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Cardiorespiratory Physiotherapy > Week 2 > Flashcards

Week 2 Flashcards

1
Q

What is the aim of lung function tests

A

assess the effectiveness of lung function to meet metabolic demands of the body’s tissues

  • ventilation
  • pulmonary blood flow
  • diffusion
  • control of ventilation
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2
Q

What is spirometry

A

a physiological test of lung function, assessing the mechanical properties of the pulmonary system

  • timed measurement of how the lungs work and is used to
    • measure how effectively air moves into and out of the lungs : how fast it flows and how much volume

–provides measure of airway size, lung size and muscle strength

Uncomplicated, non invasive investigation

affordable, portable equipment
minimal training required to perform
most broadly used test

**important test to detect, quantify and monitor diseases that limit ventilator capacity

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3
Q

What is COPD

A

Chronic Obstructive Pulmonary Disease

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4
Q

Indications for spirometry (8)

A

screening, detecting and assessing for respiratory disease
Assessing respiratory function
differentiating respiratory and cardiac diseases as the cause of breathlessness
diagnosing respiratory diseases - obstructive vs restrictive
Assessing the severity of disease
Assessing the response to treatment
Assessing pre-operative risk
Occupational health related assessments

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5
Q

Complications of spirometry

A 
Requires maximal effort and subject cooperation
-Transient breathlessness 
oxygen desaturation
syncope
chest pain
cough
light-headedness
bronchospasm
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6
Q

Contra-indications of spirometry

A

High positive intr-thoracic pressure and its transmission to vascular, abdominal and other body parts may be detrimental = best to delay spirometry

Recent eye surgery (1-4wks) or recent brain surgery(3-6wks)
Recent thoracic and abdominal surgery (in last 7 days)
Aneurysms (cerebral or abdominal)
Recent CVAs
Unstable cardiac function / angina or recent myocardial infarction in past 7 days
uncontrolled hypertension
haemoptysis of unknown cause
Pneumonthorax in last 3 weeks
Nausea, vomiting or diarrhoea
Untreated pulmonary embolism

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7
Q

What can cause an inaccurate result

A 
Chest or abdominal pain
pain in mouth or face
stress incontinence
dementia 
recent alcohol consumption
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8
Q

Patient related problems with spirometry

A 
variable or submaximal effort
insufficient inspiration or expiration 
leaks between the lips and mouthpiece 
slow or hesitation at the start of the test 
cough particularly within the 1 sec
glottis closure 
tongue blocking mouth piece
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9
Q

Repeatability criteria for spirometry

A

to ensure that the tests are producing reliable and consistent results
these criteria determine when more than 3 manoeuvres are required to achieve an accurate result

  • the difference between the best FEV1 and the second best FEV1 must be within 0.15L
  • -if FEV is
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10
Q

Acceptability Criteria for spirometry

A

•Used to determine that the patient has performed the test manoeuvre correctly

•Criteria required to be met:
–Test begins from full inspiration (start of test)
-Rapid start of test (start of test)
–Continuous maximal expiratory flow (end of test)
–Expiration time >6 secs (adult) and >3 secs (child) or no change in volume for at least 1 sec (end of test)
–No obstruction, hesitation or artefact impeding the blow (end of test)

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11
Q

On x-ray signs of a pneumothorax

A
  • visible lung edge - sharply outlined diaphragm

- loss of lung parenchyma markings within the lung fields

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12
Q

Pneumothorax is

A

A pneumothorax involves damage to the lung tissue and pleura so that air accumulates within the pleural space.

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13
Q

Presenting complaints of a pneumothorax

A
  • pleuritic chest pain
  • dyspnea – decreased breath sounds on affected side
  • tachypnoea
  • tachycardia
  • low O2 sats (not necessary in all cases)
  • history of recent chest wall injury (not necessary in all cases)
  • previous history of spontaneous pneumothorax (not necessary all cases)
  • tracheal deviation (late sign).
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14
Q

Haemothorax is

A

A haemothorax involves damage to the lung tissue and pleura so that fluid (i.e. blood) accumulates within the pleural space.

