OMT for the critically ill patient Flashcards
Other appropriate techniques that were not practiced in lab
- Myofascial release- especially of the thoracic inlet and diaphragm
- Counterstrain
- Gentle muscle energy technique
Dosage of OMT
Small sessions more frequently (2-3x daily if possible) rather than a large treatment at once
How can somatic dysfunction effect the O/A and cranial base
- Direct muscular pressure and myofascial tension on CN X as it exits the cranium through the jugular foramen
- Compression of the jugular vein as it exits the jugular foramen putting direct venous back pressure on the vagus nerve as it exits the cranium through the jugular foramen
- The cranial venous sinus’s and vertebral veins venous back pressure can also extend back into the lower brainstem area where the vegetative brain centers for the GI tract, heart, and respiration are located.
- Compression of vagus can also facilitate excessive sensory input to the vomit center, which can increase nausea and vomiting.
Steps in treating the critically ill patient
- Perform OA decompression and release
- Perform rib raising to the thorax
- Perform lumbosacral pelvic soft-tissue and articulation and/or lumbosacral pelvic decompression and release
- Perform thoracic diaphragm soft tissue and myofascial release
How can rib raising help the critically ill pt?
- Enhance and encourage expectorant function and mucus drainage within the lungs
- Facilitate venous and lymphatic circulation and drainage within the thorax
- Increase ribcage mobility which encourages ventilatory effectiveness
- Decrease pulmonary inflammation and congestion
- Stimulate bronchodilation through increased SANS tone
Benefits of the kidney pump
Encourages urine flow and facilitates removal of the dead cells, inflammation and congestion by direct mechanical stimulation to the kidney and by increasing venous and lymphatic drainage of the area
Pumping also increases arterial blood flow to the kidney which will in turn increase the perfusion of oxygen, medications, and naturally occurring intrinsic healing factors
What problems can SD in the lumbar vertebrae and sacrum cause?
Compromise of the SNS and PNS supplies to the kidneys, bladder, and distal colon can lead to
- distal colon stasis
- accumulation of excessive gas
- constipation
- urinary retention
- decreased kidney and adrenal function
- decreased urinary output and altered catecholamine levels
How can diaphragm soft tissue and myofascial release benefit a pt experiencing respiratory distress of a pt who is on a ventilator
- Increase diaphragm tone if too relaxed (ventilator) or decrease tone if in contracture
- Encourage the diaphragm to return to normal physiologic function
- Promote venous and lymphatic drainage
- Encourage overall ventilatory effectivness and efficiency
- Improve O2 and CO2 exchange
3 ways to directly stimulate the diaphragm to go back to its normal physiologic functioning
- soft tissue stretching
- inhibition along the costal margin
- myofascial release of the diagphram
Goals of OA release
- Relax cervical muscle spasm and fascial tension
- Relax tension and stress on the vagus nerve
- Improve overall functioning of brainstem, lungs, heart, and GI tract
Clinical uses of OA release
- Headache
- Respiratory depression
- Asthma and COPD
- Pneumonia
- Congestion in the thorax
- Nausea and vomiting
- Ileus
Where do your fingers go in OA release?
In the groove formed between the occiput and the atlas
Clinical uses for rib raising
- Pneumonia and respiratory infections
- Asthma and COPD
- Congestion in the thorax and other parts of the body
- Post-operative patients, especially for atelactasis and poor respiratory effort
- Pregnancy
- thoracic spine dysfunction, especially flexed dysfunciton
- ileus
- Acute renal failure, prevention and treatment
Where do fingerpads go in rib raising?
1-2 inches lateral to the spinour processes
Goals of lumbar, sacral, and pelvic soft tissue and articulation
- Reduce lumbosacral myofascial pain
- Decrease pelvic congestion
- Improve mechanical function of low back and pelvis
- Improve diaphragm function
- Normalize automatic activity in the pelvis
