Foundational Info Flashcards
Shoulder abduction, myotomes patterns
C5
Shoulder adduction, myotomes patterns
C6, C7, C8
Elbow flexion, myotomes patterns
C-5, C6
Elbow extension, myotomes patterns
C6, C7
Wrist flexion and extension, myotomes patterns
C6, C7
Wrist, supination, myotomes patterns
C6
Wrist pronation, myotomes patterns
C7, C8
Digital flexion and extension myotome
C7. C8
Finger adduction and abduction and finger lateral and medial abduction and adduction myotome patterns
T1
C4 Dermatome landmarks
Shoulders
C6 Dermatome landmarks
Thumb
C7 Dermatome landmarks
Middle finger
C8 Dermatome landmarks
Pinky
T2 Dermatome landmarks
axillary
T4 Dermatome landmarks
Nipples
T10 Dermatome landmarks
Belly button
L4 Dermatome landmarks
Inner ankle
L5 Dermatome landmarks
Outer calf, and first three toes
S1 Dermatome landmarks
Ankle and last two toes
Elbow flexion
4
Biceps brachii, coracobrachialis, brachialis, brachioradialis
Elbow extension
2
Triceps brachii, Anconeus
Wrist flexion
4
Flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum profundus
Wrist extension
4
Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor indicis
Forearm supination
3
Biceps brachii, brachioradialis, supinator
Forearm pronation
4
Brachioradialis, Anconeus, pronator teres, pronator quadratus
Radial deviation
3
Flexor carpi radialis, extensor carpi radialis longus, extensor carpi radialis brevis
Ulnar deviation
2
Flexor carpi ulnaris, extensor carpi ulnaris
Finger flexion
8
Flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus, flexor pollicis brevis, flexor digit minimi, palmar interossei, dorsal interossei, lumbricals
Finger extension
6
Extensor digitorum, extensor digiti minimi, extensor indices, Palmar interossei, dorsal interossei, lumbricals
Thumb abduction
2
Abductor pollicis longus, abductor pollicis brevis
Thumb adduction
Adductor pollicis
Thumb extension
3
Abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus
Thumb flexion
2
Flexor pollicis brevis, Flexor pollicis longus
Thumb opposition
3
Flexor pollicis brevis, abductor pollicis brevis, opponens pollicis
Hip ER Myotomes
S1
Hip IR Myotomes
L5
Hip Abduction Myotomes
L5
Hip Adduction Myotomes
L3
Hip Flexion Myotomes
L2
Hip Extension Myotomes
S2
Knee Flexion Myotomes
S2
Knee Extension Myotomes
L3
Dorsiflexion Myotomes
L4
Plantarflexion
S1
Eversion
S1
Inversion
L4
Toe Extension
L5
Toe Flexion
S2
Deep External rotators
-Piriformis
-obturator internus
-superior and inferior gemellis
-quadrate femoris
Quad Muscles
-Rectus Femoris
-Vastus medialis
-Vastus lateralis
-Vastus intermedius
Medial Thigh/ Adductors
-Gracilis
-Adductor longus
-Adductor brevis
-adductor magnus
-Obturator externus
Posterior thigh/Hanmstrings
-Biceps Femoris (short and long head)
-Semitendinosus
-Semimembranosus
Triceps Surae
-Gastrocnemius
-Soleus
-Plantaris
Deep Posterior Leg
-Popliteus
-Tibialis Posterior
-Flexor Digitorum Longus
-Flexor Hallucis Longus
Lateral Lower Leg
Fibular Longus and Brevis
Anterior Lower Leg
-Tibial anterior
-Extensor hallucis Longus
-Extensor Digitorum Longus
-Fiburlaris Tertius
Flow of arterial supply
-Abdominal Aorta
-Common iliac
-External iliac———–Internal iliac (to PF)
-(@inguinal lig) Femoral A.–Deep Femoral (circumflex)
-(@hiatus) Popliteal A.
-(@soleal line) Pos. Tib A. —— Fibular A.
-Ant. Tib A.
