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PHTY3250 > L17: Physiotherapy in Intensive Care I > Flashcards

L17: Physiotherapy in Intensive Care I Flashcards

1
Q

What are 7 reasons for admission to intensive care?

A
  1. Failure of one or more organs
  2. Need for one-on-one nursing
  3. Post major surgery or major risk factors
  4. Postoperative respiratory failure
  5. Medical respiratory failure eg pneumonia
  6. Weakness of respiratory muscles eg Guillian Barre syndrome
  7. Major injuries
    • Multi-trauma/chest trauma/spinal injuries, head injury
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2
Q

What are 10 subspecialties of Intensive Care (ICU)?

A
  1. Surgical
  2. Medical
  3. Neurological/Neurosurgical
  4. Cardiac/Cardiothoracic
  5. Endocrinological
  6. Oncology/Haematology
  7. Burns
  8. Obstetric
  9. Spinal
  10. Dermatological
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3
Q

What are 3 reasons (3/1/3) why physiotherapy required in ICU?

A
  1. Pulmonary complications
    1. Intubation, mechanical ventilation, immobilization predispose to
      1. Atelectasis
      2. secretion retention
      3. weakness of respiratory muscles
  2. Circulatory complications
    1. eg venous stasis
  3. Musculoskeletal & neurological complications
    1. disuse atrophy, loss of muscle mass
    2. contractures, increased tone
    3. critical care neuropathy
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4
Q

What are the ICU attachments?

A
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5
Q

What are the 4 characteristics of patient chart in ICU?

A
  1. Presenting condition (What have they come in with)
  2. Co-morbidities
  3. Surgical details
  4. Investigations (CXR)
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6
Q

What are the 6 characteristics of physical examination in ICU?

A
  1. Chest shape
  2. Colour
  3. Pain
  4. Diaphoresis ie sweating
  5. Palpate
  6. Auscultation
    • R =L + post Rx
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7
Q

What are 3 sources of information for ICU?

A
  1. Patient Chart
    1. Presenting condition
    2. Co-morbidities
    3. Surgical details
    4. Investigations (CXR)
  2. Physical examination
    1. Chest shape
    2. Colour
    3. Pain
    4. Diaphoresis ie sweating
    5. Palpate
    6. Auscultation
      1. R =L + post Rx
  3. Subjective
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8
Q

What are 3 differences in assessment in ICU?

A
  1. Flow sheet
  2. Paper or computer
  3. Important to see pattern of changes over last few days/hours
    1. Respiratory
    2. Haemodynamic
    3. Neurological
    4. Medication
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9
Q

What are 8 characteristics of communication with staff in ICU?

A
  1. Conscious state/sedation
  2. Tolerance of procedures
  3. Stability
  4. Movement orders eg RIB, log roll (worried about spine)
  5. Changes in ventilation
  6. Changes in medical management
  7. Analgesia
  8. When is it convenient for me to see the patient?
    • If it isn’t, when is it convenient for you/me to come back?
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10
Q

What are the 7 characeristics of monitor in assessment?

A
  1. Will show what is happening now
  2. ECG trace
  3. Invasive blood pressure
  4. Oxygen saturation
  5. Central venous pressure
  6. Respiratory rate
  7. ± ICP, Cardiac output
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11
Q

What are the 5 common types of medication in ICU?

A
  1. Sedation
    1. Propofol, Midazolam
    2. Often mixed with pain relief
  2. Pain relief
    1. Morphine, Fentanyl
  3. Bronchodilators
    1. Ventolin, Theophylline
  4. Cardiac anti-arrythmic agents
    1. Amiodarone
  5. Inotropes/Vasopressors
    1. Noradrenaline, Adrenaline, Dopamine,
    2. Low blood pressure (protect brain and kidneys) –> vasoconstriction
    3. Septic shock
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12
Q

What are 5 respiratory assessments in ICU? What are 11 parameters in ventilation?

A
  1. Ventilation –
    1. MODE – spontaneous? SIMV? PVC?
    2. Oxygen percentage – FiO2
    3. Humidified ?
    4. Respiratory rate – self/ventilator
    5. Tidal volume self/ventilator
    6. PEEP, Pressure support,
    7. Flow-by
    8. I:E ratio
    9. Airway pressures (PIP)
    10. End tidal CO2
    11. Length of time on weaning?
  2. Arterial blood gases
  3. Oxygen saturations (SpO2)
  4. Sputum – amount, colour, tenacity
  5. Palpation, auscultation
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13
Q

What are the 5 neurological assessment in ICU?

