Medical Rehab Flashcards
Cardiac Rehab - goals/equations
goal is for skeletal muscle conditioning to make body more efficient at utilizing O2
- *VO2 max = CO x AVO2 difference**
- high VO2 max is better*
AVO2 = arterial O2 - venous O2
if skeletal muscle can use more O2, then venous O2 is lower → VO2 max is higher
CO = HR x SV
- CO is how good the heart is a pumping blood*
- higher CO → higher VO2 max*
MVO2 = HR x SBP
cardiac oxygen consumption; lower is better
METs
how strenuous is an activity relative to baseline metabolic rate
METs are 1-8
1: lying flat
2: golf
3: walking on treadmill
5: sex = climbing 2 flights of stairs; no sex for 2 wks after MI
6-7: shoveling snow
6-8: tennis
Borg Scale
ranges from 6-20; allows patients to report perceived level of challenge with an activity
strive for something like 14-15 as a good level of exercise
“Bjorn Borg won Wimbledon on 6/20”
Wimbledon is in summer
Phases of cardiac rehab
3 phases:
1: inpatient (1-14 days)
* *2: supervised outpatient (3-6 months); very closely monitored**
* *3: less supervised outpatient phase**
4: unsupervised outpatient, maintenance phase; goal
usually questions on phases 2-3 because 1 and 4 are easy to remember
contraindications for cardiac rehab enrollment
uncontrolled disease
severe disease
severe pain limitations
grossly inappropriate vitals
NYHA 1-4 classes of heart failure
1: can do anything over 7 METs wo limitations/Sxs
2: can do anything between 5-7 METs (sex/2 flights of stairs - shoveling snow) w dyspnea w more than a little activity
3: can do anything between 2-5 METs (treadmill walking - sex/2 flights of stairs) w dyspnea w smallest activities
4: can’t do any activities w comfort; dyspnea at rest
post transplant changes in cardiac function
new heart:
lower peak HR, higher resting HR, early atherosclerotic disease (bc foreign tissue)
common px cancers (brain, spinal, osseous)
headache, weakness, seizures → brain tumor → MRI w con
back pain worse at night → spinal cord tumor (usually thoracic, epidural) → MRI spine
extremity pain → primary or metastatic bone disease → NWB, XR, CT, MRI (surgery if pathologic fx risk)
most common primary brain tumor
astrocytoma (often glioblastoma)
most common metastatic cancer
lung, breast, GI
most common pediatric brain tumor
cerebellar astrocytoma, medulloblastoma
most common primary osseous cancer
osteosarcoma (usually knee)
most common primary for bone mets
lung, breast, prostate, MM
most are osteolytic
prostate is osteoblastic
most common pediatric cancer
leukemia
brain tumors are the most common solid pediatric cancer
pilocytic astrocytoma, medulloblastoma, ependymoma
posterior fossa tumors
most common pediatric peripheral soft tissue cancer
rhabdomyosarcoma
osteosarcoma is the most common primary bone cancer (knee)
transient myelopathy v delayed XRT myelopathy
DDX per Px and prognosis
sensory bowel and bladder involvement with delayed → permanent
grading of lymphedema
1 - 4
1: reversible w limb elevation
2: reversible whole limb (compression stockings, massage, elevation)
3a: edema of whole quadrant, not reversible, tough tissue, infxn common
3b: edema of 2 limbs/quadrants, not reversible, tough tissue, infxn common
4: edema more severe in every way than what is 3b
Tx: limb elevation, compression, massage, PT/OT, diuretics, Abx
burns - zone of coagulation v stasis
coagulation: dead tissue
stasis: at risk
burn classification
superficial partial thickness: epidermis and part of dermis
deep partial thickness: epidermis and most of dermis
full thickness: epidermis and dermis
indication for hospitalization w burns
any electrical, inhalational, fracture related, medically complicated, facial, perineal
rule of 9s
head, each UE: 9% (27%)
anterior/posterior torso each: 18%: (36%)
each LE: 18% (36%)
perineum: 1%
anticipated contractures w burns
distal part of extremity will contract towards burn
e.g., wrist flexion contracture w forearm flexor surface burn
pediatric rule of 9s
head is 18% (v 9%)
legs are 14% (v 18%)
every year after age 1, subtract 1% from head and add 0.5% to each leg
bedrest deconditioning
strength decreased 1% each day
calcium resorbed from bones bc no longer weight bearing → osteopenia, hypercalcemia
immobilization tachycardia (resting HR increases)
decreased lung volumes
renal stones
constipation
skin breakdown
osteoporosis v osteopenia
osteoporosis - decreased bone mass; “porous bones”
t-score < -2.5 on DXA scan
osteopenia → decreased bone mineralization (Ca, PO4)
DXA scan scores - osteoporosis/osteopenia/normal
normal: -1 to 1
osteopenia: -2.5 to 1
osteoporosis: less than -2.5
Tx w bisphophonates (decrease osteoclast activity bone-resorption activity; beware jaw osteonecrosis), diet, vit D, Ca, weight bearing exercise, calcitonin, estrogen (inhibits osteoclasts), vertebroplasty/kyphoplasty if severe, bracing