-Dorsalis Pedis
Sciatic Nerve Pathways
-travel buddy: posterior cutaneous
-Tibial———————-Common Fibular
-med & lat plantar—- Superficial & deep
Posterior incision hip replacement precautions
No flexion past 90°, no internal rotation past neutral, no adduction past neutral, keep pillows in between knees during long-term positioning
Anterior incision hip replacement precautions
No extension passed 90°, no external rotation past neutral, no abduction past neutral, please pillows on outsides of legs, it during long-term positioning
Right Coronary Artery
-Supplies right ventricle, AV node and SA node
-Right posterior descending
-Right marginal
Left Coronary Artery (supplies)
-supplies left ventricle, L atrium, septum, SA node
SA Node
-sets heart at pace of >100 without other input
-Susceptible to disease due to pericarditis, occulsion
Cardiac Output
-CO= HR x SV
-5-6L at rest, can increased 4-7x with exercise
-Effects systolic BP
Blood Pressure
BP=HR x SV x Total peripheral Resistance
TPR affects diastolic BP
Mean Arterial Blood Pressure
-average pressure in the systemic system, perfusion of organs and peripheral tissues
MAP= DBP + 1/3 (SBP-DBP)
-Normal: 70- 93 mmHg
-cautions <60mmHg
Determined By:
-BV, CO, Peripheral resistance, distribution of blood in veins
Pulse Pressure
SBP-DBP, difference
-how hard heart is working
>60 working too hard; HTN
<40 failing heart; cardiomyopathy;shock
BP Normal
<120/<80
BP Elevated
120-129/<80
High BP Stage 1
130-139/80-89
High BP Stage 2
> 140/>90
Hypertensive Crisis
> 180/>120
HR
-Beats per minute
->120bpm @ rest, not enough time to refill, decreases CO
-<45bpm @ rest not enough CO, low bp
Affected by: Baroreceptors, ANS, endocrine, integrity of the system, temperature, emotions
SV
-amount of blood pumped out each beat
-Afterload-Preload, heart contractility
-increases 40-60% during exercise
Cardiac Preload (& determinants)
-End diastolic volume: amount of left ventricular blood volume prior to contraction
Dependent on:
-venous return, BV, LA contraction, Starling law
Cardiac Afterload
-Amount of resistance encountered by left ventricle
Ejection Fraction
Ejection Fraction= SV/EDV
-55-70%
-Low EF indicates systolic heart failure: <40
-EF can be preserved with overall decrease in BV, weak heart increases backflow that increases SV
Hypoxia
O2 concentration of tissues
Hypoxemia
O2 concentration of blood
Fick equation
-VO2= HR x SV x (a-vO2 diff)
Ventilation to Perfusion Ratio (V/Q)
-blood flow to alveoli must match ventilation or =hypoxemia
-changes with posture
-Norm: 0.8
Reduced: decreased ventilation to perfusion, blood shunted to other parts of the lung, vasoconstriction at arterioles to reduce BV, corrected with O2
Increased: increased ventilation to perfusion, vasodilation to increase BV, dead space
Causes of Cardiac Muscle Disease: Hypertension
Increased BP
-increased workload w/o increased blood supply
-decreased BV
-hypertrophy of myocardium that cannot relax well
-BV damage
Causes of Cardiac Muscle Disease: Coronary Artery Disease
-2nd most common cause of CMD
-supply and demand issue
-lipid deposits: atherosclerosis
-scar formation: decreases contractility
Causes of Cardiac Muscle Disease: Myocardial Infarction
-irreversible myocardial necrosis
-most commonly affects left ventricle
PT
-Increased Troponin, CK-MB that needs to come down
-ST elevation on ECG “Stimmy”
Causes of Cardiac Muscle Disease: Cardiac Arrhythmias
-abnormal rate of contractions
-can cause sudden cardiac arrest from SA node
-can lead to decreased CO
-Sick Sinus node syndrome
-Suprasventricular tachycardia
-V fib
Causes of Cardiac Muscle Disease: Renal Insufficiency
-contributes to CMD due to increased fluid triggered by low BP or low BV
-RAAS
-maintains Na and K balance
Causes of Cardiac Muscle Disease: Cardiomyopathy
-disease of heart muscle leading to heart failure
