Cardio Flashcards
What are the 6 physio problems for Cardio?
- Impaired A/way clearance
- Impaired Gas exchange
- Exercise Tolerance
- Reduced Mobs
- Low Lung Vol
- Dyspnoea
What’s the difference b/n asterisk, clinical signs and contributing factors?
*- measurable, expect them to change w/ treatment
CS- maybe measurable or not, difficult to reassess e.g. collapse on CXR
CF- assist in explaining * pathophys., e.g. prolonged bed rest explains reduced mobility
Where do you auscultate anteriorly?
1- Below clavicle close to midline, ~T1
2- Under armpit level
3- Lower under armpit, mid-axillary line
Where do you auscultate posteriorly?
1- T1 level
2- Inside scapular border
3/4- T10 level, one closer to spine
How many breaths at each auscultation point are required?
2
How do you measure degree of inspiration in thoracic Xray?
Count no. of ribs above diaphragam, should meet at 5-7 along midclavicular line
Which hemidiaphragm sits higher?
Right due to liver
What is consolidation and how does it appear on Xray?
Air filled spaces replaced by products of disease e.g. water, pus, blood
White opaque appearance, dark worms, loss of demarcated borders
How does atelectasis appear on Xray?
Increased whiteness on affected lobe
Affected areas pulled adjacent structures towards them
What does sailsign indicate?
Left lower lobe collapse
How does pneumothorax appear on Xray?
Thin white lines parallel to chest
What is subcutaneous emphysema and how does it appear on Xray?
Presence of air in soft tissues
Blackened fascial planes within soft tissue, striations of muscles appear
What is pleural effusion and how does it appear on Xray?
Fluid b/n visceral and parietal pleura layers
Opaque meniscus (think test tube) and blunting of costophrenic angle
How does congestive heart failure appear on Xray?
Pulmonary oedema, fair floss appearance
What is the typical approach for a thoracic surgery?
Posterolateral
How does general anaesthesia affect the lungs?
- Decreased FRC
- Reduced lung compliance
How does postop pain affect recovery?
Sympathethic responses- tachy and HTN
Impair Respiratory- weak cough, low tidal volumes
Biggest barrier to early mobs
How does general anaesthesia impact mucociliary function?
Paralysed cilia, reduced humidification and thus dried airways, increased secretion viscosity as secretions cannot be cleared
How does general anaesthesia impact atelectasis?
Usually tidal volume lies above closing capacity, general anesthesia lowers tidal volume causing it to fall below closing capacity and atelectasis
What is PPC?
Pulmonary abnormality that produces disease or dysfunction following surgery
What time period does PPC usually occur?
First three days postop
How is PPC diagnosed?
Melbourne Group Score, 4 or more clininical, diagnostic or other factors in one day
e.g. ausc, sputum, collapse, WCC, pneumonia
What are some risks for PPC pre, peri and postop?
Pre- age, smoking, resp disease, fitness, obesity (all increase closing capacity
Peri- haemorrhage, surgery length
Post- delayed mobs
Where is atelectasis the greatest typically?
Regions close to diaphragm
What is acute cardiopulmonary dysfunction and how does it occur?
- Impairment in one or more steps of oxygen transport system
- Impact of acute illness and prolonged bed rest
- Incl. CV, resp, MSK and other changes (cognitive, metabolic)
What are the CV aspects of acute cardiopulomary dysfunction?
- Fluid moving from periphery to thorax
- Impaired blood flow regulation
Risk of DVT
Blood viscosity
Increased filling pressure, reduced cardiac output and cardiac stress
Increased HR
What are the respiratory aspects of acute pulmonary dysfunction?
- Decreased VO2max
- Increased WOB
- Risk of pneumonia and atelectasis
- Decreased exercise tolerance
What are the MSK aspects of acute pulmonary dysfunction?
Reduced muscle mass, tone and strength and endurance
What are the other aspects of acute pulmonary dysfunction?
- Lowered immunity
- Decreased metabolism and appetite
- Anxiety and depression
What’s the aim of mobs in acute cardiopulmonary dysfunction?
- Increase ventilation and lung volume
- Mucociliary clearance
- CV fitness
- Reduce cognitive issues and improve psychological wellbeing
- Optimise independence
What is the rationale behind exercise helping low lung volumes?
