Theory Flashcards
ISBAR Handover
Introduction and Identity
Situation
Background
Assessment and Actions
Recommendation
What are risk factors for stroke?
hypertension, diabetes, increased cholesterol, poor diet (increased alcohol, salt, saturated fats), smoking, obesity, lack of regular exercise, genetics, cardiac disease (e.g., AF)
What is the most common stroke presentation and why?
MCA infarct - this is because the MCA is a direct continuation of the internal carotid/common carotid artery. Therefor emboli from the heart can travel up this pathway and lodge in the MCA.
What are the key impairments found in a person with a L MCA infarct?
R hemiplegia (UL>LL)
R hemisensory loss (UL>LL)
R homonymous hemianopia
Dysphasia
Dyspraxia
Criteria for PPC (as per Scholes 2005)
Combination of 4 or more of the following criteria:
- CXR report of collapse and/or consolidation
- Raised maximum oral temperature >38 degrees on more than one consecutive post-op day
- SpO2 <90% on more than one consecutive post-op day
- Productive of yellow or green sputum which is different to pre-op assessment
- Presence of infection on sputum culture report
- An otherwise unexplained white cell count >11x10^9/L or prescription of antibiotic specific for respiratory infection
- New abnormal breath sounds which are different to pre-op assessment
Physicians diagnosis of post-op pulmonary complication
Define Hemineglect
Neglect is a disorder of spatial attention defined as failure to attend to one side of the body and/or environment (either sensory, visual or auditory input), however primary sensation is in tact. It is associated with poorer prognosis for functional outcomes.
Cause: strongly correlated w/R (non-dominant) parietal lobe damage
Signs of a scaphoid fracture
1 - Palpate scaphoid in snuff box
2 - compress push Mc down onto scaphoid
3 - ulna deviation overpressure
(+ve for pain)
dysmetria
dysmetria = inaccurate amplitude of movement and displaced force
dyspraxia (apraxia)
a disorder of skilled voluntary movement not attributed to motor, sensory or perceptual disorders
(ie. difficulty motor planning)
cause = associated w/frontal, parietal and temporal lobe damage
dysdiadochokinesia
Difficultly performing rapid alternating movements (RAM)
Cause = ataxia
agnosia
inability to interpret and thus understand sensory information, however primary sensation is intact
cause = parietal/occipital lobe damage
rigidity
an increase in muscle tone leading to resistance to passive movement throughout ROM
- Lead-pipe = constant
- cog-wheel = episodes/jerky
spasticity
motor disorder characterised by a VELOCITY DEPENDENT increase in tonic stretch reflexes (muscle tone) w/exaggerated tendon jerk
Cause: upper motor neuron (UMN) lesion
Clonus
involuntary, repeated, rhythmic muscle contractions
Homonymous hemianopia (HH)
visual field deficit whereby half (L or R) of the visual field is lost
Rebound Phenomena
dysfunction in agonist/antagonist relationship (ie. ability to brake movement)
cause: ataxia
Dysphagia
difficultly swallowing (gag reflex)
dexterity
fine motor skills (especially hands)
What are the common cardiorespiratory physiotherapy problems?
1 - impaired airway clearance
2 - dyspnoea (increase WOB)
3 - decreased Ex. tol.
