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Cardio theory > 2. Pleural disease, pneumothorax, oxygen therapy, cardiothoracic surgery > Flashcards

2. Pleural disease, pneumothorax, oxygen therapy, cardiothoracic surgery Flashcards

1
Q

What is the collection of air in the pleural space called?

A

Pneumothorax

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2
Q

What is the collection of pus in the pleural space called?

A

Empyema

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3
Q

To which region will air travel if trapped in the pleural space?

A

apical regions

Following laws of physics

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3
Q

To which region is air most likely to travel if trapped in the pleural space?

A

apical regions

Following laws of physics

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4
Q

To which region is fluid most likely to travel if trapped in the pleural space?

A

lower regions

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5
Q

What would you expect to hear on auscultation of pleural effusion?

A

Decreased or absent breath sounds

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6
Q

What would you expect to see on a CXR of pleural effusion?

A
  • Blunted or no costo-phrenic angle
  • Meniscus sign - concave line obscuring costo-phrenic angle and part of the hemidiaphragm
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7
Q

What is the primary cardiorespiratoy problem associated with pleural effusion?

A

Low lung volumes
Shortness of breath

Due to lung tissue compression and reduced bolume of expansion

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8
Q

What is a pneumothorax?

A

Air which has entered the pleural space, causing the visceral and parietal pleural layers to separate, and collapses the lun (full or partial).
Disruption to the negative pressure

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9
Q

What are the 5 causes of pneumothorax?

A
  • Traumatic
  • Spontaneous
  • Primary (idiopathic)
  • Secondary (rupture of alveoli in respiratory disease)
  • Consequence of meidcal procedure
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10
Q

What are clinical features of pneumothorax?

A
  • Decreased lung volumes
  • Impaired gas exxchange
  • SOB
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11
Q

Clinical signs of a pneumothorax?

A
  • CXR changes
  • Reduced or absent BS on ausc
  • SOB
  • Reduced chest wall movement on that side
  • Reduced SpO2
  • Increased RR
  • Pain on inspiration
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12
Q

What changes would you expect on a CXR for a pneumothorax?

A
  • No vascular markings
  • Visible lung edge
  • Flattened hemidiaphragm (due to pressure)
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13
Q

pH, PaCO2, PaO2, HCO3-, BE/BD

What are the normal ranges for ABGs?

A
  • pH = 7.35 - 7.45
  • PaCO2 = 35-45mmHg
  • PaO2 = 80-100 mmHg
  • HCO3- 22-26 mmol/L
  • -2 to +2
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14
Q

What conditions cause respiratory acidosis?

A
  • Hypoventilation

COPD, airway obstruction, weakness of respiratory muscles

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15
Q

What conditions cause metabolic acidosis?

A
  • Diabetic ketoacidosis
  • Renal failure
  • Lactic acidosis due to shock
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16
Q

What conditions cause respiratory alkalosis?

A
  • Hyperventilation

Anxiety, severe asthma, pneumothorax

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17
Q

What conditions cause metabolic alkalosis?

A
  • vomiting
  • diuretic therapy
18
Q

How do you work out predicted PaO2 if patient is on Oxygen?

A

FiO2 (%) x 5 = predicted

19
Q

Clinical indications for O2 therapy?

A
  • Exacerbations of cardiac and respiratory conditions/failure
  • Postoperative period
  • Desaturation during exertion/exercise
  • Increased metabolidc demand (burns., severe infection, multiple injuries, shock)
20
Q

What is a fixed performance device?

A

Delivers fixed FiO2 by providing a high enough flow of pre-mixed gas which should exceed the patient’s peak inspiratory flow.

Delivers high flow of oxygen
Can be combined with humidification
Changes in breathing pattern have less effect on FiO2

21
Q

What is a variable performance device?

A

Delivers a flow of O2 less than the patient’s inspiratory flow, therefore the FiO2 will vary with the rate and volume of each breath.

**These devices cannot deliver a high FiO2

22
Q

What is peak inspiratory flow?

A

Fastest flow of air that can be inhaled in 1 second

23
Q

What is normal PIFR in adults?

A

25-35 L/min

24
Q

Name two variable performance devices and thier flow ranges.

A
  • Nasal prongs
  • deliver 0.25 - 4 L/min
  • … FiO2 of 24-40%
  • Hudson mask
  • Delivers 6 - 15 L/min
  • … FiO2 45-65%
25
Q

What is the role of delivering O2?