Exercise increases ventilation of atelectatic regions, inflating more alveoli which will in turn pull open adjacent alveoli
What is the rationale behind exercise for airway clearance?
- Increased ventilation to alveoli, with air going through collateral channels to clear obstructions
- Also an increased lung volume will increase power of cough
What drop in BP indicates postural hypotension?
Greater than 20/10 mmHg drop
What are some signs of postural hypotension?
Nausea, dizziness, fatigue, sweating
What are some strategies to manage postural hypotension?
Daily sitting, dangling legs and standing
What is the normal range of RR?
12-16
What is the normal, precaution and contraindication range of Hb?
12-18 g/dl
<10
<8
What pain level is okay to mobilize?
Below 7
What are the intensity guidelines for mobs?
10-20 beats above resting HR
3-5 on Borg exertion, somewhat hard
In ausc, what does reduced or absent sound indicate?
Atelectasis, postop
In ausc, what does fine inspiratory crackles indicate?
A/ways opening up
In ausc, what does coarse crackles indicate?
Secretions/sputum
May be COPD or pneumonia
In ausc, what does wheeze indicate?
Brochnospasm e.g. asthma
What are instructions for ausc?
SOOB, breathe in and out through mouther slightly deeper and faster than normal, rest if feeling dizzy, 5-6 breaths at a time
What is the dosage for TEEs?
6x6 2-3 times a day
What is the dosage for SMI?
2-3 reps
What does open heart surgery on pump mean?
Cardiopulmonary bypass, blood is removed, oxygenated and then mechanically pumped back into the aorta
What are the pros and cons of open heart surgery off pump?
Less operative time and risk of cerebral emboli
Harder to access posterior heart and maintain haemodynamic stability
What is an example of a peripheral procedure and when is it used?
Catheter finds occlusion, inflate balloon to allow reperfusion. Done in STEMI with no comorbidities
What are some surgery requirements for coronary artery bypass grafting?
Hypothermia: protect myocardium by reducing O2, rewarmed after surgery
Cardioplegia: induced asystole
What are the considerations for postop support in cardio surge?
- Organ perfusion
- Minimize cardiac demand
- Maintain gas exchange
- Reduce PPC
What are some preop, periop and postop risk factors?
Pre- fraility, 65+, low PA
Peri- non-elective, intraoperative bleeding, surgery >4-6 hours
Postop- delirium, delay mobs, ICU LOS >5 days
What does the literature say about UL exercises in cardiac surgery?
Less sternal pain post discharge
What does the literature say about moderate intensity exercises in cardiac surgery?
Higher function (6MWD) at D/C
What are cardiac surgery sternal precautions?
- Do not lift arms above 90
- No objects 2kg+
- Do not reach backwards
- Do not push through arms
4-6 weeks from time of op
What is temporary pacing?
Helps heartbeat go back to regular pace after surgery
How to treat low lung volumes?
Mobs
Deep breaths
SMI/TEE
Inspiratory Muscle Training
NIV
How to treat excessive secretions?
ACBT
Gravity Drainage
PEP
Flutter
Exercise
How to treat dyspnoea?
Relaxation positions
Pursed lip
Breathing control
How to treat exercise tolerance?
Prehab, rehab and exercise
How long are SMIs held?
3 seconds
What is the physiological explanation of SMI?
Expands to TLC, gas enters areas of low lung compliance and re-expand collapsed alveoli
Go through collateral ventilation to clear any secretions
What is the dosage for breathing exercise?
5 breaths to TLC/hour
What is the reasoning behind IMT?
Strengthen muscles to assist with inspiration
What occurs in respiratory prehab?
Education e.g. PPC
Explain postop mobility
Teach ACBT
What is the reasoning behind CPAP?
Positive airway pressure on insp and exp, keeping air in lungs and increasing FRC
What does high flow O2 allow?
Reduced RR
Increased end expiratory and tidal lung volume
Reduced WOB
Improved mucus clearance
Whats a lobectomy and pneumonectomy?
Taking out a lobe and taking out a lung
What are the two thoracotomies?
Posterolateral- divides lats
Anterior- muscle sparing
What are the adv and dadv of video assisted thorascopy?
A- Minimal trauma, option for higher risk pts, less pain
D- takes longer, higher risk pt
What are the three chambers of UWSD?