4 - low lung volumes
5 - impaired gas exchange
6 - decrease mobility
7 - respiratory muscle dysfunction
8 - pain
Respiratory Muscle Dysfunction (Cardio PT Problem)
signs: increase WOB, nocturnal symptoms (e.g. orthopnoea)
treatment: respiratory muscle training, relaxed controlled breathing
Orthopnea
Difficultly breathing in supine position
Impaired Gas exchange (Cardio PT Problem)
Signs: decrease SpO2 (<95%), decrease PaO2 (<80mmHG), increase PaCO2 (>45)
treatment: O2 therapy
Re-Assess: SpO2, ABGs, O2 requirements
decreased mobility (Cardio PT Problem)
signs: decreased ROM, inability to complete ADLs/transfers, bed-bound, post-op, acutely unwell (sedated)
treatment: positioning, assist w/transfers, walking
re-assess: assistance required, functional questionnaires
Impaired airway clearance/mucociliary clearance/sputum retention (Cardio PT Problem)
signs: increase sputum production, change in sputum colour, coarse crac ales, febrile, difficult/weak/ineffective cough, CXR consolidation
Treatment: ACBT, PEP, exercise/mobility, autogenic drainage, postural drainage, manual techniques (vibs and percussions), inhalation therapy (nebs)
Re-assess: sputum expectorated (colour and amount), auscultation, CXR, cough, exacerbations (chronic), palpation (fremitus)
Dyspnoea and SOB (increase WOB) (Cardio PT Problem)
signs: patient reported SOB (BORG scale), increase RR, increase accessory muscle use, distress/anxiety, shallow breaths (decrease TV)
Treatment: relaxed controlled breathing, pursed lips breathing, positioning (forward lean), gait aid for mobility, reliever/inhaler education, O2 therapy, exercise (long-term)
Re-Assess: modified BORG scale, MRC dyspnoea scale, QoL measures, SpO2
decrease exercise tolerance (Cardio PT Problem)
signs: decrease exercise (e.g. walking distance) compared to normal, limited by fatigue/SOB
treatment: mobilisation and exercise (endurance and strength), long term cardiac/pulm rehab, education
Re-assess: 6MWT, distane walked, duration, SOB during/after exercise, limiting factors
low lung volumes (Cardio PT Problem)
signs: CXR (shows collapse, fluid etc.), decrease BS on Auscultation, decrease SpO2, decrease bibasal expansion, weak cough
Treatment: upright positioning, NIV (CPAP), deep breathing exercises (+/- SMI)
Re-Assess: CXR, auscultation, cough, bibasal expansion, SpO2
Pain (Cardio PT Problem)
signs: patient reported, VAS/NRS ratings
Treatment: pain-medication, rest
Re-assess: VAS, NRS
What is the difference between pneumothorax and tension pneumothorax? (and on CXR)
Pneumothorax = air in pleural space but it is able to move between lungs and pleural space
Tension pneumothorax = air in pleural space, but the air can not move out of plueral space
On CXR: both have loss of peripheral lung markings w/visible lung edge, however, tension pneumothorax will result in a mediastinal shift AWAY from the affected lung
What are the common features of COPD on a CXR?
1 - Hyperinflation (low/flat diaphragm, increased rib count, flattened ribs)
2 - elongated mediastinum and hilum
3 - increased radio-translucency
4 - barrel-shaped chest
5 - bullae (areas of increased darkness due to trapped air)
6 - decreased vascular markings
What is a meniscus sign? (CXR)
A meniscus sign is a concave line obscuring costophrenic angle and part or all of hemidiaphragm
This is due to fluid collecting at lowest part of chest (in erect position due to gravity) in the case of a PLEURAL EFFUSION (fluid in pleural space)
pleural effusion
the accumulation of fluid in between the parietal and visceral pleura, called the pleural cavity
Crepitus
crepitus describes a popping, clicking or crackling sound in a joint
Pneumothorax
A pneumothorax is a collection of air outside the lung but within the pleural cavity. It occurs when air accumulates between the parietal and visceral pleura inside the chest. The air accumulation can apply pressure on the lung and make it collapse
What is a silhouette sign? (CXR)
a silhouette sign is a loss of normal borders between contents of the thoracic cavity on CXR (including loss of R heart and aortic knuckles). This is usually the result of a mass of the same tissue density as another structure being present and thus obscuring clear borders in the XR
Systematic approach to reading CXR
- check name, date, time and type
- check quality RIP
Rotation: spinner process and clavicles
Inspiration: 6th rib on R and 7th rib on L
Penetration/exposure: vertebrae just visible behind heart - Anatomical structures (ABCDE)
Airways, Breathing, Circulation, Disability/bones, Everything else (attachments)
What are the limitations of an AP CXR? When may an AP image be taken?
An AP CXR may be performed when a pt. is too unwell to stand (e.g. in ICU, emergency)
Disadvatages: heart and mediastinum appear enlarged.