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15
Q

On x-ray signs of haemothorax

A

On an upright x-ray, a haemothorax may present with a visible fluid level. aka. Air-­fluid level
–No mensicus sign

Although the cause of a pleural effusion is quite different to a haemothorax, radiologically they are similar in appearance.

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16
Q

On x-ray signs of Pleural Effusion

A

–Fluid collects in pleural cavity
–Collects in the costophrenic angles
–“Mensicus sign”

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17
Q

Acid-Base balance Equation

A

H2O + CO2 = H2CO3 = H+ + HCO3-

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18
Q

Hyperventilation signs and symptoms

A

•Low PaCO2
•Rise in pH
•Symptoms
–Tingling around the mouth and extremities
–Light‐headedness
–Syncope
•Secondary hyperventilation occurs in Metabolic Acidosis

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19
Q

Clinical signs of hypercapnia

A
  • Confusion
  • Flapping tremor
  • Warm extremities
  • Drowsiness
  • Bounding pulse
  • Headache
  • Flushed skin
  • Coma
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20
Q

Clinical Signs of Hypoxaemia

A
  • Restlessness
  • Confusion
  • Aggression
  • Sweating
  • Fittng or convulsions
  • Plucking
  • Increased RR, HR and BP
  • ECG changes
  • Blurred vision, tunnel vision
  • Pallor
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21
Q

Type 2 Respiratory Impairment

A

•High PaCO2 (>50mmHg)
•Usually low PaO2
•Due to inadequate alveolar ventilation
•Type 1 Respiratory Impairment – can lead to Type 2
•Treatment
•Improve ventilation
•SaO2
– no help to monitor as doesn’t monitor CO2

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22
Q

Type 1 Respiratory Impairment

A

•Low PaO2 (

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23
Q

3 Disorders of Gas Exchange

A
  • Hypoxia
  • Hypoxeamia
  • Impaired oxygenation
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24
Q

Hypoxia is

A

any state in which tissues receive an
inadequate oxygenation to support normal
aerobic metabolism

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25
Q

Hypoxeamia is

A

any state in which the O2 content in arterial blood is reduced

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26
Q

Impaired oxygenation

A

hypoxaemia resulting from reduced transfer of O2 from lungs to the bloodstream. PaO2

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27
Q

Oxyhaemoglobin Dissociation

Curve shifts to the left when

A

increase PH
decrease PCO2
decrease temp
decrease 2,3 DPG

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28
Q

Oxyhaemoglobin Dissociation

Curve shifts to the right when

A

decrease PH
increase PCO2
increase temp
increase 2,3 DPG

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29
Q

Haemoglobin Oxygen Saturation SaO2

A

•PO2 doesn’t tell us how much O2 is in blood
–Measures free, unbound O2 molecules (tiny
proportion of the total)
•Almost all O2 molecules in blood are bound to Haemoglobin (Hb).
•The amount of O2 in blood depends on 2 factors:
–Hb concentration
–Saturation of Hb with O2

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30
Q

Normal pH

A

7.35-7.45

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31
Q

Normal PCO2

A

35-45mmHg

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32
Q

Normal HCO3

A

22-26

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33
Q

Normal PO2

A

80-100mmHg

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34
Q

Normal BE

A

-2.0-2.0

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35
Q

conditions that may result in the appearance of air bronchograms

A
  • pneumonia / lung consolidation
  • atelectasis
  • pulmonary oedema.
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36
Q

Oxygen therapy is

A

the administration of oxygen to a patient at concentrations greater than that in ambient air with the intent of treating or preventing the symptoms and manifestations of hypoxia.