-impaired contractility
-HTN, MI, metabolic disorders, heart valve issues
Causes of Cardiac Muscle Disease: Dilated Cardiomyopathy
Heart failure with reduced ejection fraction (<40)
-systolic dysfunction: less effective pump, decrease CO, fluid back up
-increased LV EDV
-lead to electrical issues
Causes of Cardiac Muscle Disease: Hypertrophic Cardiomyopathy
-enlarged heart that cannot relax
-Heart failure with preserved EF
-diastolic dysfunction: less compliant
-increases left EDP
-rapid ventricular emptying
-muscle cells disorganized
-common cause for sudden cardiac arrest in young athletes
Causes of Cardiac Muscle Disease: Restrictive Cardiomyopathy
-cannot relax
-EF preserved
-diastolic dysfunction; decreased filling
-scar tissue in myocardium (sarcoidosis/radiation) OR defect in myocardial relaxation
-hypertrophy
Pulmonary Embolism
-lung infarction due to decreased BV
-increased pulmonary hypertension
-increases load to right side of heart
-presence of ascities, bilateral LE edema and jugular vein distension
-increases V/Q ratio
Pulmonary Hypertension
-risk for cardiac disease
->20mmHg
-increased R ventricle work (Swangan’s Catheter)
Congestive Heart Failure
-decreased CO
-LV failure
-increased BNP (stretch protein in heart)
-attempts compensatory strategies (sympathetic, RAAS, heart receptors, EPO)
Rate Pressure Product
-SBP*HR
-exercise threshold
-myocardial o2 demand
->10,000 @ rest, increase risk of angina
S1
-first heart sound (higher frequency)
-closure of M1 and T1
-best heard in Mitral Area
S2
-second heart sound (lower frequency)
-closure of semilunar valves valves
-best heard in Aortic Area
S3
-dilated/large ventricle causes rapid flling causes loud sound
-systolic issue
-could be abnormal (heart failure, dilated cardiomyopathy, late diastole) or normal (pregnancy/children, athletes)
-extra heart sound after S2
-“kenTUCKy”
-listen with bell @ apex
S4
-rigid ventricle decreases filling, atria contract late to push past force
-diastole issue
-always abnormal (HTN, MI, atrial kick of blood into stiff ventricle diastolic bad)
-right before S1
-gallop
RV Failure S/S
-venous insufficiency, edema, weightt gain, liver issues
LV Failure S/S
-pulmonary issues, effusion, S3, crackles, decreased O2, paleness, increased HR, increased Breathing
Arrhythmias (Medications)
-inhibit abnormal impulses by affectting membrane permeabiliy to specific ions (Cl, K, Ca, Na)
-SA & AV node
-prelong refractory period
Hypertension (Medications)
-reduce fluid, limit SNS, decrease RAAS
Beta Blockers
-olol
-reduced beta receptor binding
-selective of nonselective
B1: increases HR and contractility
B2: bronchoconstriction and vasodilation
CI
-HTN, ischemic HD, heart failure, arrhythmias
SE
-sedation, may mask hypoglycemia, reduced thermoregulatry response, spasms, orthostatic hypotension
Max HR: 164 - (.7 x age)
Orthostatic Hypotension
decreased of BP 20 and HR increase of 30 when standing from sitting
Calcium Channel Blockers
-pine
-decrease HR & BP, conrtactility, O2 demand
-cause vasodilaiton of coronary artieries
CI
-reduce re-infarctions (dead tissue releases Ca), ischemic HD, heart failure, arrhythmias
SE
-negative inotropic effects, blunted HR responses to exercise
Nitrates
-nitr
-slows HR, reduce preload and afterload, decrease contrtactility, lower BP, vasodilation
CI
-HTN, ischemic HD, heart failure, angina
SE
-hypotension, dizziness, reflex tachycardia, skin flushing
Angina (Medications)
-chest pain due to ischemia
-lack of O2 stimulates pain receptors
-treated by nitrates, BB, CC blockers
S/s
-tightness and chest pain
-simular to MI
-ECG ST downward shift
Thrombolyic Agents
-break clots up quickly
-goal to keep ischemic time <120min
SE
-arrhythmias due to rapid reperfusion (high K, reflex tachycardia), bleeding, hemorrhage CVA
Anti-Platelet Agents
