CHEST PRESCRIPTION Flashcards
Prescription of alveoli
Tableau summary
Prescription of intra-thoracic airway
Summary
Prescription of extra thoracic airway
Summary
Pathologies possible for ≠ types of alveoli pbs
Summary
Strategy of absence of blood flow in alveoli
Controlled mobilisation “GET UP AND WALK”
1. Upright posture (reduces pressure on diaphragm) 2. Natural deep breathing
3. 1st line strategy for patient who can get out of bed
Get up & walk: not a technique it’s a strategy
Positioning description
Used in its own right or conjunction with other techniques
Physiology of positioning: modify pressure of viscera against diaphragm
Positioning for lung volume (atelectasis +)
- Side-lying: diaphragm free from abdominal pressure - Inclined toward prone + uppermost arm support
Positioning for improving alveoli blood perfusion
- Perfusion not even in lung
- Prolonged bed immobilization reduces both ventilation & perfusion on dependent zones
Positioning for gas exchange (unilateral lung disorders) - Affected lung up rule (spring model)
Exceptions:
- Recent pneumonectomy
- Large pleural effusion
- Bronchopleural fistula
- Large tumor in main stem bronchus
- Any situation in which oximeter or patient comfort contradicts above
Positioning for recruit alveoli
- Unaffected lung on dependent zone
Most homogenous ventilation - Prone
4 factors of cardiopulmonary dysfunction
- Underlying disease pathophysiology
- Bed rest/recumbency & restricted mobility
- Extrinsic factors imposed by patient’s medical care (surgery, invasive lines…)
- Intrinsic factors relating to patient (age, gender, congenital abnormalities, smoking history, obesity, nutritional deficits…)
Conditions with lost lung volume & decrease gas exchange + def of each
Atelectasis = collapse from few alveoli to whole lung
Consolidation = inflammatory process
Pleural effusion, pneumothorax, abdominal distention = compression of lung
Restrictive disorders of lung or chest wall
Causes of disorders with lost of lung volume & decrease of gas exchange
Prolonged period of shallow breathing
Pleural disorder
Surfactant depletion
Diaphragm inhibition from poor positioning
Pain
Compression from abdominal distention or neurological impairment
Mucous plug
Slow inspiration breathing exercises: description of each
- Deep breathing
- End-Inspiratory Hold: boosts collateral ventilation
- Abdominal breathing: improve lung inflation & oxygenation in post-operative patients
- Sniff : after full inspiration : collateral ventilation
- Rib Springing/Vibrations : chest compression during expiration, quick release at end-expiration
EDIC & RIM = slow inspiration applications
Slow inspiration applications description of each
Exercice à débit inspiratoire contrôlé (EDIC)
“débit” = control flow
= slow inspiration maneuver applied on side lying placing affected lung on supra-lateral
- Associates superolateral lung hyperinflation with increasing transversal thorax diameter
- Increase effect of gravitational forces over parenquima
=> only model which do not follow spring model for positioning of patient
Resistive Inspiratory Maneuver (RIM)
- Improve lung volume
= maximal inspiratory maneuver from residual volume against fixed resistance (2mm wide resistor or spring load)
- Inspiratory pressure must be calibrated to 80% of MIP
Incentive spirometry
If patient unable to do previous exercises
- Sustained deep breath can be facilitated
- Visual feedback of volume & flow
- Can prevent & reverse atelectasis
- Same effect can be obtained by deep breathing without incentive spirometer
Indications,contra indications & outcomes of slow inspiration
Tableau
Positive airway pressure: who, what, effects & indications, complications, contra-indications & technique
WHO
- For spontaneously breathing patients
- FRC improved by PAP
- Gas exchange improved by pneumatically splinting open of alveoli
WHAT
- 1st choice to improve hypercapnia
- CPAP delivers same flow of air at inspiration & expiration - BILEVEL delivers 2 levels of pressure:
• IPAP: Inspiratory
• EPAP: Expiratory (always lower than IPAP)
EFFECTS & INDICATIONS
- Pneumonia
- Pulmonary edema
- Flail chest
- Postoperative patients
- Raising FRC primarily aimed at improving gas exchange rather than recruiting lung volume - Atelectasis prevented
- Resolution of atelectasis requires increase in VT rather than FRC
- Splint open airways : allow escape of trapped gas, dec. hyperinflation (severe COPD)
- Obstructive sleep apnea
- Improve exercise tolerance by improving gas exchange
COMPLICATIONS
- Restriction of depth of breathing
- Chafed skin, sore ears or dry eyes (mask)
- Bridge of nose (skin injury)
- Gas forced in stomach
- Coughing requires removal or adjustment to avoid high
pressure that damage ears or pneumothorax (emphysema, late-stage CF)
- Alveolar vessels compression : blood distribution chest => abdomen
• Inc. right ventricular afterload => reduce cardiac output
- CO2 retention occur if hypercapnic patient breathes with small VT against high pressure setting (CPAP)
CONTRAINDICATIONS: should not be used
- Barotrauma (undrained pneumothorax, subcutaneous emphysema) - Inability to protect airway from aspiration
- Facial trauma including surgery
- Excessive secretions
- Haemoptysis of unknown cause
TECHNIQUE
1. High-dependency area
2. Explanations, consent => pressure chosen usually 5-10cmH20
3. Flow turned on
4. Patient assists with putting on mask (reduce anxiety). Mask not strapped until patient ready 5. Flow, pressure & FiO2 readjusted for patient comfort & target SpO2 6. Regular checks
7. Mask should be removed before turning off flow
Slow expiration description
ELTGOL (Expiration Lente Totale Glotte Ouverte en infra latéral)
- Consists of performing slow & prolonged expirations with glottis opened from functional residual capacity to residual volume, in lateral decubitus position with affected lung in inferolateral position
- During expiration, chest & abdominal compressions performed by patients to enhance technique’s efficacy
ACBT
= combines ≠ breathing techniques helping clear mucus from lungs in 3 phases
- 1st phase helps you relax your airways
- 2nd phase helps you to get air behind mucus & clears mucus
- 3rd phase helps force mucus out of your lungs