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37
Q

Interpretation of spirometry results

A

Once the acceptability and repeatability criteria have been met and at least 3 test manoeuvres completed, the best results need to be selected for interpretation

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38
Q

The American Thoracic Society and European Respiratory Society 2005 Spirometry guidelines state

A

Stipulate that the best test values are selected by
-identifying that the best test values are selected by:
-identifying the highest FVC and FEV1 measurements from acceptable and repeatable tests.
- these do not need to be from the same manoeuvre
-Identify the manoeuvre with the highest sum of FEV1 + FVC = best curve
-Identify other indices that need to be reported from the best curve (e.g. PEF, FEVt etc)
Only data from acceptable and repeatable efforts are to be included

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39
Q

Predicted Reference values

A

interpretation begins with comparison between patients actual spirometry values and predicted values for health individuals of the same age, height, gender and ethnic origin

Patients values

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40
Q

Lower limit of normal (LLN)

A

Predicted value = average value which has been calculated form typical normal healthy subjects

The data allows for a normal range (bell curve) to allow for variation in lung size

LLN = the point in the normal range below which only 5% of normal subjects values fall

  • any values below the LLN are considered abnormal
  • not all spirometry curves give you LLN’s
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41
Q

Interpreting Diagnostic Patterns

A

Interpretation of spirometry involves recognising abnormalities or patterns in the measurements while evaluating results against the patients clinical state

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42
Q

What are four diagnostic patterns

A

normal
obstruction - cannot blow out quickly
restriction - small lungs
mixed - small lungs and cannot blow out quickly

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43
Q

What is normal

A

normal FEV1, FVC and FEV1/FVC

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44
Q

What is obstruction

A

Reduced FEV1 and FEV1/FVC

normal FVC

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45
Q

What is mixed

A

Reduced FEV1, FVC and FEV1/FVC

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46
Q

Percentage of FEV1 predicted value mild degree of severity

A

> 70%

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47
Q

Percentage of FEV1 predicted value moderate degree of severity

A

60-69%

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48
Q

Percentage of FEV1 predicted value moderately severe degree of severity

A

50-59%

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49
Q

Percentage of FEV1 predicted value severe degree of severity

A

35-49%

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50
Q

Percentage of FEV1 predicted value very severe degree of severity

A

> 35%

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51
Q

Reversibility testing

A

spirometry used to assess airway reversibility
patient is tested pre and post bronchodilator
used to diagnose and treat patients reversible airways disease i.e. COPD and asthma, by assessing the effects that bronchodilators have on lung function

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52
Q

Define a significant change post bronchodilator

A

Increase in FEV1 or FVC of 12% or > and
Change must be at least 0.2L

Absolute change in FEV1 = (post bronchodilator FEV1- baseline FEV1
% improvement FEV1 = Post bronchodilator FEV1 - baseline FEV1 / baseline FEV1) x 100

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53
Q

How to assess reversibility

A

Conduct 3 acceptable and repeatable test manoeuvres prior to bronchodilator and a long time since last bronchodilator

patient takes bronchodilator

after 10 mins, no later than 25 mins conduct 3 more acceptable and repeatable manoeuvres

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54
Q

Why do physio’s care about ventilation?

A

Breathing is essential to life

ventilation strategies are essential to your physio toolkit

Aim :
-identify ventilation problems or those at risk of these problems
select and implement most appropriate technique for that individual

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55
Q

Respiration

A 
Respiratory controller 
to respiratory muscles 
to rib cage & pleura and abdomen 
to movement of air
to alveolar ventilation
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56
Q

Characteristics of Respiratory controller

A

respiratory centre - involuntary
cortical control - voluntary

conditions that may affect this

  • pharmacological
  • head injury
  • tumour
  • CVA
57
Q

Pathway to muscles

A

nerve conduction and synapses

conditions that may affect these

  • guillian barre syndrome
  • spinal cord injury
  • MS
58
Q

Respiratory Muscles

A

Diaphragm
intercostals
SCM
Scalenes

conditions that may affect these 
-myopathies 
muscular dystrophy
fatigue 
surgery
59
Q