A PA is usually taken because: cardiac size more accurate, scapula can be out of the way
Pleural Rub (auscultation)
creaking, squeaking, grating or rubbing around during inspiration and expiration due to friction between pleural surfaces
causes: inflammation or infection of pleura
Wheezes (auscultation)
continuous, high-pitched musical tones produced by air vibrating in narrow airway during late inspiration or expiration
Causes: bronchospasm, narrowed airway diameter, mucosal oedema, sputum, foreign body
bronchial breath sounds (auscultation)
normal tracheal sounds heard at lung periphery (louder in periphery)
cause: consolidation
coarse crackles (auscultation)
popping or clicking sounds mainly heard in inspiration (coarse crackles are louder and longer laster and lower pitch
cause: sputum retention, pulmonary oedema, aspiration
Fine crackles (auscultation)
popping or clicking sounds heard mainly on inspiration (fine crackles are shorter, quicker and more prominent on late inspiration)
cause: atelectasis, pulmonary fibrosis
Reduced breath sounds (auscultation)
decreased intensity of breath sounds (heard during inspiration and short periods of expiration)
cause: atelectasis, pneumothorax, pleural effusion
absent breath sounds (auscultation)
no sounds during inspiration or expiration
cause: localised fluid/air in pleural space, obstruction due to large sputum plug or carcinoma
Atelectasis
Atelectasis, the collapse of part or all of a lung, is caused by a blockage of the air passages (bronchus or bronchioles) or by pressure on the lung. Risk factors for atelectasis include anesthesia, prolonged bed rest with few changes in position, shallow breathing and underlying lung disease
Ataxia (+ 8 symptoms)
A general term used to describe abnormal coordination of movements (clumsiness/loss of coordination demonstrated by decrease speed, amplitude, accuracy and force)
8 = dysmetria, rebound phenomen, dysdidochokinesia, intention tremor, dyssynergia, hypotonia, dysarthria, nystagmus
Cause: cerebella, vestibular, or sensory (stroke, MS, CP, TBI, Peripheral neuropathy)
nystagmus
repetitive, uncontrolled movements of the eyes
freezing
difficultly in starting or continuing rhythmic, repetitive movements (e.g., speech, handwriting, gait/FOG)
cause: Parkinsons, (can be triggered by cognitive or emotional challenges)
Akinesia
difficultly initiating movement and freezing during movement
cause: Parkinsons
hypokinesia
decreased amplitude of movement
cause: Parkinsons
Bradykinesia
Slowness of movements (decrease speed)
cause: Parkinsons
dysarthria
motor speech disorder (ie. muscles are damaged, paralysed or weakened
cause: damage to cerebellum
Cardinal signs of Parkinsons
1 - Bradykinesia
2 - Rigidity
3 - Resting Tremor
4 - postural instability (balance deficits)
Dysexecutive syndrome
dysregulation of executive functions such as emotion, motivation, behaviour and cognition
cause: frontal lobe damage
dysphasia
language disorder marked by deficiency in generation (expressive) or comprehension (receptive) of speech
cause: damage to Wernicke’s or Broca’s
Wernicke’s Area
(Left/dominant temporal lobe)
Comprehension of sounds (especially speech)
Damage results in receptive dysphasia
Broca’s area
a region in the frontal lobe of the dominant hemisphere, usually the left, of the brain with functions linked to speech production.
damage results in expressive dysphasia
Signs of PCA infarct
Visual deficits
agnosia
memory deficits
Effects inf- post- parietal lobe and occipital lobe
What structures are present in both the superior and inferior mediastinum?
oesophagus
aorta (arch & descending)
vagus nerve
thoracic duct
lymphatic trunks
OTTAWA Knee rules
pts with acute knee injury an x-ray is only necessary if they have any of:
- over 55yrs of age
- isolated patella tenderness
- tenderness over head of fibula
- have less than 90 knee Flex
- unable to WB 4 steps BOTH initially and in ED (regardless of limp)
OTTAWA Ankle Rules
acute ankle pain
ANKLE PAIN: pts only need x-ray if pain in malleolar zone and any of:
- Tenderness of post- aspect of distal 6 cm of tib or fib
- unable to WB 4 steps initially and in ED
MID-FOOT PAIN: pts only need x-ray if pain in mid foot and any of:
- tenderness on base of 5th metatarsal
- tenderness of navicular
- unable to WB 4 steps initially and in ED
Landmarks of end of Spinal Cord
Spinal cord ends at T12
Dural sac ends at S2
Filum terminale attaches to coccyx (elongation of Pia mater)
What is a bronchopulmonary segment?
the smallest functionally independent segment of a lung
Openings of the diaphragm
Caval Opening (vena cava) at T8 level
Oesophageal opening (oesophagus) at T10 level
Aortic opening (aorta) at T12 level
Hilton’s Law
States that a nerve that supplies a muscle producing movement at a joint will also supply that joint
Why is biceps femoris prone to injury?
