Station 2: Manual Techniques

Question 1

Why is ACBT effective?

Answer 1

• Helps improve ventilation of lungs - deep breaths open collateral alveoli channels
• Helps loosen secretions - deep breathing exercises gets behind the secretions
• Helps move secretions - forced expiratory technique: small lung huff (moves sputum from low down in chest) big short huff (moves sputum from upper chest)

Question 2

Contraindications for percussions, shakes and vibs

Answer 2

• Rib fractures
• Osteoporosis
• Chest wall pain
• Chest injuries
• Recent surgery of the chest
• Spinal fusion
• Unstable angina
• Pulmonary embolus
  Start with percussions and see if they can manage this first

Question 3

Incision for sternotomy

Answer 3

Verticle incision down sternum

Question 4

Incision for supra pubic (C-section)

Answer 4

Transverse incision above pubic bone

Question 5

Right inguinal hernia repair incision

Answer 5

Along underwear line

Question 6

Appendectomy incision

Answer 6

Lower right hand side of belly button

Question 7

Lower midline incision (to prostate, bladder, pelvic lymph nodes)

Answer 7

Vertical line below belly button

Question 8

Left paramedian (laparotomy) incision

Answer 8

Vertical line left of the midline.

Question 9

Bilateral subcostal incision

Answer 9

Two incisions, both under end of ribs (for liver transplant)

Question 10

Cholestectomy incision (gall bladder removal)

Answer 10

Under subcostal incision on right of body

Question 11

Which part of ACBT is most effective for someone with breathlessness?

Answer 11

• Breathing control - for returning to normal controlled breathing and relaxation
• Thoracic expansion exercises - to increase lung volumes. To open the alveolar collateral ventilation channels

Question 12

Which part of ACBT is most effective for someone who has retained secretions and have an unproductive cough/ unable to cough?

Answer 12

• Thoracic expansion exercises - gets air behind the secretions to loosen them to make them easier to move
• Forced expiratory technique - short huff to help movement from bases to middle and long huff to get the mucus in the upper airways
• Ask if they feel like they can cough. If they have surgery wounds/broken ribs place towel and pressure

Question 13

Contraindications for Hernia repair/Emergency laparotomy

Answer 13

• ## Can do vibs and progress to shakes if patient can tolerate

Question 14

Contraindications for AAA

Answer 14

• Start on vibs and say you would do shakes if the patient can tolerate

Question 15

Contraindications for falls with chest trauma/ fractured ribs

Answer 15

• Do not do vibs or shakes- stick to percussions
• Can lay them on their side for this unless they have a floating rib

Question 16

Contraindications for Osteoporosis/ Frailty

Answer 16

• Do not do vibs or shakes- stick to percussions
• This is because they are at higher risk of bone breaks and fractures
• Can lay on side

Question 17

Contraindications for lung conditions AND CR

Answer 17

• Can do shakes and then regress to vibs if patient is struggling
  CR: the shear forces from this technique will loosen the thick sticky secretions on the chest wall to allow them to be moved into respiratory airways using mobilising and ACBT to then be coughed/ suctions