Evidence base and clinical reasoning CIR Flashcards
What is the guideline if a patient’s oxygen saturations drop below 85%?
BTS guidelines say that you put the pt on a non re-breath mask at 15L/min and request urgent clinical assessment.
If the patients saturations are below 94% and they are not at risk of hypercapnic respiratory failure?
BTS guidelines:
Place them on nasal cannula at 2-6L/min or simple face mask 5-10L/min
And adjust according to SpO2
What oxygen saturations do you aim for with COPD pt or conditions at risk of hypercapnic resp failure?
88-92%
What oxygen therapy should you use for patients with COPD or other conditions which put them at risk for hypercapnic resp failure?
BTS:
Use a 24% Venturi mask at 2–3 L/min or hihg flow nasal cannulae at 1–2 L/min
(excess O2 can disrupt the bodies hypoxic drive which stimulates breathing when low O2 is detected)
Important to use a fixed flow device to avoid CO2 retention
When should you consider humidified O2 therapy?
BTS guidelines:
Consider use of a large volume O2 humidifier device for Pt requiring high-flow rates or longer-term oxygen.
especially is sputum retention is a clinical problem
What are the guidelines about lowering O2 concentration?
BTS guidelines:
If the patient is clinically stable and the O2 sats are above target range or if they have been in the upper target range for approx 4-8 hours.
Once O2 delivery removed, the pt should be monitors for 5 mins and be re-checked in 1 hour if they remain in the desired range
Suctioning guide for open suctioning
Bradford teaching hospital guidelines:
If no ET tube/ tracheostomy/ mini-tracheostomy, then NP suction should be chosen over OP, as long as no contraindications exist
What is the research for ACBT
It has found to be effective for short term improvement in respiratory tract secretion clearance and pulmonary function
- Zisi et al
Management of shoulder pain, treatment option research.
Consider 1 or more of the following options for the management:
Taping
NMES
Intra-articular corticosteroid injection
Nerve block
- NICE guidelines (2023)
What is the Bamford stroke classification
A classification systems which categorizes ischaemic strokes based on signs and symptoms without the need for imaging
Pulmonary rehab for COPD (research)
PR should include exercise training for muscles of ambulation (improve exercise tolerance, reduce breathlessness).
Consider PR soon after exacerbation for patients with COPD.
Association of Chartered Physiotherapists in Respiratory Care (ACPRC guideline)
Managing breathlessness with COPD (guidelines)
Diaphragmatic breathing should not be taught routinely to patients with severe COPD
(ACPRC and BTS)
Secretion clearance for patients with cystic fibrosis (guidelines)
Consider high frequency chest wall compression/oscillation when
recommending an airway clearance technique for adults with cystic fibrosis.
(ACPRC and BTS)
Community acquired pneumonia and positive expiratory pressure (guidelines)
Continuous Positive Airway Pressure (CPAP) should be considered for patients with pneumonia and type I respiratory failure who remain hypoxaemic despite optimum medical therapy and oxygen.
(ACPRC and BTS)
What should be considered if a spinal cord patient has an inadequate cough (guidelines)
- Mechanical insufflation-exsufflation should be considered for individuals with upper spinal cord injury, if simpler techniques fail to produce an adequate effect
- Where cough effectiveness remains inadequate with mechanical in-exsufflation alone, combine it with manually assisted coughing.
(ACPRC and BTS)
Airway clearance guideline for patients with neuromuscular disorders
When oxygen saturation falls below 95% the use of non-invasive
ventilation and/or strategies to aid airway clearance should be
considered.
(ACPRC and BTS)
What is the SBAR tool and what is the reference?
NHS England: developed this tool to improve handovers by reducing the risk of error and has a positive effect on patient safety