- hamstring muscles are highly frequently injured as they cross two joints and have eccentric action.
- biceps femoris has two heads (short and long) which have the same insertion (lateral side of head of fibular), however, they have different origins (long: ischial tuberosity, short: lines aspen and lateral supracondylar line of femur).
They also have differing innervation, (long: tibial portion of sciatic nerve, whilst short: common Peroneal nerve), meaning there is possibility for discoordination of muscle contraction and hence increased risk of injury.
differences in male and female pelvis
Female:
1) shape: oval
2) wider outlet
3) wide and shallow
4) wider subpubic angle (80)
5) lowest point of peritoneal cavity is vesicoultenne and rectouterine pouch
Male:
1) shape: heart-shaped
2) narrower outlet than inlet
3) taller and narrower
4) narrower subpubic angle (50)
5) lowest point of peritoneal cavity rectovesical pouch
NEXUS Criteria
For low probability of Cx injury:
- no midline tenderness
- no focal neurological deficit
- normal alertness
- no intoxication
- no painful distracting injury
** if don’t fulfil ALL criteria, then imaging IS required
Why are ear infections more common in children than adults?
Because the Eustachian tube (which allows for equalised pressure when swallowing by opening) is more horizontal and shorter in children and hence easier for infection to travel
What does ‘dominance’ refer to in relation to the arterial supply of the heart?
the ‘dominant’ side is defined by whether the left or right coronary artery gives rise to the posterior intraventricular artery
UL myotomes
C1- Cx flex
C2 - Cx E
C3 - Cx L.F
C4 - shoulder elevation (trapezius)
C5 - shoulder abd (deltoid)
C6 - elbow F (Biceps brachi)
C7 - elbow E (triceps)
C8 - Thumb E (EPL)
T1 - finger add. (or abd in 90 MCP F)
LL myotomes
L2 - hip F (Iliopsoas)
L3 - knee E (quadriceps)
L4 - DF w/supination (tib ant)
L5 - big toe ext. (EHL)
S1 - pronation (peroneus)
(S4 - bladder and rectum motor control)
List possible causes of developmental delay
Premature birth
cultural practices
use of play equipment such as jolly jumper or baby walker
other management strategies such as for SIDs
lack of practice/environmental opportunity
APGAR test
Appearance, Pulse, Grimace, Activity, Respiration (in newborns 0-5 mins after birth)
Reflexes present in newborns
asymmetrical tonic neck reflex
placing and stepping reflex
grasp reflex (plantar and palmer)
moro/startle reflex
rooting reflex
Define TIA
Transient ischemic attack is defined as a temporary period of symptoms similar to those of stroke, and can be considered an ‘early warning sign’ of a stroke
Most appropriate standardised assessment tool for acute stroke?
MSAS (motor scale for acute stroke patients)
Most appropriate standardised assessment tool for 2 weeks post-/chronic stroke?
MAS (motor assessment scale)
Role of Acetylcholine
stored in pre-synaptic end of motor nerve in vesicles. release to cross the neuromuscular junction/synapse and attaches to receptors, it then acts to rapidly depolarise the muscle leading to muscle contraction
Post-Polio syndrome
Development of new weakness, atrophy and fasciculations in previously unaffected muscles, new symptoms of fatigue and atrophy, occurs after 15-20yrs+ after initial infection
Cause is unknown (? due to prolonged stress on recovered motor units)
Physio: non-fatuging exercise, sufficient rest, submax strength, stretching to prevent contractures, safe mobility and aids, falls strategy and edu, Respiratory managament, energy conservation strategies, cardiopulmonary conditioning
Myasthenia Gravis (MG)
autoimmune disease that affects the neuromuscular junction (auto-antibodies attach to acetylcholine receptor sites decrease no. of available receptors)
Results in weakness, and abnormal fatiguability. Symptoms usually improve with rest, worse at end of day and with repetitive movements
paralytic ileus
the condition where the motor activity of the bowel is impaired, usually without the presence of a physical obstruction.
