1. Future Medical Cost Projections
Module 7
Common Conditions, Part 2

2. Common Injuries and Conditions
Overview
Discusses common medical conditions and typical treatment protocol for catastrophic conditions and uncommon injuries
Objectives
Understand basic complexities of spinal cord injury
Understand basic complexities of significant brain injury
Understand basic complexities of amputations
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Common Conditions
Traumatic brain injury
Spinal cord injury
Amputation
Burns
Chronic pain
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4. Traumatic brain injury
Mild TBI
Physician evaluations dependent on medications prescribed
Monthly prescriptions dependent on individual formulary
At least one neuropsychological evaluation in lifetime
Limited sessions of behavioral/cognitive therapy
Medical mileage reimbursement if worker’s compensation coverage
Significant TBI
May impact function, loss of motor and sensory nerve pathways
Treatment plan in response to functional limitations
Includes medications, physician visits, diagnostics, behavioral counseling
Could include in-patient rehabilitation
Could involve cortical blindness and hearing loss
Requires periodic neuropsychological evaluations
May require home attendant care, equipment, home modifications
Significant co-morbidities: facial and/or cervical fractures
Typically requires ongoing physical, occupational, and speech therapies
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Spinal Cord Injury
Comprehensive, interdisciplinary team approach needed
Regular, periodic evaluations by several specialty physicians
Ongoing, lifelong therapy cornerstone of treatment
Major issues: skin breakdown, infection (bladder and lung), contractures, autonomic dysreflexia
Home renovations, accessibility issues, transportation, equipment, medications, injections, bracing, home attendant care
Needs life care planner expertise involvement: especially in personal injury cases
Worker’s compensation cases typically do not settle medical on these catastrophic cases
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6. Amputation Lower Extremity
Below the knee, above the knee
Significant potential complications and secondary conditions
Treatment
Bi-annual diagnostics to monitor status of orthopedic condition
Bi-annual liver and kidney function studies due to chronic use of medications
Periodic urine drug screening if narcotics prescribed
Monthly physician evaluations for medication management
Monthly prescriptions depending on individual formulary
Regular physical therapy for flare up of condition, monitor skin and contractures
Periodic replacement of prosthetics
Standard equipment needs, including wheelchair, transportation, commode, and other assistive devices
May need home modifications
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7. Amputation Upper Extremity
Wrist, hand, fingers
Arm, below or above elbow
Treatment
Bi-annual diagnostics to monitor status of orthopedic condition
Bi-annual liver and kidney function studies due to chronic use of medications
Periodic urine drug screening if narcotics prescribed
Monthly physician evaluations for medication management
Monthly prescriptions depending on individual formulary
Regular physical therapy for flare up of condition, monitor skin and contractures
Periodic replacement of prosthetics
Standard equipment needs for assistive devices
May need home modifications
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Burns
Electrical
Thermal
Chemical
Solar
DIC
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Electrical Burns
Entrance and exit wounds
Be mindful of internal impact
Brain
Heart
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Chemical Burns
Skin
Nasal passages
Respiratory tract
Multiple agents
Treatment
Dermatology
ENT
Neurology
Pulmonology
Neuropsychology
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DIC
Disseminated intravascular coagulation
Significant internal injuries
Brain
Kidneys
Lungs
Hot weather danger
Cars and environment
Treatment
Physician conferences
Multi-factoral
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Chronic Pain
Types
Nociceptive
Neuropathic
CRPS
Treatment
Medication
Injections
TNS unit
Therapy
Spinal cord stimulator
Pain pump
Diagnostics and laboratory, drug screening
Physician evaluation
counseling
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Uncommon Conditions
Environmental toxic exposure
Hearing/vision loss
Brachial plexus ED
PTSD
Addiction
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Hearing loss
Common Industrial accident
ENT specialist
Audiologist
Hearing aids
Supplies
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Dental Injuries
Common in MVA and falls
Concurrent facial injuries
Concurrent head injuries
Treatment
Can usually obtain estimate from treating dental team
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16. Brachial Plexus Injuries
Traumatic
Often missed
Motorcycle/bicycle accidents
Hanging/shoulder accidents
Chronic pain issues
Limited use of affected arm and hand
Obstetrical
Malpractice case
Life Care Planning
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PTSD
Diagnoses sometimes difficult
Need psychology, psychiatry evaluations
Co-morbid conditions
Drug abuse
Alcohol abuse
Verbal, physical abuse
Treatment
Medications
Cognitive-behavioral therapy
Inpatient rehabilitation
Desensitization
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Common condition found with significant back injuries
Crush injuries
Effect of medications for other conditions
Psychological conditions
Treatment
Urologist
Sex education specialist, counseling
Medications
Penile Pump
Injections
Penile implant
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Homework
Research brain injury rehabilitation services in your local area
Contact local occupational therapist and discuss home modification evaluation, driving evaluation, and other services available for spinal cord injured clients
Research and download these: Glasgow coma scale, revised trauma scale, global assessment of functioning scale, Asia spinal cord injury scale---retain in records
Contact local ED specialist and discuss various treatment options for ED: pump, injections, implant, retain in records
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Contact Information
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