A
  • Improves hypoxemia
  • Improves SpO2
26
Q

What is the role of O2 flow?

A
  • Assists WOB
  • Improves SpO2
  • Decreases RR
  • Increases TV
27
Q

What are the benefits of humidification?

A
  • Maintain mucociliary transport - improved mucus clearance
28
Q

What are the indications of humidification?

A
  • Thick secretions
  • > 35% FiO2
  • Tracheostomy (natural humidifing process bipassed)
29
Q

Name 4 common closed cardiac surgical procedures

A
  1. Endoscope
  2. PTCA (Percutaneous Transarterial Coronary Angioplasty)
  3. Stent insertion
  4. Pacemaker or implantable cardiac defibrilator insertion
30
Q

Name common open cardiac surgery procedures

A
  • Coronary artery bypass grafts (CABGs)
  • Valvuloplasty
  • Valve replacement (aortic/mitral)
  • Thoracic aortic aneurysm repairs
  • Cardiopulmonary bypass
31
Q

What is the basic clinical pathway for postoperative management of caardiac surgery?

A
  1. ICU 24h till SOOB
  2. Ward - mobilise, drains removed
  3. Discharge day 5
32
Q

What are the 3 components of acute postoperative cardio physio management?

A
  1. Assessment in ICU (premorbid mobility, baseline history, any problems identified)
  2. Early mobilisation - at least SOOB ++ Day 1. Progress > 100-400m as tolerated
  3. Educaiton - sternal precautions, safe transfers
33
Q

Explain conservative sternal precautions

A
  • Avoid pushing or pulling through arms
  • Avoid unilateral arm movement
  • Limit elevation to 90 degrees
  • Avoid lifting >2kg
  • Use sternal support (pillow/towel) when coughing
  • Limit arm use for position transfers
  • Avoid placing arms behind back
34
Q

Explain modified sternal precautions

A
  • Use pain/discomfort to guide arm use
  • Avoid unilateral arm pushing/pulling
  • Try to keep arms as close to the body when lifting or doing other tasks
  • Avoid stretching both arms backwards at the same time
  • Use sternal support when coughing (pillow/towel)
  • DUring transfers, roll onto side, then legs over the edge, then carefully use arms to help into sitting position
35
Q

What are the main focuses of mobility with physio for postoperative cardiac rehabilitation?

A
  • Evaluation
  • Return to exercise
  • Education and counselling
36
Q

What are some common problems following thoracic surgery?

A
  • Pain
  • Reduced lung volumes
  • Impaired airway clearance
  • Impaired gas exchange
  • Reduced mobility
  • Decreased exercise tolerance
37
Q

What is the purpose of an UWSD and ICC?

A
  • Facilitate remobal of air/fluid from pleural space
  • Re-extablish normal negative pressure in pleural space -> re-inflates lung
  • Prevents air/fluid moving back into pleural space
38
Q

True/false: Interpleural pressure is usually negative during inspiration AND expiration

A

True

39
Q

What are the 4 components of physio assessment of UWSD?

A
  1. Drainage (amount and colour)
  2. Suction (port at top, how much?) (if suction on, pt may not be moved, marching on spot)
  3. Bubbling (intermittent is normal during inspiration and expiration) (no bubbling if suction on)
  4. Swing (when patient breaths)
40
Q

What are methods of physiotherapy management following thoracic surgery?

A
  • SOOB, early mobilisation
  • Respiratory care guided by Ax findings - treat low lung volumes, sputum etc
  • Consider to pulmonary rehab
  • Education on return to function and activities of daily living
41
Q

What are physiotherapy problems associated with rib fractures?

A
  • Pain - hypoventilation and reduced FRC
  • Impaired airway clearance - secreations increase
  • Increased WOB
  • Hyoxaemia/hypercapnoea
  • Poor mobilisation
42
Q

What is the main aim of rib fracture treatment?

A

Control pain and prevent pulmonary complications

43
Q

What physiotherapy management can be employed for chest trauma?

A

Oxygen therapy and humidification
Increase lung volumes
* Mobilisation (SOOB, sit-stand, ambulation
* Positioning
* Breathing exercises to improve lung volumes
* CPAP/BiPAP

Airway clearance
* ACBT, supported cough, FET

Cardio theory (4 decks)

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