-prevent platelet aggregation and thrombus formation
-decrease platele adverance to site of injury
Anticoagulants
-prevention of blood clots, inhibit thrombin
Common: heparin, pradaxa, xarelto, eliquis
Diuretics
-ide
-decrease blood volume by peeing
-improve cardiac contractility
-reduce cardiac demand
-act of kidneys (loop of henle most potent)
CI
-HTN, heart failure
SE
-hypotension, arrhyhmias (K+)
ACE Inhibitor
-pril
-prevents conversion of ang 1 to 2
SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia
Angiotensin Receptor Blockers (ARBs)
-sartan
-limits effects of ang 2
SE
-hypotension, dizziness, angioedema (life thrreatening tongue swelling), hyperkalemia
Cardiac Glycosides
-positive inotropes
-increase Ca+
-decrease HR
-increase delay from SA to AV
-increase PR interval
-anti arrhythmics
ex: digoxin
CI
-dilated cardiomyopathy
-a fib
NOT FOR 2nd or 3rd Heart Blocks
SE
-lots of symptoms of digitalis toxicity
Sympathomimetics
-positive inotropes
-mimic SNS, treat shock, heart failure
-short term use only to prevent downrreg
CI
-parenteral use for hheart failure
Phosphodiesterase Inhibitors
-positive inotropes
CI
-severe CHF, strengthen contractions
Vasodilators
-decrease bv, vascular resistance
-Arterial: reduce afterload
-Venous: reduce preload
CI
-HTN, HF, ischemic heart disease
SE
-compensatory SNS actitvation
Critical Illness Polyneuropathy
-sensory and motor nerves involved
-main contributor to persistent disability
-sepsis and organ failure
-chronic denervation
Critical Illness Myopathy
-diffuse flaccid weakness in all limbs
-can have complete recovery
-chronic denervation
-can be caused by steroid use
PEEP
-Positive End Expiratory Pressure
-resisdual pressure in alveoli after exhalation
-pressure required to inflate alveoli and prevent collapse
Low PEEP 3-5: normal
Moderate PEEP 5-15: treat refractory hypoxemia
High PEEP >15: severe lung injury
-put pressure on IVC and decreased CO
Mode of Ventilation
-how breath is delivered
- Assist-Control
- SIMV and Pressure Support
- Pressure Support
Assist-Control
-non weaning: breathing for patient
-rate and tidal volume pre-set
-patient can trigger breaths with pre-set tidal volume
SIMV
-synchronized intermittent Mandatory Ventilation
-Weaning mode: starting to take them off
-rate and tidal volume pre-set
-patient can trigger breaths with pressure support instead of pre-set tidal volume
Pressure Support Ventilation
-weaning mode: 0-30cmH20 (10 normal)
-applies to spontaneous breaths
-tidal volume not pre-set
-NOT air, only pressure
CPAP
-constant positive pressure applied in airways
-noninvasive ventilation
BIPAP
-Bi-level pulmonary airway pressure
-noninvasive ventilation
SaO2
-actual o2 content in blood
SpO2
-estimated o2 content in blood
-<88 is concerning, drop in hemoglobin curve
SE
-syncope, dizziness, paleness, quick breathing (>30bpm at rest)
Lead I
-limb lead
Right arm to Left arm
-normal wave form
-Circumflex A.
-lat wall of LV
Lead II
-limb lead
Right arm to lower limb
-normal wave form
-Right Coronary A.
-Inferior portion of heart/apex
Lead III
-limb lead
-leftt arm to lower limb
-normal wave form (may have inverted P and t wave)
-Right Coronary Artery
-Inferior portion of heart/apex
aVF Lead
-augmented lead
Middle of body to lower limb
-Right coronary Artery
-Inferior portion of heart/apex
-normal wave form
aVL Lead
-augmented lead
From middle to Left arm
-Circumflex A.
-lat wall of LV
-normal wave form
aVR Lead
-augmented lead
From middle of body to right arm
-Top of RV
-inverted wave form
V1
On Right 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.
-inverted P-wave, deep S
-RV
V2
On Left 4th intercostal space
-septal, precordial lead
-L Ant. Descending A.
-inverted P-wave, deep s
-RV, septum
V3
On left between 2 and 4
-Anterior Heart, precordial lead
-Right coronary A.