1st- collects fluids
2nd- underneath level of water, controls air unilaterally
3rd- suction, regulates negative pressure
What 4 things in UWSD are Ax?
Swing- no swing = all fluid drained or occlusion
Bubbling- air leak
Volume drained
Suction with balloon, should peak out to show adequate suction
What does 1 pack year mean?
1 pack a day for a year
Where does oesophageal cancer appear?
Generally appear near gastro oesophageal junction or middle and upper oesophagus
Spreads deeper into layers of stomach and then beyond
How is oesophagus cancer treated?
Chemoradiotherapy
Oesophagectomy (always on right)
What is the precautions of oesophagectomy?
- No head tip down
- Avoid neck extension
- Avoid suction or high PAP
What are common vascular presentations?
- Ulcers
- Necrosis
- AAA
What are common surgeries for vascular issues?
- Revascularization (angioplasty balloon dilate, stenting, bypass)
- Amputation
- AAA repair
What are considerations for amputation?
- Healing before mobs
- Prevent contractures (elevate stump, rigid dressing)
- Phantom limb
- Impaired balance/falls risk
- Stump care
How is amputation managed?
- Preop counselling and education
- Prosthetic training
- T/F options, avoid hopping
What is the highest priority for vascular surgery postop?
Preserve contralateral limb
What areas are the dermatome tests?
L1 Lateral groin
L2 Slightly lower
L3 Medial near knee
L4 Medial calf
L5 Lateral anterior
S1 Heel
S2 Popliteal Fossa
What are potential causes of dyspnoea?
Resp- pneumonia, atelectasis, COPD
CV- congestive heart failure
Neurological- resp m. weakness
Psychological- anxiety, depression
What are clinical features of dyspnoea?
- Breathing rate
- Pursed lips
- Reduced exercise tolerance and communication
- Fatigue
- Overuse of accessory muscles => weight loss
- Panic and anxiety
How should you behave around dyspnoeic pts?
Talk quietly, slowly
Yes/no Q’s
Do not make dyspnoea worse
What is the modified Borg?
Measures shortness of breath 1-10
What positions help dyspnoea?
Tripod- fix shoulders reverse attachment, employs accessory muscles
Forward lean- hands on either side of table, relax shoulders, contraindicated for back issues
Supported lean- anchor chest to hard surface allows postural muscles to relax, conta for balance
High side lying- push up abdominal content, diaphragm in better position, for sleep
What is the rationale of pursed lip breathing and the dosage?
PEP splints open airways, prevents gas tapping
2 s inhale, 4 s exhale
What’s the rationale behind pulmonary rehab?
- Less ventilation for same work
- Reduced hyperinflation
- Improved overall body funcitoning
What are normal values for ABG?
pH 7.35-7.45
CO2 35-45
O2 80-100
HCO3 22-26
What distinguishes respiratory and metabolic acidosis/alkalosis?
Acidosis- resp acidotic CO2
metabolic acidotic HCO3
When is O2 therapy required?
- Hypoxaemia/hypoxia
- Resp distress
- Cardiac arrest
Distinguish between hypoxaemia and hypoxia?
Hypoxaemia- low O2 in blood
Hypoxia- low O2 in tissue
Distinguish between Flow and FiO2
FiO2- concentration of O2 that a person inhales
Flow- steady continuous supply
What is peak inspiratory flow demand?
Maximal inspiratory flow required during tidal breathing
Normal 25-35 L/min
How do you work out average FiO2?
Av FiO2 = FiO2/PIFD
What does high flow mean?
Matching or exceeding PIFD
Distinguish between variable and fixed performance devices
Variable- flow less than patients minute volume, vary with rate and volume of breath
Fixed- known concentration of O2 at a higher flow rate
What is a standard variable O2 therapy?
Nasal prongs
Hudson mask- min 6L/min
What is a standard fixed O2 therapy?
Venturi- humidified, <15L/min
What is a fixed high flow O2 therapy?
AIRVO- humidified, 2-60 L/min
What are signs of COPD?
Barrel chest
Wheeze
High RR
Tachycardia
Fatigue
What is a physios’ role in COPD?
- Pulmonary rehab
- Breathing exercise
- A/way clearance
- Manage exacerbation
What are causes of ILD?