Guillain Barre Syndrome (GBS)
polyneuropathy that occurs 1-3wks post viral or other infection
macrophages and lymphocytes Destroy segmental parts of myelin sheath meaning that there is not effective conduction of nerve impulses.
Symptoms: sensory deficits, weakness, pain (LBP and post. thigh), autonomic nervous system dysfunction, deep tendon reflexes are absent
Management:
pharma: intragam and plasma exchange (PE)
physio: acute Respiratory (ventilation, tracheotomy care), neuromuscular management, positioning, msk care, endurance
Cells that form myelin sheath in CNS
Oligodendrocytes (form myeline around multiple axons)
ECG
P wave = atrial depolarisation
PR segment = av node delay
QRS complex = ventricle depolarisation
T wave = ventricle repolarisation
Keller’s procedure
a soft tissue release and bony resection used to correct Hallux Valgus (bunions)
Ober’s Test
Test for iliiotibial band (ITB) tightness
Lachman Test
Passive accessory movement test of the knee to identify integrity of the ACL (anterior cruciate ligament)
Neer test
Used to assess for subacromial impingement syndrome
Thomas Test
measure hip flexor length, assess for Iliopsoas tightness
Apley’s Test
Apley’s ‘grind’ test assesses for problems with the meniscus in the knee
What amount of the brain’s dopamine is located within the basal ganglia
80%
dysserngia
Dyssynergia = decomposition of movement (due to breakdown of normal coordination resulting in abrupt movements)
cause = ataxia
Cardiac output
CO = HR x SV
(total volume of blood pumped out of the heart per minute)
Frank- sterling law
is based on the link between the initial length of myocardial fibers and the force generated by contraction (length-tension of the heart muscles)
**as the heart fills, muscle stretches, the more it stretches the more force that can be generated
Hilton’s Law
A nerve that supplies a muscle that creates movement at a joint will also supply that joint
Factors affecting CO
HR (increase = increased CO, however increase HR, can decrease SV because less time for filling)
Stroke volume:
- pre-load (end-diastolic volume)
- after load (resistance in aorta)
- contractility of the heart
Factors that affect resistance to blood flow
- viscosity of fluid (increase = increase R)
- Length of tube (increase = increase R)
- radius of tube (decrease = increase R) **biggest impact due to equation x/r^4
Normal Vitals
HR 60-100bpm
BP 120/80 (95/60-140/90)
Temp. = 36.5-37.5
RR= 12-16
Functional residual volume
the volume remaining in lungs after a normal, passive exhalation
Total lung capacity (TLC)
max. amount of air contained in lungs after a max. inspiratory effort
vital capacity (VC)
max. amount of air that can be inspired and then expired with Mac. effort
Forced vital capacity (FVC)
amount of air that can be expelled when the subject takes the deepest possible inspiration and forcefully expires as completely and as rapidly as possible
Forced expiratory volume (FEV1)
measures the percentage of the vital capacity that is expired during one second of the FVC test (normally 75-85% of VC)
Normal Inflation on Chest xray
6th. ant rib on R side
7th ant. rib on L side
Pyrexia
fever = increase of an individual’s core body temperature
daytime somnolence
excessive sleepiness during waking hours
girdlestone’s procedure
a surgeon will simply remove the affected femoral head and neck of the thigh bone (femur)
pes anserinus
(say grace before tea)
Satorius
gracilis
semi-tendinosis
cranial nerves
“oh oh oh to touch and feel vera green’s very amazing hat”
“Some say marry money but my brother says big boobs matter more”
1 - olfactory (S)
2 - optic (S)
3 - oculomotor (Motor)
4 - Trochlear (M)
5 - Trigeminal (B)
V1 ophthalmic (s), V2 maxillary (s), mandibular (b)
6 - abducens (M)
7 - Facial (B)
8 - Vestibulocochlear (S)
9 - Glossopharyngeal (B)
10 - Vagus (B)
11 - Accessory (M)
12 - Hypoglossal (M)
ABG normal values
pH: 7.35-7.45
PaO2: 80-100mmHg
PaCO2: 35-45mmHg
HCO3-: 22-26mmol
BE/BD: -2 - +2