A
  1. Glasgow coma scale
    • Score of /15
  2. Sedation score – eg RASS
    • -5 to +5
    • +5: highly agitated
    • 0: neutral
    • -5: heavily sedated
    • Aim for -1
  3. Pupil size and reactivity
  4. ± Intracranial pressure*
  5. ± Cerebral perfusion pressure*

* NB only monitored in head injuries, intracerebral bleeds

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14
Q

What is pupil size & reactivity in neurological assessment in ICU?

A
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15
Q

What are 5 common techniques of intracranial pressure monitoring in neurological assessment in ICU?

POSSIBLEEXAMQ

What exam parameters would you use for this patient? (need to be specific to the case)

A
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16
Q

What are 6 other systems in ICU?

A
  1. Orthopaedic
  2. Haematological
    • Egg. Bone marrow transfusion Platelets can be low –> avoid vigorous treatmemts (heavy percussions or heavy suction)
  3. Gastrointestinal
  4. Renal
  5. Musculoskeletal
  6. Psychological
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17
Q

What are 6 haemodynamic assessments in ICU?

A
  1. Arterial blood pressure
  2. Invasive
  3. Non=invasive
  4. Heart rate
  5. ECG – rhythm
  6. Central venous pressure
  7. Fluid balance
  8. ± Cardiac output, pulmonary artery occlusion pressure
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18
Q

What are 9 characteristics of an arterial line (intra-arterial line) in ICU?

A
  1. Invasive line into majory artery (femoral, cubital fossa, radial)
  2. Heparinized - into pressure transducer
  3. Instant readout/alarm of BP
  4. SAP, DAP, MAP
  5. [DAP +(1/3 of SAP-DAP)]
  6. Arterial blood gases can be taken- Benefit (no need for additional procedure)
  7. Precautions
  8. Don’t bend joint with IAL
  9. Care not to dislodge

For blood pressure; consistently measuring

19
Q

What are 5 characteristics of a central line in ICU?

A
  1. Line into major central vein (Superior vena cava)
  2. Instant access for medications
  3. Reflects fluid balance, venous return
    1. Normal values -
    2. 5-15cm H2O or 4-9 mmHg
  4. Response to fluid loading & trend is important not actual figure
  5. Inaccurate in Hypoxaemia, Hypercarbia, Acidosis, A-a gradient of 50-150mmHg

For instant and multiple medication (unlike IV drip)

20
Q

What are 5 precautions of a central line in ICU?

A
  1. Pneumothorax may occur after insertion
    1. → wait for CXR to check before using positive pressure
  2. Atrial arrhythmias may occur with positioning if CVL slides into R atrium eg side lying
  3. Don’t percuss over line
  4. Disconnection → air embolus → patient head down
  5. If CVP < 5cmH2O (Not enough fluid (not good for vertical/upright positions or give extra positive pressure))
    1. Hypovolaemic
    2. → may not tolerate MHI or mobilization
21
Q

What is advanced haemodynamic monitoring? What are 4 examples of monitoring?

A
22
Q

What are 5 conditions that use advanced haemodynamic monitoring?

A
  1. Septic shock
  2. Extensive fluid loading
  3. Cardiogenic shock
  4. Pulmonary Hypertension
  5. At risk cardiac surgery
23
Q

What are the 12 PiCCO parameters?

A
24
Q

What are the 3 limitations to physiotherapy treatement in ICU?

A
  1. Lack of co-operation of patient
  2. Haemodynamic/respiratory instability of patient
  3. Invasive lines/wounds/equipment
25
Q

What are 6 charcateristics of intensive care?

EXAM QUESTION

A
  1. Conscious level
  2. Airway (A tube in situ (unable to cough))
  3. Ventilation (Independence)
  4. Respiratory/circulatory support (Blood pressure)
  5. Primary problem
  6. Secondary problem
26
Q

What are 5 treatments for secretion mobilising and removal techniques as PT RC in ICU?

A
  1. Positioning (Esp. important in ICU)
  2. Suction
  3. Manual Hyperinflation
  4. Percussion, vibration
  5. Flutter valve, PEP mask – possible if not ventilated
27
Q

What are 6 treatment techniques to increase ventilation as PT RC in ICU?

A
  1. Positioning
  2. MHI
  3. Stretch reflex
  4. Active, active/assisted and /or passive movements
  5. Continuous passive movement (CPM)
  6. Inspiratory muscle training
28
Q

What are 5 passive techniques for mobilising/removing secretions and increasing ventilation in ICU?