Infection/virus
Occupation exposure
Radiation
Mostly idiopathic
What are features of ILD?
Dypsnoea on exertion
Dry cough
Fatigue
How is ILD treated?
- Pulmonary rehab
- Anti-fibrotics
- Smoking cessation
- Breathing exercise
What is Equal Pressure Point and why is it relevant?
Point at which pressure in pleura is higher than that in alveoli, compressing airways
This is the rationale for FET moving secretions
When is each phase of AD progressed?
3 breaths, 3 huffs
ERV, move when crackles at end of expiration
TV, prolonged crackles
IRV, coughing
What are contra for GAD?
Post eating
Reflux
Head or neck surgery
What is the rationale behind high flow?
Reduce physiological dead space
Reduced WOB
Humidification
Why is humidification needed in high flow?
- Inhalation of dry gas reduces humidity
- Prevents drying of sputum
What is type I and II respiratory failure?
I- Hypoxaemia PaO2 <60
II- Hypoxaemia and hypercapnia PaCO2 >45 PaO2 <60
What is the rationale of CPAP?
Treats Type I respiratory failure, positive pressure on insp and exp
Collateral ventilation, opens alveoli, increasing FRC, increased gas exchange
Who should receive CPAP?
Postop
Immobilized
Chest wall abnormalities
What are precautions/contra of CPAP and BiPAP?
Oesophageal surgery
Vomiting
Prescence or risk of pneumothorax
Facial trauma/burns
Facial Fracture
What is the rationale of BiPAP?
Treat Type II respiratory failure, PAP throughout but different levels of pressure with exp lower than insp
Lower PaCO2 by increasing tidal volume
Lower WOB
Lower RR, longer expiration
Who should receive BiPAP?
Hypercapnic- COPD, bronchiectasis, CF
What are the three types of bronchiectasis?
Cylindrical- enlarged and cylindrical
Irregular- some dilated some constricted
Saccular- clusters or cysts
What is the pathophys of bronchiectasis?
Infection (potentially from COPD or CF) -> Inflammation -> Airway Damage (elastic and muscular tissue, high mucus production) -> Impaired Clearance -> Infection
What are features of bronchiectasis?
Fatigue
Cough
Chest pain
Dyspnoea
How is bronchiectasis Ax?
Spirometry
Sputum
ABG
Imaging
How is bronchiectasis Mx?
- Antibiotics, bronchodilators, mucolytics
- A/way clearance lit
- Pulmonary rehab lit
What is the rationale of PEP?
- Breath towards a resistor, positive pressure
- Increase FRC, slightly larger insp volumes
- Elastic recoil increases and uses collateral ventilation to get behind secretions
What is dosage of PEP?
6x6, 6 breaths followed by FET and cough
2-3 s in, hold 1-2, out 3-4s
What are precautions for PEP?
Facial #
Pneumothorax
Post lung lobectomy
What is Hi PEP?
Same equipment with mask but 8-10 breaths, FET against mask
What benefit does OPEP have?
Creates vibrations, further mobs of secretions
How is bottle PEP set up?
10-12 cm deep (threshold resistance), tube cannot touch bottom
Water discarded after each treatment, wash bottle
How can exercise act as an ACT?
- Increases RR, recruitment of lung units
- Increase flow speed, more sheering
How does CF occur?
CFTR mutation
What is the pathophys of CF?
- Mucociliary escalator impaired, cannot clear mucus
- Infection
- A/way damage
- Further impaired cilia Fx and destruction
What are the features of CF?
- Chronic cough
- Dyspnoea
- Haemoptysis
- Coarse insp crackles
- Reflux
- MSK pain
How is CF managed?
- ACBT, PEP, AD, GAD
- Exercise, strength, fitness, spinal mobility
- MSK Mx, posture advice, weight bearing activity
- Mucolytics
- Pelvic floor strength/endurance for continence
How can you adapt Rx in CF children?
- Less percs and vibes
- Assisted AD
- Creative to keep engaged
What is dosage of IMT?
2 X 15
Aim 20mmHg
What is the pathophys of diastolic and systolic heart failure?
Diastolic- too little blood into stiff ventricles, barely filled thus little blood pumped out, stretch stimulus encourages hypertrophy
Systolic- filling enlarged ventricles, not enough pressure to pump out blood
How is heart failure Mx?
