Chest Physiotherapy Prescription

Question 1

Positioning of Patient for Lung Volume

Answer 1

Atelectasis.
Side-lying (diaphragm free from abdominal pressure), inclined towards prone + uppermost arm supported.
Recruitment of alveoli, Affected lung in dependant zone (bottom).

Question 2

Positioning of Patient for Gas Exchange (Unilateral)

Answer 2

Affected lung up (spring model) to improve SpO2.
Exceptions: recent pneumonectomy, large pleural effusion, large tumor in main bronchus.

Question 3

Most Homogenous Ventilation

Answer 3

Prone.
Most capillaries in the dorsal part of the lungs, if laying supine, they will be compressed.
Best for ventilation/perfusion matching.

Question 4

Loss of Lung Volume Conditions (6)

Answer 4

Atelectasis
Consolidation (inflammatory process)
Pleural effusion
Pneumothorax
Abdominal distension
Restrictive disorders of lung or chest wall.

Question 5

Deep Lung (Alveoli) Lung Volume Conditions (5)

Answer 5

Atelectasis
Pneumonia
Insufficient Resp I & II
Pulmonary edema
COPD (chronic bronchitis)

Question 6

Slow Deep Inspiratory Exercises - Types

Answer 6

To increase lung volume/open collapsed alveoli we either decrease even more intrathoracic pressure (slow deep inspiration) or increase alveoli pressure (PEP).

Question 7

Breathing Exercises to Increase Lung Volume (6)

Answer 7

Deep Breathing (slow inspiration)
End inspiratory hold (boosts collateral ventilation)
Abdominal breathing
Sniff (after full inspiration, collateral ventilation)
Rib springing/vibrations
SIGHS

Question 8

Incentive Spirometry

Answer 8

Facilitates slow and deep inspiration. Visual feedback of volume and flow. Can prevent and reverse atelectasis.

Question 9

EDIC

Answer 9

Controlled inspiratory debit exercise.
Slow inspiration maneuver applied in side-lying with affected lung up. Elastic properties of the lung pull the alveoli open.

Question 10

RIM

Answer 10

Resisted inspiratory maneuver.
Maximal inspiratory maneuver from residual volume against a fixed resistance. Slows down the flow to reach the alveoli.
Improves weaning from mechanical ventilation, improves dyspnea during exercise and QoL in COPD paitents.

Question 11

Contraindications for End Inspiratory Hold, EDIC and RIM (6)

Answer 11

Pain
Severe hypoxemia
Resp. muscle fatigue
No compliance
Bronchospasm
Non-drained pneumothorax

Question 12

Outcomes for End Inspiratory Hold, EDIC and RIM (7)

Answer 12

SpO2
PaO2
RR
Breathing pattern
Auscultation (vesicular sounds)
HR
BP

Question 13

CPAP/BILEVEL

Answer 13

Continuous positive airway pressure.
Splints open alveoli, ↑ ventilation, gas exchange → ↑ exercise tolerance. Balance EPP. Improves hypercapnia, allows escape of trapped gas (COPD).
For spontaneously breathing patients.
Obstructive sleep apnea: keeps extrathoracic airways open.
Non-invasive ventilation.

Question 14

Airway Clearance

Answer 14

ELTGOL
FET
DA
Chest compression/vibration

Question 15

ELTGOL

Answer 15

Removes secretion in intermediate bronchi.
Side-lying with affected lung at the bottom. Slow and prolonged expiration with glottis open, also help in inspiration.

Question 16

FET

Answer 16

Forced expiratory technique
Increase expiration time and flow.
Low volume: small airways, big volume: large airways.
Huffing with an open mouth, tongue out.

Question 17

DA

Answer 17

Autogenic Drainage. Breathe in, hold 5 sec, breathe out. Start with low volume, then moderate and large. To move secretion from small airways to large.

Question 18

Chest Compressions/Vibrations

Answer 18

Gain expiratory volume by compressing chest, vibrations modify viscoelastic properties of secretion.

Question 19

PEP

Answer 19

Positive expiratory pressure device.
Alveoli recruitment via collateral channels. Prevents airway collapse. Displaces EPP to central airways.
Improves chronic cough and mucus production.
Resistance on out end.

Question 20

OPEP

Answer 20

Oscillatory positive expiratory pressure device.
Helps remove secretion with turbulent flow, changes viscoelasticity of secretion.
Flutter and acapella.

Question 21

Airway Clearance - Extrathoracic Airways (6)

Answer 21

Inhilation of saline solution (hydrate secretion)
Nasal showers or DRR (snorting).
Mechanical IN/EXsufflator
Nasotracheal suctioning
Orotracheal suctioning

Question 22

Airway Clearance Intra and Extrathoracic - Contraindications

Answer 22

Pain
Bronchospasm
Non-drained pneumothorax
Relative:
Increased intracranial pressure
Resting tachycardia
Rib-fracture

Question 23

Airway Clearance Intra and Extrathoracic - Outcomes

Answer 23

SpO2
PaO2
RR
Breathing pattern
Auscultation (crackle reduction, vesicular sound improved)
HR
BP