PT Implications for Cardio & Thoracic Interventions

Question 1

Purpose of posterior & lateral thoracotomies

Answer 1

Lung resection procedures

Question 2

PT intervention post-lung resection/lateral thoracotomy

Answer 2

Segmental breathing
Side bending
Lateral chest wall stretching

Question 3

Purpose of thoracoabdominal incision

Answer 3

Access to diaphragm, esophagus, biliary tract, spleen, R lobe of liver, adrenal gland, and kidney

Question 4

Patients who undergo a thoracoabdominal incision are likely to present with difficulty…

Answer 4

Coughing, deep breathing, and with thoracic extension

Question 5

PT intervention post-thoracoabdominal incision

Answer 5

Breathing exercises & mobilization EARLY
AVOID forward flexed postures (issue is not so much pulling as it is scarring into flexed position)

Question 6

Five Sternal Precautions

Answer 6

1. No shoulder flexion >90 deg
2. No lifting > 5 lbs
3. No pushing/pulling with UEs
4. No sitting behind airbag
5. No painful bilateral UE movement

Question 7

How long do patients have to abide by the sternal precautions?

Answer 7

6-8 weeks following surgery

Question 8

Idea behind “Keep your move in the tube”

Answer 8

Alternative approach designed to teach patient show to perform load-bearing movements in a way that minimized sternal stress. Keeps UEs close to the body in an attempt to minimize lateral pull on sternum with humerus movement

Created due to natural pressure applied to sternum during coughing, sneezing, & lifting everyday items

Question 9

Common complications seen after CABG procedures

Answer 9

Pulmonary infection
Atelectasis
Shoulder soreness
LE discomfort/infection

Question 10

PT Interventions post-CABG

Answer 10

Mobilization of LEs
Moving to sitting EOB
Deep breathing
Incentive spirometry
Coughing
Progressive mobility

Question 11

How often should incentive spirometers be used?

Answer 11

10 reps every 1-2 hours

Question 12

How long does it typically take for an incision to heal after a pacemaker surgery?

Answer 12

4-6 weeks - This allows firm adhesion of leads to myocardium as well

Question 13

Common physician recommendations post-pacemaker

Answer 13

Keep standard sling on for 24 hours
NO exercise to involved shoulder for 4-6 weeks
Limit shoulder flexion to 90 degs for 4-6 weeks
No lifting >5 lbs for 4-6 weeks
No driving until cleared
No diathermy or e-stim

Question 14

T/F - Chest tubes do not need to remain upright

Answer 14

FALSE - Chest tubes must remain upright in gravity dependent position.