plane of Louis
T4/5 IV disc, manubriosternal joint
azygous vein terminates
aortic arch begins and ends
recurrent laryngeal nerve passes under aortic arch
trachea bifurcates (carina)
thoracic duct crosses to L
phrenic nerve
C3-5
supplies parietal pleura
irritation of parietal pleura can result in pain on tip of shoulder
Sympathetic supply to heart and lungs
‘fight or flight’
sympathetic trunks (cardiac plexus T1-5, pulmonary plexus T2-T6, oesophageal plexus T4-6)
effect: bronchodilation, vasoconstriction in lungs, inhibit secretions, increase HR, increase strength of ventricular contractions
Parasympathetic supply to heart and lungs
‘rest and digest’
vagus nerve (CNX)
effect: bronchoconstriction, vasodilation in lungs, promote secretions, decrease heart rate
Cx spine red flags/VBI insufficiency
5D’s and 3N’s
Dizziness
Diplopia (double vision)
Dysphagia (swallowing)
Dysarthria (speech)
Drop attacks
Nausea & vomiting
Numbness (sensory changes)
Nystagmus
(acute onset of mod-severe unfamiliar headache or neck pain)
Red Flags
unexplained LOW
WIN (pain)
general health (fever, recent surgical procedures, recent travel)
medications (ie. long term corticosteroids)
any investigations (x-rays, CT, MRI, blood tests)
yellow flags (psychological/social factors that may impact)
Cauda Equina Red flags
- any difficulty using bladder and bowel?
- any pins, needles, numbness in saddle area
- any pins, needles, numbers in both arms or both legs
WOCSNOR
Where
Other (location)
Constant (or intermittent)
Severe
Nature
Other (symptoms)
Relationship
SLAP lesion
Superior labral anterior posterior (SLAP) tears are injuries of the glenoid labrum. They involve the superior glenoid labrum, where the long head of biceps tendon inserts.
Not usually associated with GH instability
Cause: FOOSH or repetitive stress
Bankart Lesion
Bankart lesions are injuries of the anteroinferior aspect of the glenoid labral complex (and are often found in association with a Hill-Sachs lesion on humerus head) This injury is a common complication of anterior shoulder dislocation and/or repeated anterior shoulder subluxations.
Symptoms of ACA infarct
- contralateral hemisensory loss (LL>UL)
- contralateral hemiplegia (LL>UL)
- incontinence
- dyspraxia
- decrease attention
- dysexecutive syndrome
(supplies medial and sup frontal lobe, and ant. parietal lobe // includes medial pre/post central gyri)
Symptoms of R (non-dominant) MCA infarct
L hemiplegia (UL>LL)
L hemisensory loss
L homonymous hemianopia
neglect (motor, sensory, visual)
spatial/perceptual dysfunction
Pre-central gyri function
primary motor cortex
Post-central gyri
primary somatosensory cortex
Signs of cerebellar infarct
- dizziness
- ipsilateral ataxia/dyspraxia
- dysarthria
- nystagmus
(NO sensory loss)
hill Sachs lesion
an osseous defect or “dent” of the postero-supero-lateral humeral head that occurs in association with anterior instability or dislocation of the glenohumeral joint.[1][2] It is often associated with a Bankart lesion of the glenoid.
Well’s criteria for DVT
- active cancer
- calf swelling >3cm
-swollen unilateral superficial veins - unilateral pitting oedema
- previous documented DVT
- swelling of entire leg
- localised calf tenderness (along veinous system)
- paralysis, paresis or recent cast immobilisation of LL
- recently bedridden for >3days (or major surgery within 12 weeks)
What is form closure?
theoretical stable structure of a joint with close fitting articular surfaces.
refers to stability due to anatomical shape of bones and articular surfaces
SIJ has very form closure to allow for good force distribution between ilium and sacrum
What is force closure?
the dynamic stability pressure that actively compresses a joint. (this includes muscular systems, fascia, ligaments that create active compression force across joint surfaces)
Spondylosis
degeneration of the spine
Spondylolysis
is a stress fracture through the pars interarticularis of the lumbar vertebrae.