Rib cage and pleura

A 
Bones 
-Rib #'s 
-Post surgery
-Scoliosis 
Abnormal chest wall compliance
Pleura 
-pneumothorax
-Haemothorax
-Pleural effusion
60
Q

Abdominal

A

pressure changes

  • distended
  • obesity
  • pregnancy
  • constipation
  • abdominal surgery
  • pancreatitis

Abnormal mechanics (muscle flaccifity)
-spinal cord injury
guillian barre

61
Q

Movement of air

A

inhibition - pain
-surgery
chest trauma

compression
-tumour
pneumo or haemothorax
cardiomegaly

62
Q

Alveolar Ventilation

A

Bronchi to alveoli

  • secretions within bronchi
  • tumour within bronchi
  • asthma
  • Bronchitis

Within alveoli

  • decreased surfactant
  • pulmonary oedema
  • inflammation of tissue -pneumonia
63
Q

What does FRC stand for

A

Functional Residual Capacity

64
Q

What is Functional Residual Capacity

A

Volume of gas in the lung after a normal expiration
Balance between the inward recoil of the lungs and the outward recoil of the chest wall
Volume of gas that participates in gas exchange during inspiration and expiration
-Gas exchange still occurring even when not breathing

65
Q

Closing Capacity (CC)

A

Volume of air in lung when small airways in dependant lung start to collapse during expiration

Healthy individuals

  • CC approx. =RV
  • CC > FRC
66
Q

Critical Opening Pressure

A

The pressure needed to overcome surface tension and achieve initial re-inflation of collapsed regions

Inflating alveoli is similar to blowing up a balloon

67
Q

Physiotherapy techniques to improve ventilation

A 
Pain relief 
positioning 
breathing exercises
demand ventilation / mobilisation
facilitation techniques 
incentive spirometry
positive expiratory pressure devices 
non-invasive ventilation 
oxygen therapy
68
Q

Pain relief

A

physiotherapists don’t prescribe or administer

required to optimise inspiratory volume

PT
-monitor patient’s pain levels before, during and after treatment
time tr

69
Q

What do chest X-rays do

A

provide an insight into the lungs and chest wall
used as the main radiological investigation of the chest
indicated in almost any condition in which pulmonary abnormality is suspected
do have limitations
-x-rays findings tend to lag behind other measurements

70
Q

CXR views

A

frontal -PA vs AP
Lateral
Lateral decubitus

71
Q

PA

A

posterioanterior view
beam passed from posterior to anterior of patient
optimum view for the lungs
usually done erect (standing) allows for full inspiration with shoulders abducted
gas passes upwards - pneumothorax
fluid passes downwards - pleural effusion or haemothorax

72
Q

AP

A 
anteriorposterior view 
beam passed from anterior to posterior of patient 
sitting or supine position
disadvantages 
-mediastinum is magnified
poor inspiration due to sitting
rotation
73
Q

Lateral

A

labelled side is closest to the cassette
beam passes through laterally
confirms if PA/AP equivocal opacity is real

74
Q

Lateral decubitus

A 
patient lying on their side
beam passes anteroposteriorly 
used to problem solve 
-pneumothorax 
-pleural effusion
75
Q

Abnormalities

A

can be identified as

  • too black
  • too white
  • too big
  • in the wrong place
76
Q

X ray reading

A

patient details
position
technical adequacy
systemic interpretation

77
Q

Assessment of technical adequacy

A

inspiratory effort
rotation
angulation
exposure

78
Q

Inspiratory effort

A

anterior aspects of at least 6 ribs sit above right hemidiaphragm

complications

  • cardiac size may appear enlarged
  • crowding of vessels at the lung bases
79
Q