-RV, septum, ant. heart
V4
On left 5th intercostal space mid clavicular line
-Anterior Heart, precordial lead
-Larger R, small s
-Right coronary A., ant heart
V5
On left 5th intercostal space anterior axillary line
-Lateral heart, precordial lead
-Larger R, small s
-Circumflex A., lat wall of heart
V6
On left 5th intercostal space mid axillary line
-Lateral heart, precordial lead
-Larger R, small s
-Circumflex A., lat wall of heart
Premature Ventricular Contraction
-random cell in ventricles fire out of sync of the rest, prematurely
-wide QRS
Ventricular Bigeminy
-PVCs occur every 2 beats
Ventricular Trigeminy
-PVCs occur every 3 beats
Ventricular Couplet
-PVCs occur in 2s
Ventricular Triplet
-PVCs occurr in 3s
-non sustained ventricular tachycardia
-STOP and check vitals
Ventricular Tachycardia
-fast/large/wide QRS with no p wave, regular
-emergency
Supraventricular Tachycardia
-fast/narrow QRS
-comes from atria not SA node
Junctional Rhythm
-slow (40bpm) /no p wave/inverted T wave
-originates away from atria but depolarizes ventricles
ST Elevation
-Acute MI
-Stimi
ST Depression
-Angina/ischemia/infarction
P Wave Inversion
-Heart block with junctional rhythm
T Wave Inversion
-MI or ischemia
-BBB
-hypertrophy
-pulmonary embolism
Ventricular Fibrilation
-dangerous, call code
-irregular/fast/small
Atrial Fibrilation
-chaos/irregular
-QRS present, no p wave
-multiple cells firing
-valve issues, ischemia, stroke, arrhythmia
Atrial Flutter
-saw tooth/bread knife
-1 cell going crazy
-QRS present and irregular
Torsades De Pointes
-V tach with prolonged QT, irregular
-Looks crazy…how are you alive
Right Bundle Branch Block
-delayed depolarization of RV
-right lead (V1): “M” in QR, deep S
-Left lead (V6): “W” in S wave
Left Bundle Branch Block
-delayed depolarization of LV
-right lead (V1): “W” in R wave
-Left lead (V6): “M” in R wave
-anomally always at tip of QRS
1st Degree AV Block
-husband is late but comes home, long PR interval
-from SA node
-slow HR
2nd Degree AV Block : Type 1
-husband is later and later and then doesn’t come home
-longer PR interval then dropped QRS
-AV node
2nd Degree AV Block : Type 2
-husband randomly doesn’t come home
-normal PR intervals
-randomly dropped QRS
-Bundle of his
-DONT WORK WITHOUT PACEMAKER
3rd Degree AV Block
-normal p wave unrelated to QRS, no correlation of QRS
-random p waves
-DONT WORK WITHOUT PACEMAKER
Angioplasty
-balloon inflated to push plaque against lumen
-stent then put in
-prone to bleeding
-5-7days no exercise
Arthrectomy
-larger plaque buildup, cut out the plaque
Coronary Artery Bypass Graft
-CABG
-open heart surgery
-place another vessel from one spot to bypass blockage (radial arteries, saphenous veins, mammary arteries)
Sternal Precautions
-limit movement for 6-8 weeks
-gentle coughing
-move “in the tube”: keep arms to the side
-infection control
Intraortic Balloon Pump
-severe heart failure; shock
-restore CO
-inserted in femoral (bedrest) and axillary (might be allowed to exercise) to ascending aorta
-balloon inflates and deflates to increase CO by 40%
Anesthesia
-restrictive
-depresses breathing and diaphram contractions (intubation)
-decreases TLC, FRC, RV, lung compliance
-can cause collapse, shunting, atelectasis
-consider time under and O2 given during procedure
-airway obstructions from tubes/fluids
FRC
-causes alveolar collapse in supine
Bed Rest Effects
Cardio:
-increased resting HR, risk of DVT
-decreased max HR, Vo2max
Respiratory:
-decreased vital capacity, inpaire toilet, increase V/Q mismatch
Abnormal Response to Exercise
-HR increase 20-30 or drop below resting
-SBP increase 20-30 or drop by 10
-Spo2 drop
-High RR, accessory muscles
ECMO
-Veno-Arterial Ecmo: supports heart and lungs
-Veno-venous Ecmo: supports lungs
-cannot be turned off by PT
LVAD
-Left ventricular assist device
-pump blood from LV to aorta
-has outer controller
-3-10L/m (drop in flow could be pump failure)
-Speed usually fixed (abnormal condition)
-10 Watts
-Pump Index (higher is better LV function
Complications:
-bleeding, infection, MAP
Heart Transplant
Indications:
-CHF, Cardiomyopathy, low prognosis
Post op:
-infections, low response to activity, sternal precautions
Denervated heart:
-no ischemic pain
-higher RHR >90
-slower HR changes