- Pharmaco, ACE, beta blockers
- Life style, salt intake, weight, diet
- Pacemaker
- Exercise, no guidelines, early ambulation in stable pts, reduced LOS and readmission
Describe the phases of cardiac rehab
Phase 1: inpatient, 1-3 times daily 5-20 min, resting HR +20, 3-4/10 Borg
Walking, stationary cycling, prevent PPC
Phase 2: outpatient 4-12/52,
5-7 times/week, moderate intensity, 60 min
Max exercise capacity
Ax, education, nutrition
Phase 3: LT maintenance, behaviour change
What are the benefits of HF exercise?
- Improve QoL
- Increase VO2 Max (associated with survival
- Reduce fatigue
- Improve dyspnoea
How do you prescribe aerobic intensity for walking?
80% x (6MWT distance/ 6x prescribed duration)
e.g. 220m 6MWT, 36.7m in 1min
30 min distance 1101m
80% of 1101m = 881 m in 30 min
How do you prescribe aerobic intensity for treadmill speed?
Speed= 80% 6MWT average speed
e.g. 300 m in 6min, 0.3 km in 0.1 hr = 3km/hr
80% of 3= 2.4km/hr
What is the dosage for resistance training 0-4 weeks post surgery/HF and 4+ weeks?
0-4: 12-15 reps, 1-3 RPE
4+: 8-12 reps, <5 RPE
How do you determine target HR?
THR = ((max HR - resting HR) x intensity) + resting HR
Max HR 220-age
THR = ((197- 50) x 50%) + 50
THR = (147 x 50%) + 50
= 73.5 + 50 = 123.5
What are indications to stop exercise?
- Excessive sweating
- Palpitations
- Dizziness, breathlessness
- Physical inability to continue
What are the five malignancy types?
Carcinomas- epithelial
Sarcinomas- muscle/bone
Melanomas- skin
Lymphoma/leukemias- blood cells
Germ cell tumours
What are the side effects of cancer surgery?
- Pain
- Low mobility/Fx
- PPC
What is radiotherapy and its side effects?
Electron radiation, free radicals damage cancer cell DNA
Damage to healthy cells and inflammatory response causes
- Fatigue
- Flulike symptoms
- Joint stiffness
What is chemo and its side effects?
Chemical substances that interfere with mitosis
- Anaemia
- Fatigue
- Nausea
- Cognitive problems
What are cancer guidelines?
Moderate intensity 3 times a week for at least 30 min
Resistance at least 2 times a week
What are the benefits of exercise in cancer?
- Reduce fatigue, anxiety, depression
- Prevent deconditioning
- Increase tolerance to treatment
- Higher recovery profile
Lit
What are precautions for exercise in cancer pts?
- Avoid activities with significant balance and coordination
- Mild intensity
- Fatigable pts, break down into smaller parts
What are some prehab for cancer exercises and their dosage?
Walking, cycling, STS, resistance, inspiratory muscle
4-6 RPE, at least 2 weeks, 4 weeks best
What are the aims of pulmonary rehab?
- Reduce symptom burden
- Increase participation
- QOL
- Promote autonomy
What are considerations for pulmonary rehab with COPD pts?
- Limited due to dyspnoea, dynamic hyperinflation, resp load, may be deconditioned
- Improve oxidative capacity, reduce ventilation requirement, reduce hypercapnoea
What is the dosage for Phase 2 Pulmonary Rehab?
6-12/52
4-5 x week
60 mins
Moderate intensity
Endurance + resistance
What are some resistance exercises in pulmonary rehab?
- Leg extension, squat, step ups
- Abduction, rows
What is the dosage for Phase 1 Pulmonary rehab?
1-3 x day
5-20 min
Light intensity
Walking, cycling, functional
What is a common problem for axilla node dissection pts?
MSK dysfunction, pain and numbness
What is 1’ and 2’ lymphoedema?
1’ excessive accumulation of lymph fluid due to genetic malformation
2’ same but due to damage or destructions of lymph nodes (surgery or cancer)
What are some dissection precautions?
Limit ROM and WB for LL
Why is neuropathic pain seen in neck lymph node dissection?
Spinal accessory nerve may have to be sacrificed
What are the greatest risk factors for ENT cancer?