Rotation

A

vertical line drawn through the centre T1-T4
Each clavicle should be equidistant from the median end
complications
-heart size and shape
-relative density of lung fiends, one side looks blacker

80
Q

Angulation

A

clavicle should be projected over the posterior 3rd rib

81
Q

Exposure

A 
should be able to see T4, not T5
Over exposed
-appears black 
- low density lesions are missed 
Under exposed 
-falsely white
82
Q

Opacity vs Lucency

A 
Tissues absorb x-rays differently to produce film
black = air
slightly lighter than black= fat
grey = soft tissue
light grey = bone
83
Q

Systemic approach to interpretation

A 
Tubes and lines
lung fields
hilum 
Heart and mediastinal contours 
diaphragm including underneath 
costophrenic angles
trachea
bones
soft tissue 
comparison with previous imaging
84
Q

Tubes and Lines

A 
endotracheal tube (ETT)
Tracheostomy Tube 
Intercostal catheter (ICC)
Central venous lines (CVL)
Swan ganz catheters
Nasogastric tubes (NGT)
Pacemaker leads
Pittfalls
85
Q

Lung fields

A

should be equal transradiancy
horizontal fissure - hilum to the 6th rib in the axilla - displaced a sign of collapse
compare size

86
Q

Hilum

A

Pulmonary vein and artery, bronchi and lymph

left hilum higher than right
compare shape and density should be concave

Distance apex to hilum = distance base to hilum

87
Q

Heart

A

check that the heart is normal shape

maximum diameter is >50% of the transthoracic diameter

  • 1/3 to right of midline
  • 2/3 to left of midline

Check no abnormally dense areas of heart shadow

cardiophrenic angles

88
Q

Mediastinum

A

borders

  • fuzziness normal at angle between heart and diaphragm
  • fuzzy edges in other areas suggest problem with neighbouring lung
  • -collapse or consolidation

trachea should be visible

89
Q

Diaphragm

A

2 hemidiaphragms - right and left

right is higher than left

90
Q

costophrenic angles

A

angles between the diaphragm and ribs laterally

should be well defined acute angles

91
Q

trachea

A

should be central but deviates slightly to the right

if shifted suggest a problem with mediastinum or pathology within the lungs e.g. collapse

92
Q

Bones

A

look at the ribs, scapulae and vertebrae
follow the edges of each individual bone for any fractures
compare density of bones between each side

93
Q

Soft tissue

A

look for any enlargements of soft tissue areas

94
Q

Pleural effusion

A

fluid collects in pleural cavity
collects in the costophrenic angles
-“meniscus sign”

95
Q

Pneumothorax

A

lack of lung markings

inferiorly - deep sulcus sign and sharply outlined diaphragm

96
Q

Tension pneumothorax

A

Ipsilateral disaphragm depressed and flattened

mediastinum and heart pushed to other side

97
Q

Haemothorax

A

Air fluid level

no meniscus sign

98
Q

Collapse

A

displacement of mediastinum, hilum, fissure - volume loss
elevation of hemidiaphragm
decrease in rib spacing
opacity

99
Q

Consolidation

A

air filled spaces replaced with fluid, blood, sputum

100
Q

Don’t forget

A

rib # and subcutaneous emphysema

101
Q

The measurement of pH and the partial pressures of oxygen and carbon dioxide in arterial blood

A

Pa02 and PaCO2 used to assess the state of acid base balance in blood and how well lungs are performing their job of gas exchange

102
Q

Gases move down partial pressures

A

air in alveolar - higher partial pressure of 02 and lower partial pressure of CO2 than capillary blood

103
Q

PaCO2

A

PaCO2 is controlled by ventilation and the level of ventilation is adjusted to maintain PaCO2 within the right limits

104
Q

Normal values

A 
pH - 7.35-7.45
PCO2 35-45mmHg
PO2 - 80-100mmHg
HCO3 - 22-28
BE (-)2.0 - 2.0
105
Q