-orthostatic HTN
Lung Transplant
Single:
-Thoracotomy
Double:
-clamshell
Complications:
-pneumothorax, plural effusion, hypoventilation, phrenic n injury
Denervated Lungs:
-decreased cough reflex, ciliary mmt
-Increased infection risk, edema, mucous
Emphysema
-COPD
-Obstructive
-red skin, skinny, pursed lips
-working hard to exhale air, can still oxygenate
-hypercompliant lung balloons alveoli trapping air
-O2 desaturation during exercise
Panacinar: alveoli only, genetic
Centrilobular: bronchioles only, progression of bronchitis
Chronic Bronchitis
-COPD
-obstructive
-inflamation of bronchioles obstructing/narrowing airway and increasing mucous/cough
-“blue bloater”
S/S:
-Cor pulmonale, jugular vein distension, edema, decreased FEV1
Hypercapnic
-increased Co2
-hypoventilation: increases Co2, lowers pH
>45 PaCo2
Hypoxemia
-decreased blood o2
<80% PaO2
Hypercompliant Lung
-stretches excessively without returning to normal during exhalation
-increased FRC, PaCo2, airway resistance
-Decreased PaO2, intrathoracic pressure
-COPD, Obstructive
Hypocompliant Lung
-does not expand or contrac correctly
-decreased VC and RV
-increased work and pressure
-restrictive, obesity, surgery
Tidal Volume
-500ml
-amount of air moved in and out in each breath
Inspiratory Reserve Volume
-3000ml
-max inspiration after normal inspiration
-decrease with restrictive
Expiratory Reserve Volume
-1100ml
-max one can expire after normal exhale
Residual Volume
-1200ml
-volume of air left in lungs after max exhale
-FRC-ERV=RV (cannot be measured)
Functional Residual Capacity
-volume of air in lungs after normal expiration
-RV + ERV
(cannot be measured)
-balances lung and chest wall forces
Inspiratory Capacity
-max volume one can inspire
-TV+ IRV
-decrease with restrictive
Vital Capacity
-max volume one can exchange in a respiratory cycle
-IRV+TV+ERV
-decrease with restrictive
Total Lung Capacity
-air in lungs during full inflation
-IRV+TV+ERV+RV
-RV+VC=TLC
(cannot be measured)
-decrease with restrictive, increase obstructive
FEV1
-forced expiratory volume in 1 sec
-80% of predicted/max
-based on age, gender, race, height
FVC
-forced vital capacity
-how much can you force out and in
FEV1/FVC
-percentage of vital capacity exhaled in 1 sec
->70% norm
pH
-<7.4 acidic
->7.5 alkaline
7.35-7.45
Hgb
-hemoglobin (12-16)
Acid Base Regulation
-kidneys can extrete or retain HCO3 (slowly)
Increased Ecretion: low pH, metabolic acidosis
Decreased Extrcetion/Increased Retention: high pH, metabolic alkalosis
-respiratory
Hyperventilation: raises pH, reduces Co2, respiratory alkalosis
Hypoventilation: increases Co2, lowers pH, respiratory acidosis
Respiratory Acidosis
-excess CO2, low pH
Causes:
-CNS depression
-ashyxia/hypoventilation
Compensation:
-high HCO3-
S/S:
-sweating, headache, tacycardia, restlessness
Respiratory Alkalosis
-low CO2 (excretion), high pH
Causes:
-hyperventilation
-respiratory stimulation
-bacteria
Comensation:
-low HCO3-
S/S:
-rapid breathing, parasthesia, light headedness, twitching
Metabolic Alkalosis
-HCO3- retention (acid loss), high pH
Causes:
-renal disease
-vomiting
-decreased K
Compensation:
-high CO2
S/s:
-shallow breathing, confusion, twitching, restlessness
Metabolic Acidosis
-HCO3- loss (excretion), low pH
Causes:
-kidney disease
-hepatic disease
-endocrine disorders
-high K
Compensation:
-low CO2
S/s:
-rapid breathing (kuzmals), fatigue, fruity breath, headache
Evaluate ABG Results
- pH
-high= alkalosis
-Low= acidosis - CO2
-high: resp acidosis (with low pH)
-low: res alkalosis (with high pH) - HCO3
-high: metabolic alkalosis (with high pH)
-low: metabolic acidosis (with low pH) - Compensatory
ABG Short Cut
Metabolic: look @ pH and HCO3- same (look at co2 for compensations-must be same)
Respiratory: look @ pH and CO2-different (look at HCO3 for compensations-must be same as CO2)
Obstructive Disorders
-airway obstruction, reduce flow rates
-asthma, COPD, cystic fibrosis
-FEV1/FVC= <70%
Restrictive Disorders
-reduction in vital capacity
-pulmonary or neuro
Acute:
-atelectasis, pneumothorax, pneumonias, respiratory distress syndrome, Pleural effusion, ascities, LVAD
Chronic:
-BPD, pulmonary fibrosis, SLE, scleroderma, cancer, skeletal issues, neuromuscular issues
Adventitious Sounds