Tobacco and alcohol
What are some complications of flap reconstruction?
Ischaemia, haemotoma, infection, wound healing failure
What are some considerations for surgeries around the face?
Vestibular issues
Facial nerve palsy
Tracheostomy
CSF leak
What are some considerations for laryngectomy?
Humidification and coughing issues due to absent glottis
Communication
What are the 4 categories in the gen med ward?
Palliative care- no longer responsive to curative treatment
Acute reversible conditions e.g. pneumonia
Non-acute patients with urgent needs e.g. falls
Exacerbation of chronic disease e.g. COPD
What is the main aim in palliative care?
Maximize QOL and manage symptoms
What are common symptoms in UTIs?
- Dysuria
- Increase urgency
- Haematuria
- Fever
- Confusion, drowsy, agitated
How can physios manage UTI pts?
- Education on IDC (in dwelling catheter)
- Pelvic floor retraining
What are the most common comorbidities?
HTN and T2D
How are exacerbations managed by physio?
- May alter Fx
- Smoking cessation
- Prevent readmission
Where does oedema occur in LHF and RHF?
LHF- pulmonary
RHF- LL
What are some symptoms of cardiac failure?
- Dyspnoea
- Fine crackless
- Peripheral oedema
- Pink, frothy sputum
How is cardiac failure managed?
- Diuresis (more urine) and fluid restrictions to lower volume for heart to pu,p
- Oxygen therapy and NIV to treat hypoxia
What is the age that falls risk is significant?
65
What is functional decline?
Decrease in physical/cognitive Fx, less likely to be able to complete ADLs
What are adverse outcomes of functional decline?
- Decreased indep
- Pressure areas
- Falls
- Delirium
What are the four aspects of functional decline maintenance program?
Physical- exercise, mobs
Nutrition
Cognitive- stimulation, prevent decline
Occupational performance- ADLs e.g. showering, feeding
What is delirium?
Disturbance of consciousness, attention, cognition and perception often caused by trigger
How is delirium diagnosed?
CAM ICU
How can delirium be managed?
- Regular mobs
- Family visits
- Reorientation (e.g. room with window for time orientation), reassurance
- Reduce stimulation and noise
What are some outcome measures used in gen med?
- DEMMI
- mILOA
- 5x STS
- SPPB
- Berg Balance Scale
What is PAC?
Therapy in home, 1-2 sessions over 4 weeks
Achieve ST goal or gap until community therapy
What is rehab in the home?
2-5 times per week, 4-12 weeks
ST and LT goals
What is commonwealth home support program?
65+, low level support
Meals, allied health, domestic assistance, transport
What is hospital in the home?
Daily visits 2-4 weeks medical and nursing
What is subacute@home?
Home based alternative to inpatient rehab, daily input but non-intensive therapy
What is inpatient rehab?
MDT goals, 2 sessions of PT daily, any age
What is GEM?
MDT goals, slower stream than IPR, 2-5 days a week
What is residential care and respite?
Resi: high care needs, PT mostly for maintenance
Respite: aims to return home after period of high care need
How do neural pathologies affect the respiratory system?
Degeneration of neurons may affect diaphragm for inspiration, or glottis and abdominals for cough
What is spinal shock?
Temporary areflexic state with impaired autonomic control and muscle tone below level of injury
What is neurogenic shock?
Reduction of thoracic sympathetic innervation resulting in bradycardia and vasodilation
What is paradoxical breathing?
Flaccid intercostals allow chest wall depression and flaccid abdominals expands stomach out and reduces expiratory force
How does a cough assistance machine (in/exsufllator) help resp issues?
Positive pressure on insp, volume restoration
Negative pressure on exp, increase exp, sucks out
Begin with low pressure and progress
Expiratory flow can create sheer forces
What are precautions for cough assistance machine?
Pneumothorax, contra without drain
Bronchospasm
Thoracic, gastric or oesophageal surgery
Contra- active airway obstruction, emphesema
What is a nippy?
Similar to cough assistance machine, volume restoration and aids sputum clearance
What is the positioning for manual assisted cough?
Hands over abdomen and chest wall, time compression with exp
What are precautions for manual assisted cough?
Spinal cord injury, #s, pregnancy, recently eaten
What is the carina?
