Week 5 - Management of volume loss

Question 1

What guidelines would give patients using Incentive spirometry?

Answer 1

Breathe through mouth
Sit upright, form a tight seal and breathe out
Then breathe in as slowly and deeply as you can
Keep indicator between two arrows and try to get as high as you can
10 breaths?

Question 2

How does IPPB/ Bird work?

Answer 2

Intermittent positive pressure applied during inspiration pushes patient into IRV
Patient triggers inspiration, passive expiration

Question 3

What the indications for IPPB?

Answer 3

Atelectasis/ volume loss when patient is tired/weak/ unable to participate in more active treatments

Question 4

List some of the precautions/ contraindications for IPPB?

Answer 4

Undrained pneumothorax
Surgical emphysema of unknown cause
Bullae
Bronchospasm
Recent oesophageal and lung surgery
Nausea, gastric distension without NGT
Flail rib
Haemoptysis
CVS instability

Question 5

Describe how to use IPPB

Answer 5

Give patient clear instructions
5ml saline into nebs chamber
Attach circuit to IPPB machine
Sensitivity - set low
Inspiratory pressure - 8-15cmH20 initially progressing to 20-25
Inspiratory flow rate - commence at mid range
6-8 breaths with rest in between

Question 6

Describe the NIPPY clearway/ cough assist and when you would use it

Answer 6

Is mechanical insufflation-exsufflation
Can be delivered manually, patient triggered or time set
Same contraindications as BIRD

Question 7

Describe CPAP

Answer 7

Positive pressure applied throughout the whole respiratory cycle
Used in spontaneously breathing patients
Increases FRC above CV