Wk 12 revison

Question 1

What is a PPC, list all 8 of the Melbourne group scale

Answer 1

Post-operative Complication: Melbourne Group Scale ** MUST KNOW**
What is a PPC: A pulmonary abnormality that produces identifiable disease or dysfunction that is clinically significant and adversely affects the clinical course
Melbourne Group scale requires 4 or more of the following for diagnosis of a PPC:
1. SpO2<90% on RA
2. Chest X ray report of atelectasis or consolidation
3. fever >38 degrees
4. production of purulent sputum differing from pre-operative state
5. Positive signs of infection on sputum culture
6. unexplained increased WCC or CRP
7. readmission to ICU/HDU with respiratory problems or prolonged stay (ICU/HDU)>36 hours
8. medical diagnosis of chest infection/ pneumonia

Risk Factors: Smoking, age, pre-existing lung disease, immobility, obesity, malnutrition, cognitive impairment, type of surgery

Question 2

CXR differs from consolidation to collapse

Answer 2

LL Collapse
* mediastinal shift toward the area of collapse
* rib crowding
LL consolidation
* dense opacities
* blurring of the heart border (silhouette sign)
* blunting of costophrenic/cardiophrenic angles

Question 3

Respiratory benefits of SOOB

Answer 3

Respiratory benefits of SOOB: ** MUST KNOW**
* Increased lung volume
* increased forced expiratory volume & flow rate
* Decreased airway resistance
* Decreased airway closure
* improved gas exchange/ improved PaO2
* increased diaphragmatic excursion
* Decreased WOB
* Increased/ easier mobilisation of secretions
* Improves haemodynamic

Question 4

Sternotomy Mx

Answer 4

• no lifting >2-5kg
• No unilateral UL tasks
• wound care
• monitor for clicking/abnormal wound (mal union etc)
• No dirt bike riding e.g. context

Question 5

outcome measures

Answer 5

Outcome Measures
Dyspnoea MMRC (modified medical research council) Dyspnoea scale
COPD assessment test/ CAT Impact of COPD
Exercise tolerance 6-minute walk test
Hospital Anxiety and Depression (HAD) Anxiety and depression
St Georges reparatory Questionnaire

Question 6

EPP

Answer 6

is located at the trachea at high lung volumes, and moves peripherally as lung volume decreases

Question 7

mechanism of a huff

Answer 7

closed glottis. increased IPP, turbulent air flow with high shearing forces