Hypoxic drive

A

chronically high PaCO 2 levels (chronic hypercapnia)
Receptors become desensitized to CO2 levels
Body then relies on receptors that detect the PaO2 to gauge the adequacy of ventilation stimulus = hypoxic drive
Need to limit administering supplemental O2 when hypoxemic as an increase in O2 will depress ventilation leading to a rise in PaCO2

106
Q

Haemoglobin oxygen saturation SaO2

A

PO2 doesn’t tell us how much O2 is in the blood
-measures free, unbound O2 molecules (tiny portion of the total)
Almost all O2 molecules in blood are bound to haemoglobin (Hb)
The amount of O2 in blood depends on 2 factors
-Hb concentration
-saturation of Hb with O2

107
Q

Review pages

A

15- 2& 3

16 -1

108
Q

Alveolar ventilation and PaO2

A

factors that dictate Pa02

  • alveolar ventilation
  • matching of ventilation with perfusion (V/Q)
  • concentration of O2 in inspired air (FiO2)
109
Q

`V/Q mismatch and shunting

A

Allows poorly oxygenated blood to re-enter the arterial circulation - lowering PaO2 and SaO2

Overall alveolar ventilation is maintained, V/Q mismatch does not lead to an increase in PaCO2

110
Q

FiO2 and Oxygenation

A

FiO2 - the % of O2 in the air we breathe in
Exact FiO2 requirement varies depending on severity of oxygenation impairment and mode of delivery
Increasing FiO2 will not reverse a rise in PaCO2 in inadequate ventilation cases

111
Q

Disorder of Gas exchange

A

Hypoxia - any state in which tissues receive an inadequate oxygenation to support normal aerobic metabolism
Hypoxaemia - any state in which the O2 content in arterial blood is reduced
Impaired oxygenation - hypoxaemia resulting from reduced transfer of O2 from lungs to the bloodstream, PaO2

112
Q

Type 1 respiratory impairment

A 
Low PaO2 (>80mmHg)
Normal or low PaCo2
Implies defective oxygenation despite adequate ventilation

Severity
-mild PaO2 60-79mmHg
Moderate PaO2 40-59mmHg
Severe PaO2

113
Q

Clinical signs of Hypoxaemia

A 
Restlessness 
confusion
aggression
sweating 
fitting or convulsions 
plucking
increased RR, HR and BP
ECG changes 
Blurred vision, tunnel vision
Pallor
114
Q

Type 2 respiratory impairement

A

High PaCO2 (

115
Q

Clinical signs of hypercapnia

A 
Confusion 
flapping tremor 
warm extremities 
drowsiness 
bounding pulse 
headache 
flushed skin
coma 
Review Page 19 -2
116
Q

Hyperventilation

A 
Low PaCO2 
Rise in pH 
Symptoms 
-tingling around the mouth and extremities 
-light headedness 
-syncope

Secondary hyperventilation occurs in metabolic acidosis

117
Q

Acid base balance Pg. 20-2

A

H2O + CO2 = H2CO3 = H+ + HCO3

118
Q

Maintaining acid base balance

A 
Maintain blood pH
H+ ions removed 
-respiratory mechanisms
--removal of CO2
--Minutes to hours 
-Renal mechanisms
--kidney adjust H+ in urine and HCO3 excretion in response to changes in metabolic acid production 
--days to develop
119
Q

Disturbances of Acid-­‐Base Balance

A

PaCO2 raised - respiratory acidosis
PaCO2 raised - respiratory alkalosis
HCO3 raised - Metabolic Alkalosis
HCO3 Low - Metabolic Acidosis

