急診科物理治療實例 Practice of Physical Therapy at Emergency ...

Emergency Physical Therapy 110

Fracture and Sprain at Emergency Station

2021/11/4

06-1

Emergency Physical Therapy #06:

急診科物理治療實例Practice of Physical Therapy at

Emergency Department

– Acute Lateral Ankle Sprain

Huei-Ming Chai, PT. PhD

School of Physical Therapy

National Taiwan University

Emergency Physical Therapy

• Pre-hospital– BLS

– AED

• PT department or clinic– Medical emergency

– Trauma emergency

• Emergency department– Femur fracture

– Ankle sprain

• Disaster area– Preparedness phase

– Response phase2



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06-2

Scenario 1

• 一名男性50歲車禍病人；醫師評估左大腿骨折，雙上肢擦傷，意識清醒，等待開刀中。

• 你是急診室的物理治療師，請問下列狀況如何處理？

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• 病患疼痛哀嚎

• 病患沒有哀嚎

Scenario 2

• 32歲女性，在大賣場電梯摔下來，被送至急診室。醫生發現腳踝嚴重扭傷，X光確認無脫臼或骨折，開藥後轉介給物理治療師。

• 你是急診室物理治療師，該如何處置？

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06-3

Questions to Be Solved

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Questions Courses

How many ligaments around the ankle joint, where

are they attached, and what are their functions?

Anatomy

Surface Anatomy

What mechanism of injury results in lateral ankle

sprain?

Kinesiology

Biomechanics

Orthopedics

In general, what does a physical therapist do for this

patient at the first visit?

PT Assessment,

Orthopedic PT

Clinical Internship

What is the role of physical therapist for this patient

at the acute stage?

Athletic Taping

Elastic Taping

Orthopedic PT

How can a physical therapist help with an ankle

injury at the recovery stage?

Athletic Taping

Elastic Taping

Orthopedic PT

Clinical Internship

Clinical Pictures of Lateral Ankle Sprain

• acute inflammation：紅、腫、熱、痛

• unable to do single-leg heel-rise or – ankle plantarflex + inversion: ATF

– ankle neutral + inversion: CF

• pain during passive ankle plantarflexion

and inversion

• tenderness– ATF

– CF

• DO NOT perform anterior drawer

test at acute stage

patient cares?

PT cares?

pay more attention to?

6For chronic ankle instability only



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06-4

PT Assessment

Physical Therapy Approach

safety checking

self introduction

systemic

approach

decision-making

approach

treatment-based

approach

execute treatment

modified

treatment planevaluate

outcomes

Infection control

environment safety

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First Aid as Acute Ankle Sprain

• Protection (保護)

• Rest (休息)

• Ice (冰敷)

• Compression (壓迫)

• Elevation (抬高)

rest

elevation

ice

protection

+ compression

迷思：1. 停止冰敷時間2. 冰敷時要加水3. 第一時間冰敷控制繼續腫脹，

但已經腫脹時，冰敷無法消腫4. 已經腫漲時，消腫靠壓迫與抬高

繃帶、貼紮、按摩、淋巴引

流8

前4-6個小時，每小時冰敷15-20分鐘



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06-5

PRICE Principle

Protection (保護)

Rest (休息) 或

Ice (冰敷)

Compression (壓迫)

Elevation (抬高)

迷思：1. 第一時間冰敷控制繼續腫脹，但已經腫脹時，冰敷無法消腫

2.已經腫漲時，消腫靠壓迫與抬高

Bleakley CM, Glasgow PD, Phillips N, et al. Guidelines on the management of acute soft tissue

Injury using protection rest ice compression and elevation. London: ACPSM, 2011. 9

POLICE Principle

Protection (保護)

Optimal Loading (適度活動)

主動運動

被動運動

阻力運動(重量訓練)

Ice (冰敷)

Compression (壓迫)

Elevation (抬高)

10Bleakley CM, Glasgow P, MacAuley DC. Price needs updating, should we call the police?

Br J Sports Med 2012;46: 220-1

POLICE需要醫學專業知識否則可能造成二度傷害



2021/11/4

06-6

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https://blogs.bmj.com/bjsm/files/2019/04/

Screen-Shot-2019-04-25-at-2.58.47-PM.png

2019

British

Medical

Journal

Kinesio Taping to

Decrease Swelling of Ankle Sprain• position: knee flexed, ankle neutral, and foot

dorsiflexed and inverted

• type: fork-shaped strips (章魚)– anchor end at the muscle belly or lymph node area

– angle of two strips: ~ 30

– least tension

– tails toward distal end

• remarks– 只能消腫，無法預防二度

傷害，所以要加上白貼

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06-7

Kinesio Taping on Internet, OK?