A
  1. Positioning (Turn)
  2. Suction
  3. Manual hyperinflation
  4. Manual techniques, percussion, vibration
  5. Stretch reflex
29
Q

What are 3 techniques that require co-operation for mobilising/removing secretions and increasing ventilation in ICU?

A
  1. Deep breathing
  2. Flutter, PEP (if not intubated)
  3. Inspiratory muscle training
30
Q

What are 11 characteristics of mobility as PT Rx in ICU?

A
  1. Positioning for Tone (Esp. head injury patient)
  2. SOOB – sit out of bed
  3. SOEOB – sit on edge of bed (Good for postural muscles (even for those who have been in ICU for a long time))
  4. Tilt table
  5. Mobilisation
  6. Cycling – arms, legs, can be passive
  7. Active, active/assisted and /or passive movements
  8. Splinting
  9. Stretching
  10. Electrical stimulation
  11. Wii machine
31
Q

What are 6 passive techniques for mobility as PT Rx in ICU?

A
  1. Positioning
  2. Passive movements
  3. Cycling
  4. Electrical stimulation
  5. Splinting
  6. SOOB
32
Q

What are 6 techniques that require co-operation for mobility as PT Rx in ICU?

A
  1. Active exercises
  2. Resisted exercises
  3. SOEOB
  4. Cycling
  5. Mobilization
  6. SOOB
33
Q

What are 3 other PT Rx in ICU?

A
  1. Non-invasive ventilation (NIV)
    1. IPPB, CPAP, BiPAP
  2. Techniques to increase strength of respiratory muscles
  3. Decrease WOB
    1. Relaxation, feedback to help with weaning
    2. NIV
    3. Positioning
34
Q

What are 3 characteristics of manual hyperinflation?

A
  1. Manual hyperinflation involves disconnecting patient from ventilator and reconnecting to valve & reservoir bag attached to O2 source & ventilating manually
  2. Larger breaths with varying patterns are then given
  3. Vibrations often added in expiratory phase by a 2nd person
35
Q

What is the most common pattern (long inspiration/inspiratory hold/fast expiration)?

A
36
Q

What are the 3 types of circuits for MHI?

A
37
Q

What are the 3 effects of using ventaltor hyperinflation? What are the precautions?

A
  1. ↑TV
  2. Slow inspiration : fast expiration
  3. Give Plateau pressure

Same precautions as MHI

38
Q

What are 3 reasons (short term effects) why MHI and VHI are done? What are long term effects?

A
  1. Secretion removal
  2. Prevent or reverse atelectasis
  3. Improve compliance

long term effects are still unknown

39
Q

What are 4 characteristics of secretion removal as why MHI or VHI is done?

A
  1. Secretion and ciliary function decrease because of
    1. Intubation
    2. Immobility
    3. Mechanical ventilation & PEEP
  2. MHI → ↑ TV, fast expiration
  3. Detaching mucous from mucocilary lining requires mist flow (occurs at velocities >2500cm/sec)
    • Fast expiration by letting go off the bag
  4. Chest wall vibrations in expiratory phase ↑ EFR
40
Q

What are 2 (2/2) main prevention or reversal of atelectasis + imporvement in compliance?

A
  1. Slow inspiration
    1. Laminar flow
    2. Increased time to fill alveoli
  2. Inspiratory pause (hold, plateau)
    1. increases surfactant
    2. collateral ventilation
41
Q

What are 3 possible respiratory complications of MHI & VHI in ICU?

A
  1. Pneumothorax
  2. Barotrauma, Volutrauma
  3. Desaturation
42
Q

What are 2 possible haemodynamic complications of MHI & VHI in ICU?

A
  1. Decrease venous return
  2. Decrease cardiac output
  • Because positive pressure
  • More so if patient has decreased BP
43
Q

What are 7 contraindications of MHI & VHI in ICU?

A
  1. Pulmonary oedema
  2. Severe haemoptysis
  3. Undrained pneumothorax
  4. Nitric oxide
  5. Severe bronchospasm
  6. Acute septic shock
  7. Low BP/ increasing inotropes
44
Q

What are 4 precautions of MHI & VHI in ICU?

A
  1. Bullae • Use pressure manometer
  2. PEEP ≥ 10cmH2O*
  3. FiO2 ≥ 0.7*
  4. Low lung compliance
    • ie on PCV, or BiLevel

* VHI may still be done

PHTY3250 (20 decks)

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