120
Q

Steps to analysing ABG’s

A

pH - is there an acidosis or alkalosis
look at PaCO2
-decreased pH/increased PaCO2 or increased pH/ low PaCO2 = respiratory problem
Is it an acute or chronic respiratory problem
Look at HCO3
-decreased pH/ decreased HCO3 or increased pH/increased HCO3 = metabolic problem

pH is compensated / uncompensated/partially uncompensated

121
Q

Oxygen therapy

A 
is the administration of oxygen at concentrations greater than that in ambient air 
correct hypoxaemia (PaO2
122
Q

Goal of oxygen therapy

A

return to normal or near normal tissue oxygenation without causing
-a reduction in ventilation
increase in PaCO2
Oxygen toxicity

123
Q

Oxygen and physio

A

is a drug - prescribed by a Dr
physio
-assess oxygen delivery to ensure correct mode of delivery
-assess the need for oxygen with exercise
-advise whether oxygen therapy is sufficient
-can alter prescription in certain situations

124
Q

Dangers of OxT

A

Chronic respiratory failure
oxygen toxicity
depression of ciliary function
absorption atelectasis

125
Q

Mode of delivery

A 
low flow (variable performance devices )
-nasal prongs
-Hudson mask
-rebreather masks (partial and non-rebreather)
High flow (fixed performance devices )
-venturi mask 
-high flow
126
Q

Nasal prongs

A 
inexpensive
comfortable, less noticeable 
can eat and drink
may cause pressure areas and mucosal damage 
flow rate - 1-4L/min
FiO2 - 0.24-0.36 (low concentration)
127
Q

Hudson mask

A

Inexpensive
patient may find mask hot, confining and uncomfortable
vent holes on sides for release of exhaled gases and to mix with room air

need flow rate >5L/min to prevent rebreathing of exhaled gases

FiO2 - 0.35-0.50 (mod concentration)

128
Q

Rebreather masks

A

partial rebreather mask
-exhaled oxygen from the anatomical dead space is conserved
-insufficient flow causes rebreathing of CO2
FiO2 - 0.4-0.6 (high concentration)

Nonbreather mask
-one way valve between reservoir bag and mask and over exhalation parts of mask
-prevents exhaled gases and room air from entering
-FiO2 - 0.6-0.8 (very high concentration)
Short term use only

129
Q

Venturi mask

A

more expensive
high flow rate
able to accurately determine FiO2
FiO2 - 0.24-0.6

130
Q

High flow circuits

A

accurately determine FiO2
Can deliver via nasal prongs, mask, tracheostomy
usually used with humidification
FiO2 - 0.3- 100%

131
Q

Ciliary function

A 
adversely affected by 
-age 
-artificial airways
dehydration 
inhaled anaesthetics lack of sleep 
medications - e.g. narcotics, sedatives 
oxygen therapy 
smoking
132
Q

Prevent adverse effects of ciliary function by

A

hydration - oral or IV fluids
Humidification
nebulisation
Swedish nose (tracheostomy)

133
Q

Humidification

A

mechanism

-gas is blown over a reservoir of heated sterile water and absorbs water vapour, which is then inhaled by the patient

134
Q

Humidification indications

A 
thickened secretions 
consolidation 
major infection
artificial airway 
High FiO2
135
Q

Nebulisation

A

Mechanism
-converts solution into fine droplets (aerosol particles) suspended in a stream of gas, carried into the airways via mouthpiece or mask

used to deliver
-medications- bronchodilators, corticosteroids, antibiotics, antifungals, mucolytics, hypertonic saline

Moisten the upper airways - normal saline

136
Q

Nebulisation cont

A

particle size and deposition

  • 1-10 microns
  • pattern of deposition in bronchial tree depends on
  • particle size
  • methods of inhalation
  • degree of airflow obstruction
137
Q

Nebulisation application

A

need flow rate of 6-8L/min
can be by medical air or oxygen
mouth breathing

138
Q

Long term oxygen therapy

A

shown to improve the length and quality of life in selected patient with severe chronic airflow limitation

  • continuous
  • intermittent
  • exercise

Cardiorespiratory Physiotherapy (7 decks)

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