2.5 Early Mobilization of the Critically Ill Flashcards
Dastardly Duo
Idiopathic Pulmonary Fibrosis &
Pulmonary HTN
How can PT can improve respiratory status?
PNA we can help mobilize secretions
COPD we can do pursed-lip breathing, buffering using lungs
Body positioning - pleural effusion, atelectasis, deep breathing
Upright allows more air to open alveoli!
How can PT can compromise respiratory status?
Think O2 dissociation curve and patients S&S
What are the 9 steps of O2 transport?
1) FiO2 (21% room)
2) Airways
3) Lungs and chest wall
- alveolar ventilation
4) Diffusion O2
5) Perfusion of lungs
- gravity dependent
6) Myocardial function
- preload, afterload
7) Peripheral circulation
8) Tissue extraction and use of O2
9) Return of partially desaturated blood and CO2 to lungs
Our role as PTs & 9-steps of O2 transport:
Define where the dysfunction is and then determine:
1) can we intervene at that level to improve O2 transportation or
2) can we try to impact it indirectly from the peripheral levels?
What do we look for in the indirect history for neurocognitive?
Wake up, open eyes, move arms, and legs during sedation holiday?
Anxious, aggravated, ventilatory asynchrony?
Known trauma?
Bleed? Active or progressing?
We should look at ECG and vitals over how long?
8 hours, last 24 hours
What happens with a high CVP?
Normal is 2-8mmHg, with a high it will be harder to get the blood back into the heart, decreases preload!
Venous pressure should be?
40 mmHg
Indirect hx:
Is the patient on oxygen?
Is this the baseline? Where are they stable with O2? What the change of baseline is with O2?
Over the past 8 hours check sats!!
Respiratory reserve ratio?
PaO2/FiO2
100/21 = 4.76L (normal RRR)
What is the desired goal by physician of RRR?
3L or 300
Although if below, still work them, but be very careful and take vitals and read pts S&S!
STILL TREAT! But what is the intensity? Manipulate to be safe!
When would you not treat the critically ill patient?
No! If the patient is trying really hard to breathe uncontrolled at rest. Do not treat. Collar with team members until vitals improve! Exercise will drop the pts O2 even more!
Should anyone be exercising if their resting heart rate is above their HRmax???!
NO!
Will deep breathing be effective in a patient that has compromised CO2 (hypercapnic), decreased lung compliance, resistance?
This will cause harder work!! Leads to compromise health status! Shallow, rapid will be preferred in restrictive alveolar process!
Need BiPAP!