Spondylolithesis
a condition that occurs when one vertebral body slips with respect to the adjacent vertebral body causing radicular or mechanical symptoms or pain.
(progression from spondylolysis when fracture on bilateral pars interarticularis)
Ordering Inhalation therapy
1 - bronchodilators/relivers
2 - Hypertonic/isotonic nebuliser and airway clearance techniques
3 - inhaled antibiotics / other medications
Variable performance device
deliver a flow of O2 that is less than the patients peak inspiratory flow, hence the FiO2 will vary with the rate and volume of each breath. these devices can not deliver a high FiO2
Devices: nasal prongs (0.24-4l/min), simple hudson mask (minimum 6L/min up to 15)
Fixed performance devices
deliver a known FiO2 by providing a sufficiently high flow of premixed gas that should excess the patients peak inspiratory flow rate.
Devices: venturi, high flow nasal prongs
Craniotomy
A craniotomy is a surgical procedure in which a part of the skull is temporarily removed to expose the brain and perform an intracranial procedure. (note NO pressure can be put on a craniotomy site)
Lobectomy
surgical procedure to remove one lobe of the lung
pneumectomy
surgical removal of the whole lung
NEVER POSITION THE PNEUMECTOMY SIDE UPPERMOST
Outcomes indicative of high falls risk
- unable to pick an object up from the ground
- 180 turn >4 steps
- 360 turn >4 secs
- TUG >14.5secs
- 10MWT >12.5 secs, >21 steps
Allodynia
Allodynia is defined as “pain due to a stimulus that does not normally provoke pain.” An example would be a light feather touch (that should only produce sensation), causing pain.
What is the perineal body and what is its significance?
It is a fibromuscular (structural) node that acts as a common attachment point for muscles of the pelvic floor and perineum. It helps stabilise and support these structures.
Functions of the pelvic floor
- support viscera
- maintain continence
- contribute to raising intra-abdominal pressure
- allow for defection and childbirth
- help guide fetal head during childbirth
what is the significance of the rectouterine pouch?
lowest point of abdomen, therefore bleeding/fluid will pool here
(pouch of Douglas)
ASIA SCALE
The American Spinal Injury Association Impairment Scale is a standardized neurological examination used by the rehabilitation team to assess the sensory and motor levels which were affected by the spinal cord injury
ECR
endovascular clot retrieval
surgical procedure to retrieve clot, particularly larger clots that can not be broken down by tPA. Needs to be performed within 24hrs (with 12hrs optimal)
What is Hoover’s sign?
weakness of hip extensors returns to normal with contralateral hip flexion against resistance (ie. weakness of voluntary hip extension but normal hip ext, during contralateral hip flexion)
What is a long-lie?
Occurs when a person has been on the ground for longer than 1 hour.
Consequences include: rhabdomyolysis (breakdown of damaged skeletal muscles, which can lead to kidney failure), muscle damage, pneumonia, pressure-sores, dehydration, hypothermia, fear of falling
Lymphoedema
Swelling in one or more regions of the body (often a limb), characterised by low flow and high protein fluid (lymph)
primary = genetic
secondary = after unrelated disease/treatment (ie. cancer treatment, severe trauma ..)
Delirium
Concurrent disturbance of consciousness and attention, perception, thinking, memory, pyschomoto behaviour, emotion and sleep-wake cycle
hyperactive, hypoactive, mixed
temporary
Dementia
an organic brain syndrome that leads to deterioration in cognitive function beyond what is expected from usual consequences of biological aging
- gradual onset, progressive and irreversible
Does NOT affect consciousness
Course of the supply vessels of the heart
GAMPS Right
Great cardiac vein/Ant interventricular branch (LAD)
Middle cardiac vein/Post interventricualr branch
Small cardiac vein/Right coronary artery (marginal branch)
Indirect vs direct hernias
An indirect hernia passes through the inguinal canal (from deep to superficial ring) whereas a direct hernia is a bulge through post wall of inguinal canal (tansversalis fascia and conjoint tendon)
Pudendal nerve injury
S2,3,4
incontinence, prolapse of pelvic organs and reduced sexual function
Laslett’s SIJ pain provocation tests
- distraction test
- compression test
- thigh thrust test
- gaenslens test
- sacral thrust test
(also resisted SLR, stork test)
