(5) [DSA] Cardio-Pulm Flashcards

1
Q

Scoliosis is a _____ consideration in a cardiopulmonary patient

A

Biomechanical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the Cobb classifications used for? What are they?

A

Scoliosis classification

  1. Mild - 5-15 degrees
  2. Moderate - 20-45 degrees
  3. Severe - >50 degrees
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the Cobb angle formed by?

A

Intersection of a line parallel to the superior end plate of the most CEPHALAD vertebra with the line parallel to the inferior end plate of the most CAUDAD vertebra of the curv

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Respiratory function is compromised if the Cobb angle is ___

A

>50 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pulmonary edema, ascites, hepatomegaly, and peripheral edema are consequences of impaired _____

A

Lymphatics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The thoracic duct is under ______ control, which can affect lymphatic flow how?

A

Sympathetic control

Hypersympathetic tone => decreased lymphatic flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Sympathetic innervation of the heart

Preganglionic axons come from where? Synapse on what?

A

Interomediolateral column of T1-T6

Synapse on corresponding upper thoracic sympathetic ganglia and cervical ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sympathetic innervation of the heart

Postganglionic fibers form what?

A

Sympathetic cardiac nerves => converge at the cardiac plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Parasympathetic innervation of the heart

Preganglionic axons from where?

A

Dorsal nucleus of the Vagus N.

Nucleus ambiguus => synapse on cardiac plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cholinergic and adrenergic passing through the cardiac plexus are most strongly concentrated where?

A

SA and AV nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sympathetic fibers have what effect on HR and coronary artery?

A

Increased HR

Coronary artery dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Parasympathetic fibers have what effect on HR and coronary artery?

A

Decreased HR

Coronary artery constriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sympathetic hyperactivity at the SA node has what effect?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Right vagal hyperactivity at the SA node has what effect?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Sympathetic hyperactivity at the AV node has what effect?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Left vagal hyperactivity at the AV node has what effect?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Smooth muscle tone of the airways is predominantly _____

A

Parasympathetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cholinergic (M3) innervation controls what pulmonary responses?

A

Bronchoconstriction

Mucus secretion

Bronchial vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

______ innervation controls bronchodilation

A

Non-cholinergic (NO and VIP)

Still parasympathetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anterior/Posterior chapman’s points for myocardium?

A

A: 2nd ICS along sternal border

P: Intertransverse space b/w T2-3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anterior/Posterior Chapman’s Point for Bronchus?

A

Anterior: 2nd ICS along sternal border

Posterior: Lateral to T2 SP

22
Q

Anterior/Posterior Chapman’s Point to Upper Lung?

A

Anterior 3rd ICS along sternal border

Posterior: Intertransverse space between T2-3 AND T3-4

23
Q

Anterior/Posterior Chapman’s Point for Lower Lung?

A

Anterior: 4th ICS along sternal border

Posterior: Intertransverse space b/w T4-5

24
Q

Non-modifiable risk factors for cardiopulmonary disease (2)

A

Genetics

Age

25
Q

Modifiable risk factors for cardiopulmonary disease (4)

A

Diet

Smoking

Immobility

Stress

26
Q

What is the goal of the biomechanical model fo OMT?

A

Improve thoracic cage compliance and skeletal motion

27
Q

What is the goal of the neurological model of OMT?

A

Normalize autonomic tone

28
Q

What is the goal of the respiratory-circulatory model of OMT?

A

Maximize efficiency of the diaphragm and enhance lymphatic return

29
Q

What is the goal of the metabolic-energetic-immune model of OMT?

A

Enhance self-regulatroy and self-healing mechanisms

30
Q

What is the goal of the behavioral model of OMT?

A

Improve psychosocial components of health

31
Q

Vascular and cardiac ________ is seen in most pts with hypertension

A

Hyperreactivity to sympathetic stimuli

32
Q

Due to the widespread distribution of the sympathetic nervous system, _________ can be used to decrease SVR

A

Generalized paraspinal inhibition

33
Q

What model in the 5 model approach is targeted in HTN cases?

A

Neurological

GOAL: Decrease sympathetic tone, paraspinal inhibition, Tx OA/AA

34
Q

What model in the 5 model approach is targeted in CHF?

A

Respiratory-Circulatory

Rib raising to improve breathing, lymphatics

Neurological

  • Suboccipital release (PNS)
  • Paraspinal inhibition to T1-6 (SNS)
  • Chapman’s point
35
Q

In the setting of arrhythmias, OMT should be directed where?

A

Toward reduction of segmental facilitation in the upper thoracics and modification of vagal tonicity

36
Q

What model in the 5 model approach is targeted in arrhythmias?

A

Neurological

  • Tx OA/AA
  • Paraspinal inhibition to T1-6
  • Chapman’s
37
Q

3 main goals of Pneumonia Treatment

A
  1. Reduce congestion
  2. Reduce sympathetic hyperactivity to pulmonary parenchyma of the lung

3. Reduce mechanical impediments to thoracic cage respiratory motion

also applicable to COPD pt

38
Q

What models are targeted in the 5 model approach to pneumonia?

A

Neurological: paraspinal inhibition T1-7, CV4, tx OA/AA to normalize parasympathetic

Respiratory/Circulatory: Rib raising, treat zink, lymphatics

39
Q

What treatment is contraindicated in COPD?

A

Thoracic Vacuum

40
Q

What models of the 5 model approach are targeted in COPD?

A

Neurological: T1-7 (SNS), OA/AA (PNS), Chapman’s

Respiratory-Circulatory: Rib raising, Zink patterns, doming the diaphragm

41
Q

Specific cardiopulmonary considerations (3)

A
  1. Consider indirect > direct to avoid unnecessary strain on pt
  2. Mobilizing too much fluid from periphery to central circulation => high volume stress to CO
  3. Increasing sympathetic tone can lead to constriction of lymph and systemic blood vessels
42
Q

Summary of OMM tx in cardiopulmonary pt

A
  1. Tx OA/AA using appropriate modality
  2. Open thoracic inlet
  3. Rib raising/tx ribs
  4. Tx diaphragms
  5. Lymphatic pumps (where appropriate)
  6. Treat T1-7 dysfunctions
43
Q

Thoracic Inlet MFR

A
44
Q

Doming the Diaphragm

A
45
Q

What is the rate for pedal pump?

A

120x/min

46
Q

What direction should seated rib raising be directed?

A

Start at rib angle with T12, pull superiorly and toward the physician

47
Q

What force is applied with effleurage?

A

Stroking force distally to proximally

48
Q

What force is applied with petrissage?

A

Kneading/twisting force distally to proximally

49
Q

Where are the quadratus lumborum tenderpoints?

A
50
Q

Anterior/Posterior Adrenal Chapman’s point?

A

Anterior: 2cm lateral, 2 cm superior to umbilicus

Posterior: lateral to spinous process of T11

51
Q

Viscerosomatic - sympathetic region for lungs?

A

T1-T7

52
Q

Viscerosomatic parasympathetic region - lungs?

A

Vagus N.