Area of nerve fibre in trachea that stimulates cough
What are the implications of traches?
No air through upper airways
- Loss of voice
- Impaired cough
- Impaired swallow
What are indications for suction?
- Moist cough or sounds gurgly
- Difficulty coughing
- Decrease in sats
When is nasopharyngeal indicated and contraindicated?
Central palpable fremitus
Contra- #s, facial trauma, burns
How is manual hyperinflation applied?
Bag inflates
Compress to coincide with insp
6x6
When is ventilatory hyperinflation used over MHI?
Avoiding disconnection of ventilation
What is a STUMBL score?
Predicts outcomes in those with rib #s
Age, number of #s etc.
What is flail chest?
Floating segment of thoracic cage due to fractures, sucked in during insp, blown out during exp
Reduces TV, increases RR and WOB
How is rib # managed?
- Analgesia
- Fixation
- Oxygen therapy
- Mobs
What is a pulmonary contusion and its consequences?
Injury to lung parenchyma in absence of any lung tissue or vascular laceration
- atelectasis, bronchial obstruction, decreased compliance and FRC, increased WOB
What is pneumothorax?
Air in pleural space
Can decrease lung volume and collapse lung impair gas exchange
How is PTx managed?
- ICC
- Pleuroextomy
What is pleural effusion and how is it managed?
- Fluid in pleural space, decreases chest movement, decreased breath sounds
- ICC, surgery
How does spinal cord injury affect resp?
Decreased ability to breathe deeply and cough forcefully, paradoxical breathing
What are treatments for spinal cord injury resp pts?
- Manual assisted cough and insufflation-exsufflation
- NIV
- Abdominal binders
- Resp muscle training
What is shock?
Imbalance between oxygen supply and demand
What is sepsis?
Vigorous inflammatory response to infection, can progress to septic shock where blood pressure drops and lactate rises which is life threatening
What is ARDS?
Collection of symptoms involving refractory hypoxemia and pulmonary oedema
What is ECMO?
Life support, external pump and oxygenator
What is continuous renal replacement therapy?
Dialysis, filters blood
What is evidence for hyperinflation?
Helps atelectasis, lung compliance and gas exchange
What is a MET call and when is it called?
Pt fulfils one or more predefined criteria
e.g. HR <40, >130, RR <8, >30
Why is proning performed in the ICU?
Gets air into posterior of lungs
What is the RIKER scale and what does it measure?
1-7- unarousable to dangerous agitated
4- calm, cooperative
Agitation and alertness
What is the RASS scale and what does it measure?
+4 Combative to -5 Unarousable
0 Alert and calm
Agitation and alertness
What are the 5 commands of De Jonghe and what does it measure?
Open (close) eyes
Look at me
Open mouth stick out tongue
Nod
Raise eyebrows when I reach 5
Alertness
When is the day of awakening?
When pt responds to 3/5 of De Jonghe on 2 consecutive tests in 6hour period
What are the 4 aspects of CAM ICU?
- Any changes from baseline, no, no delirium
- SAVEAHAART, squeeze hand when I say ‘A’, 0-2 errors no delirium
- RASS, other than 0, no delirium
- Disorganized thinking , 0-1 error, no delirium
What are the 4 questions of disorganized thinking in the CAMICU?
- Does a stone float on water
- Are there fish in the sea
- Does one pound weigh more than two pounds
- Can you use a hammer to pound a nail
What are the aspects of PFIT?
Assistance STS
Cadence
Sh F Grade
Kn E Grade
ACSK
What is ICU acquired weakness?
Detectable weakness developed in critical pt with no indentifiable cause
What is a sign of ICU AW?
<11 kg male grip strength
<7 kg female grip strength
<48/60 MMT
What movements are assessed in ICU AW MMT?
Sh Ab
Eb F
Wr F
Hp F
Kn E
DF
What is Post Intensive Care Syndrome?
Series of health problems following ICU stay
What are risk factors for PICS?
- Prolonged MV
- Sepsis
- Prolonged bed rest
- ARDS
- Delirium
- 50+
- Trauma
- HTN
What is the % of ICU survivors who experience PICS?
80%
What are recommendations for ICU exercise?
Early mobs, <72 hours of ICU admission
Break up sedentary time
Bed exercise
