstrain tenderpoints around the ankle and anterior talofibular ligament. Lymphatic techniques should be used to reduce pain and edema.

12. Acute Non-Traumatic Neck Pain Randomized to IM Ketoralac(N=29) vs OMT(N=29) At one hour OMT was as effective in relieving pain and significantly better at reducing neck pain intensity Tamara M. McReynolds, DO Barry J. Sheridan, DO Intramuscular Ketorolac Versus Osteopathic Manipulative Treatment in the Management of Acute Neck Pain in the Emergency Department: A randomized clinical trial JAOA Vol 105 No 2 February 2005 57-68

13. Treatment Protocol Soft Tissue HVLA Muscle Energy

15. LOW BACK PAIN GUIDELINES First National Guidelines for using OMT National Guidelines Clearinghouse (http://ngc.gov/content.aspx?id=15271)

16. Evidence Based Guidelines Assess the efficacy of OMT for SD associated with LBP Assist in the appropriate use of OMT for patients with LBP Promote the understanding of the evidence underlying recommendations for appropriate use of OMT, Which is not detailed in guidelines developed by other physicians