-Crackles or rales: discontinuous sounds; airway obstruction or restrictive lung diseases
-wheezing: smaller airways, asthma
-stridor: crowing sound, uper airway obstruction
-Pleural rub: rubbing inflamed pleural surfaces agains lung
Diagnosis of Sounds
Pleural Effusion: conta traacheal dev, decreased sounds, dull percussion (stuff)
Consolidation: increased fremitus and pectoriloquy, decreased breath sounds, dull percussion, bronchial sounds
Emphysema: decreased fremitus, hyper resonant percussion, decreased pectoriloquy, crackles
Tension Pneumonthorax:
-contra tracheal dev, hyper resonant percussion, decreased breath sounds
Mucus Plug w/ Collapse: ipsi tracheal dev, decreased everything, dull percussion
Medicare
-65+ or disability
Part A: IP, SNF, HH, Hospice
Part B: OP, DME
Medicaid
-low income, pregnant, responsible for minor, disabilities
Discharge Planning: Independent Living
-walk 400m (different terrains, obstacles)
-1.2 m/s gait
-carry 1 gallon/8lbs
Discharge Planning: Inpatient
-3 hrs per day of therapy
-high level of prior function
-not safe to go home
Discharge Planning: Skilled nursing facility (SNF)
-unable to do 3 hrs a day
-variable prior function
-moderate progress
Discharge Planning: Outpatient
-high level of function
-stable needs
-community travel
Discharge Planning: Home health
-limited ambulation
-safe at home
-good functional prognosis
Discharge Planning: Long term acute care
-high complexity
-poor prognosis
-less need for skilled therapy
Discharge Planning: palliative care
-chronic illness
-treat pain and suffering
-fix things other than physical
Discharge Planning: Hospice
-end of life care
-6 months or less
-manage pain and symptoms
Discharge Planning: Advanced Care Directives
-identify preferences for care
Living wills, DNR, medical orders for life sustaining care, power of attorney
Injury Descriptions: Aching
Muscular
Injury Descriptions: Burning
Muscular or neural
Injury Descriptions: Shooting, lightning, electrical
Nerve root irritation
Injury Descriptions: Coldness
Blood flow issues
Injury Descriptions: Hotness
inflammation or infection
Injury Descriptions: Clicking, snapping, popping
ligament or tendon dysfunction
Injury Descriptions: Joint locking
Cartilage tear, looseness, misalignment
Injury Descriptions: Global weakness or fatigue
Cardio or pulmonary dysfunction
Injury Descriptions: Whole body pain
-central somatization: chronic pain
Red Flags Requiring Immediate Attention
-anginal pain no relieved in 10-20min
-angina with sweating, nausea, vomiting
-Diabetic client that is confused or lethargic
-onset of incontinence or saddle anesthesia
-anaphylactic shock
BATTED
-ADLS: activities of daily living
-Bathing
-Ambulation
-Toileting
-Transfers
-Eating
-Dressing
Ataxia
-lack of control of body movements
Dysmetria
-error in trajectory
-inability to touch target
Anesthesia
-complete loss of sensation
Hypoesthesia
-abnormally low sensitivity to sensation
Hyperesthesia
-abnormally high sensitivity to sensation
Hypalgesia
-diminished sensitivity to pain
Graphesthesia
-recognizing writing on skin
Hyperalgesia
-incrreased sensitivity to pain
Astereognosis
-inability to recognize familiar object by touch
Atopognosis
-inability to corrrectly locate sensation
Abaragnosis
-inability to distuingiush different weights
Paresthesia
-Abnormal sensation
Dysethesia
-impairment of any sensation
Paralysis
-loss of motor function
Hemiparaplegia
-paralysis of lover half of one side of body
Hemiparesis
-muscular weakness or partial paralysis on one side
Hemiparaesthesia
-pertaining to hemiparesis
Hemiplegia
-paralysis on one side of body
Paraparesis
-partial paralysis of LEs
Paraplegia
-paralysis of LEs
Tetraplegia
-paralysis of all extremities
Quadriplegia
-paralysis of all extremities
Triplegia
-paralysis of 3 extremities
Diplegia
-paralysis of either both UEs or LEs
AROM
-muscle strenth, coordination, willingness to move
-contractile tissue integrity
-if they can do AROM, no need for PROM
PROM
-integrity of joints, extensibility of CT, endfeels of joints
-diagnostic
-slightly > AROM
Injury Severity
Strong & Painless: intact
Strong & Painful: minor
Weak & Painful: Major
Weak & Painless: complete lesion or neuro deficit
Testing Order For Class
- Dermatome
- Periperal N.