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眼皮水腫貼紮一小時後

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2021/11/4

06-8

Lymphatic Massage

1515

• 利用淋巴引流，加速排除代謝廢物• 以<35Hg的力量對腫脹肢體做向心推動• 先做淋巴結較多的地方(有凹窩處)

• 肢體近端先開始，按摩方向是向心臟方向• 下肢順序:1.鼠蹊2.大腿 3.膝窩 4.小腿5.跟腱6.足底7.足背

16

16

3 min later

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2021/11/4

06-9

2018/12/03 Ecchymosis for a Week

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Before

(9:30 am)

Drainage Taping After

(11:30 pm)

Patient Problem

(or Population)

63 athletes who suffered an acute ankle sprain

that had occurred between 48 and 96 hours

before the 1st assessment, with visible swelling of

the ankle

Intervention Kinesio taping for 3 days, which was designed to

treat swelling

Comparison

or Control

sham Kinesio taping for 3 days

Outcome swelling measured via volumetry and perimetry,

which collected immediately after 3-day

intervention and 15 days post intervention

Results NS (no significance) 18

Nunes GS, Vargas Vz, Wageck B et al:

Kiesio taping does not decrease swelling in acute

lateral ankle sprain of athletes: A randomized trial.

J Physiother 2015;61:28-33.Is this study design reasonable?

Please criticize!!



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06-10

浴缸水滿了

• 浴缸水滿了，即將淹水，你會如何處理？

打開底部出水口關掉水龍頭

固定關節促進引流

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Principles of Management

• to enhance external support– acute: athletic taping with compression felt

– recovery: kinesio taping or bandaging

• to keep ligament in a shortening position– in a position of 0 of dorsiflexion and eversion

• PRICE or POLICE– icing + elastic bandage

– 15-20 min each hour for first 4-8 hours

• crutch walking with a toeing-out gait

• exercise under water

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2021/11/4

06-11

21

扭傷處理新觀念受傷6小時後別冰敷中央通訊社發稿時間：2017/03/16 16:55

http://www.cna.com.tw/news/firstnews/201703160369-1.aspx

恢復期的肌貼--支撐韌帶

calc.

ATF

CF

PTF

lateral view

AP

calc.

ATF

CF

PTF

lateral view

AP

ATF CF22



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06-12

恢復期的肌貼--鎖跟與支撐肌肉

支撐腓骨長肌

鎖跟

23

?

Elastic Bandaging for Ankle Sprain

• Luisana bandaging

• 口訣：腳跟、腳背、腳底、拉

5. 腳跟對側

1. 兩圈固定 2. 往腳跟拉 3. 繞過腳背

4. 繞過腳底24



2021/11/4

06-13

案例一: 亞運選手的大拇指

• 9/17 FB: 大姆指腫的不像話，有三個禮拜了，20號開始比賽

• 有無治療?

-- 冰熱敷、超音波都做了

• 那些動作不能做?-- 無法比「讚」-- 彎、直都會痛

• 你現在用按的，按關節的上、下、左、右，哪一個面比較痛?-- 上面，紅腫地方最痛-- 可以往下用力，但無法往上用力

只剩3天

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我的建議

• 做水中的超音波（選手的手指微彎）

• 關節鬆動術，做distraction

• 肌貼 X固定與黃絲帶限制

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2021/11/4

06-14

結果

• 會感到是肌貼拉住的嗎?

-- ㄧ點點--貼的地方有感到痠痛

• 痛嗎?

-- 還是會

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0917結果

• 會感到是肌貼拉住的嗎?

-- ㄧ點點--貼的地方有感到痠痛

• 痛嗎?

-- 還是會

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2021/11/4

06-15

0918修正

• 老師我剛練習完，今天是其他護員幫我貼的

• 腫起來的地方，貼起來還是很不舒服

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0921

• 9/22晚上比賽

• 還痛嗎?

-- 剛冰敷完

• 我沒想到你做冰敷-- 防護員叫我冰敷

• 那你自己處理好了，可能要一小時

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2021/11/4

06-16

改變計畫

• 將手泡在溫水裡不斷地做抓握的動作

• 如果不會不舒服做10分鐘

• 不要太燙唷

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Exercises Under Water

• contrast bath：cold started and cold ended– cold water for 2 min warm water for 30 s cold

water for 2 min …… cold water for 2 min

• to keep continuously moving– 上、下、左、右、繞圈圈

dorsiflxion/ plantarflexion

inversion/ eversion

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06-17

肌貼並非是唯一的解決方法

治療前治療後治療9小時後33

First Aid of Acute Ankle Sprain

場邊物理治療Sideline PT

隨隊物理治療Team PT

冰不冰冰不冰

按不按不按按(淋巴按摩)

貼不貼貼白貼貼肌貼+白貼

動不動不動動(水中運動)

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2021/11/4

06-18

奧運是物理治療師的競技場

35http://ptlog.pt.ntu.edu.tw/ptlog/?vol=117&aid=1879

Physical Therapy Outcomes (I)

• pain– Provocation: aggravating factors/ decreasing factors

– Patient specific functional scale (PSFS)

– Quality: sharp/ dull’ stabbing/ burning/ tingling

– Radiation: peripheralization/ centralization

– Severity: visual analogus scale (VAS)

– Time: continuous vs. intermittent

0 10

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2021/11/4

06-19

Physical Therapy Outcomes (II)

• swelling– figure of eight method

– water volumetry method

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Physical Therapy Outcomes (III)

• muscle flexibility test– ankle dorsiflexion in knee extended position

– ankle dorsiflexion in knee flexed position

• muscle strength tests– peroneus longus

– peroneus brevis

• one leg stance test– with eye open

– with eye closed

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急診科物理治療實例 Practice of Physical Therapy at Emergency ...

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