ICU + ICU Delirium Flashcards
How much strength loss occurs in the ICU?
4-5% a day in healthy subjects
How long does it take for insulin resistance and microvascular dysfx to occur in the ICU?
5 days in healthy subjects
What are some barriers to ICU rehab?
Too sick Too sedated Too delirious PT/OT underprescribed Limited equipment and staff
What problems are associated with mechanical ventilation?
As early as 4-7 days:
- Critical illness polyneuropathy
- Critical illness myopathy
- combination of both
S/S of Critical illness polyneuropathy (CIP)
Weakness Decreased DTRs Impaired pain, temp and vibratory sense Facial weakness Cranial nerves are spared
S/S of Critical illness myopathy (CIM)
Profound weakness (esp proximal muscles) DTRs preserved or diminished Sensation is intact
S/S of Post-intensive care syndrome (PICS)
Reduced ability for ADLs Reduced capacity for ambulation (up to 5 years later!) Depression Posttraumatic stress syndrome Anxiety
Treatment for PICS
Minimize sedation
Early mobility
What are some general PT interventions for the ICU?
Strength training
ROM/Joint mobility
Endurance training
Postural re-training
Balance activities
Optimizing ventilation/secretion clearance
Progressive mobility/functional activities
What are some examples of progressive mobility exercises?
Continuous lateral rotation therapy HOB elevation/ Chair position A/PROM in bed Tilt table/tilt bed Danglining OOB to chair Ambulation
Where should a patient fall on the borg scale during ICU exercise?
3-5
What are the pulmonary requirements for being medically unstable?
O2 sat < 88%
RR > 35 breaths/min
PEEP >10 mmH2O
What are the cardiovascular requirements for being medically unstable?
Resting HR 140 bpm SBP 200 New arrhythmia developed New onset angina MAP < 65 or >120 OR > 10 mmHG lower than normal SBP or DBP for pts on renal dialysis
Is a patient medically stable if they cannot follow commands?
No
Steps to mobilize ICU patient
Look at baseline vitals
Locate all wires and tubes
Move IV pole to the side you’re getting up on
Assist pt to sitting at the side of the bed
Make sure all lines are accounted for and have slack
Go.