- Opposite Tracts
- Myotome
- Reflexes
- ROM Screen
- ROM Testing
- MMT
- Outcome Measure
Most Common Areas of Spine for Disc Pathology
-C6-C7
-L4-L5
-L5-S1
Cervical AROM Values
Flx: 40
Ex: 50-70
LSB: 22
Rot: 70-90
Thoracolumbar AROM Values
Flx: 60
Ex: 25
LSB: 35
Rot: 45
Lumbar AROM Values
Flx: 40-50
Ex: 15-20
LSB: 25
Shoulder ROM Values
Flexion: 180
Extension: 50-60
Abd: 180
Internal Rot: 70-80
External Rot: 90
Elbow ROM Values
Flexion: 140-150
Extension: 0
Supination: 80
Pronation: 80
Wrist ROM Values
Flexion: 80
Extension: 70
Rad Dev: 20
Ulnar Dev: 30
Finger ROM Values
-MCP:
Flex/ext: 90/45
-PIP:
-Flx/Ext: 100/0
-DIP:
-Flx/Ext: 90/0
Gait Cycle
Stance:
-Initial contact (Preswing): heel contact, flexion hip (20)
-Loading response (initial swing): weightshift, flexed knee (15), DF (7 lack of will show)
-Midstance (Middle Swing): Neutral hip
-Terminal Stance (Terminal Swing): extended hip (20 backwards rotation of pelvis will show it flexors are tight), DF (10 at highest)
-Pre-Swing (Initial contact): full extension, flexion (40), PF (15 need toe extension for windlass)
Swing:
-Initial Swing (loading response): toe off, most knee flexion (60), pelvis rotates to catch up
-Middle Swing (Midstance): most flexion (25)
-Terminal Swing (Terminal Swimg): right before initial contact
Hemiplegic Gaitt
-one side of body is weak
-cerebral palsy, tbi, stroke
Antalgic Gait
-short stance on pain side
Ataxic Gait
-lack of coordination
Scissor Gait
-crossing over
-tightness of hib adductors
-cerebral palsy
Parkinsonian Gait
-shuffling feet with flexion placing weight on balls of feet
Steppage Gait
-excessive hip and knee flexion to clear limb
Vaulting Gait
-rapid ankle PF to clear limb
Plumb Line
-ant to mastoid
-anterior acromion
-post to hip
-anterior to knee
-anterior to malleolus
Anterior Pelvic Tilt
-tight errectors and hip flexors
-weak glutes and abs
Posterior Pelvic Tilt
-weak errectors and hip flexors
-tight glutes and abs
Coxa Valga
-greater angle of inclination >125
-straighter
-longer limb
-increase dislocation
-genu varum
Coxa Varum
-lesser angle of inclination <125
-shorter limb
-improved congruence
-more stress on neck
-genu valgum
Anteversion
-greater torsion than normal >20
-head more anterior
-more IR, toe in
Retroversion
-lesser torsion than normal <10
-head more posterior
-more ER, toe out
Deep Tendon Reflex Grades
No reflex: 0
Minimal Response: 1+
Normal: 2+
Overly Brisk: 3+
Extremely brisk; cross over reaction: 4+
Biceps Tendon
C5
-Elbow flexion
Brachioradialis Tendon
C6
-elbow flexion
Triceps Tendon
C7
-elbow extension
Patellar Tendon
L4
-knee extension
Achilles Tendon
S1
-plantarflexion
International classification of functioning disability in Health (ICF)
Body structures and functions, activities, participation, environment, personal factors, and health conditions
Controlled substances
Schedule one: highest abuse, potential and illegal (heroin).
Schedule two: approved for therapeutic purposes, with high potential for abuse (morphine)
Schedule three: mild dependence (steroids.)
Schedule 4: low abuse, potential (antianxiety drugs)
Schedule five: lowest abuse, potential (cough meds)
Steps of inflammatory response
- Vasodilation
- Increased capillary permeability
- Loss of fluid.
- Blood clotting.
- Migration of leukocytes.
Bone tissue repair
- Inflammatory phase (two weeks), hematoma forms, and initiates Fibrin
- Repairative phase(6 to 12 weeks): granulation tissue in fibrocartilage forms a soft Calus
- Endochondral ossification (months to years): soft calluses, replaced by bony callus.
Tendon healing
- Proliferation of tenoblasts
from cut ends - Vascular in growth and proliferation of fibroblasts.
- Inflammation begins 3 to 5 days after injury and proliferative phase last 2 to 3 weeks.
-Collagen orients into thick bundles and at three weeks type three collagen is replaced by type one
