(5) [DSA] Cardio-Pulm Flashcards
Scoliosis is a _____ consideration in a cardiopulmonary patient
Biomechanical
What are the Cobb classifications used for? What are they?
Scoliosis classification
- Mild - 5-15 degrees
- Moderate - 20-45 degrees
- Severe - >50 degrees
What is the Cobb angle formed by?
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
Respiratory function is compromised if the Cobb angle is ___
>50 degrees
Pulmonary edema, ascites, hepatomegaly, and peripheral edema are consequences of impaired _____
Lymphatics
The thoracic duct is under ______ control, which can affect lymphatic flow how?
Sympathetic control
Hypersympathetic tone => decreased lymphatic flow
Sympathetic innervation of the heart
Preganglionic axons come from where? Synapse on what?
Interomediolateral column of T1-T6
Synapse on corresponding upper thoracic sympathetic ganglia and cervical ganglia
Sympathetic innervation of the heart
Postganglionic fibers form what?
Sympathetic cardiac nerves => converge at the cardiac plexus
Parasympathetic innervation of the heart
Preganglionic axons from where?
Dorsal nucleus of the Vagus N.
Nucleus ambiguus => synapse on cardiac plexus
Cholinergic and adrenergic passing through the cardiac plexus are most strongly concentrated where?
SA and AV nodes
Sympathetic fibers have what effect on HR and coronary artery?
Increased HR
Coronary artery dilation
Parasympathetic fibers have what effect on HR and coronary artery?
Decreased HR
Coronary artery constriction
Sympathetic hyperactivity at the SA node has what effect?
Right vagal hyperactivity at the SA node has what effect?
Sympathetic hyperactivity at the AV node has what effect?
Left vagal hyperactivity at the AV node has what effect?
Smooth muscle tone of the airways is predominantly _____
Parasympathetic
Cholinergic (M3) innervation controls what pulmonary responses?
Bronchoconstriction
Mucus secretion
Bronchial vasodilation
______ innervation controls bronchodilation
Non-cholinergic (NO and VIP)
Still parasympathetic
Anterior/Posterior chapman’s points for myocardium?
A: 2nd ICS along sternal border
P: Intertransverse space b/w T2-3
Anterior/Posterior Chapman’s Point for Bronchus?
Anterior: 2nd ICS along sternal border
Posterior: Lateral to T2 SP
Anterior/Posterior Chapman’s Point to Upper Lung?
Anterior 3rd ICS along sternal border
Posterior: Intertransverse space between T2-3 AND T3-4
Anterior/Posterior Chapman’s Point for Lower Lung?
Anterior: 4th ICS along sternal border
Posterior: Intertransverse space b/w T4-5
Non-modifiable risk factors for cardiopulmonary disease (2)
Genetics
Age
Modifiable risk factors for cardiopulmonary disease (4)
Diet
Smoking
Immobility
Stress
What is the goal of the biomechanical model fo OMT?
Improve thoracic cage compliance and skeletal motion
What is the goal of the neurological model of OMT?
Normalize autonomic tone
What is the goal of the respiratory-circulatory model of OMT?
Maximize efficiency of the diaphragm and enhance lymphatic return
What is the goal of the metabolic-energetic-immune model of OMT?
Enhance self-regulatroy and self-healing mechanisms
What is the goal of the behavioral model of OMT?
Improve psychosocial components of health
Vascular and cardiac ________ is seen in most pts with hypertension
Hyperreactivity to sympathetic stimuli
Due to the widespread distribution of the sympathetic nervous system, _________ can be used to decrease SVR
Generalized paraspinal inhibition
What model in the 5 model approach is targeted in HTN cases?
Neurological
GOAL: Decrease sympathetic tone, paraspinal inhibition, Tx OA/AA
What model in the 5 model approach is targeted in CHF?
Respiratory-Circulatory
Rib raising to improve breathing, lymphatics
Neurological
- Suboccipital release (PNS)
- Paraspinal inhibition to T1-6 (SNS)
- Chapman’s point
In the setting of arrhythmias, OMT should be directed where?
Toward reduction of segmental facilitation in the upper thoracics and modification of vagal tonicity
What model in the 5 model approach is targeted in arrhythmias?
Neurological
- Tx OA/AA
- Paraspinal inhibition to T1-6
- Chapman’s
3 main goals of Pneumonia Treatment
- Reduce congestion
- Reduce sympathetic hyperactivity to pulmonary parenchyma of the lung
3. Reduce mechanical impediments to thoracic cage respiratory motion
also applicable to COPD pt
What models are targeted in the 5 model approach to pneumonia?
Neurological: paraspinal inhibition T1-7, CV4, tx OA/AA to normalize parasympathetic
Respiratory/Circulatory: Rib raising, treat zink, lymphatics
What treatment is contraindicated in COPD?
Thoracic Vacuum
What models of the 5 model approach are targeted in COPD?
Neurological: T1-7 (SNS), OA/AA (PNS), Chapman’s
Respiratory-Circulatory: Rib raising, Zink patterns, doming the diaphragm
Specific cardiopulmonary considerations (3)
- Consider indirect > direct to avoid unnecessary strain on pt
- Mobilizing too much fluid from periphery to central circulation => high volume stress to CO
- Increasing sympathetic tone can lead to constriction of lymph and systemic blood vessels
Summary of OMM tx in cardiopulmonary pt
- Tx OA/AA using appropriate modality
- Open thoracic inlet
- Rib raising/tx ribs
- Tx diaphragms
- Lymphatic pumps (where appropriate)
- Treat T1-7 dysfunctions
Thoracic Inlet MFR
Doming the Diaphragm
What is the rate for pedal pump?
120x/min
What direction should seated rib raising be directed?
Start at rib angle with T12, pull superiorly and toward the physician
What force is applied with effleurage?
Stroking force distally to proximally
What force is applied with petrissage?
Kneading/twisting force distally to proximally
Where are the quadratus lumborum tenderpoints?
Anterior/Posterior Adrenal Chapman’s point?
Anterior: 2cm lateral, 2 cm superior to umbilicus
Posterior: lateral to spinous process of T11
Viscerosomatic - sympathetic region for lungs?
T1-T7
Viscerosomatic parasympathetic region - lungs?
Vagus N.
