Cardio Flashcards
(236 cards)
1
Q
What are the 6 physio problems for Cardio?
A
- Impaired A/way clearance
- Impaired Gas exchange
- Exercise Tolerance
- Reduced Mobs
- Low Lung Vol
- Dyspnoea
2
Q
What’s the difference b/n asterisk, clinical signs and contributing factors?
A
*- measurable, expect them to change w/ treatment
CS- maybe measurable or not, difficult to reassess e.g. collapse on CXR
CF- assist in explaining * pathophys., e.g. prolonged bed rest explains reduced mobility
3
Q
Where do you auscultate anteriorly?
A
1- Below clavicle close to midline, ~T1
2- Under armpit level
3- Lower under armpit, mid-axillary line
4
Q
Where do you auscultate posteriorly?
A
1- T1 level
2- Inside scapular border
3/4- T10 level, one closer to spine
5
Q
How many breaths at each auscultation point are required?
A
2
6
Q
How do you measure degree of inspiration in thoracic Xray?
A
Count no. of ribs above diaphragam, should meet at 5-7 along midclavicular line
7
Q
Which hemidiaphragm sits higher?
A
Right due to liver
8
Q
What is consolidation and how does it appear on Xray?
A
Air filled spaces replaced by products of disease e.g. water, pus, blood
White opaque appearance, dark worms, loss of demarcated borders
9
Q
How does atelectasis appear on Xray?
A
Increased whiteness on affected lobe
Affected areas pulled adjacent structures towards them
10
Q
What does sailsign indicate?
A
Left lower lobe collapse
11
Q
How does pneumothorax appear on Xray?
A
Thin white lines parallel to chest
12
Q
What is subcutaneous emphysema and how does it appear on Xray?
A
Presence of air in soft tissues
Blackened fascial planes within soft tissue, striations of muscles appear
13
Q
What is pleural effusion and how does it appear on Xray?
A
Fluid b/n visceral and parietal pleura layers
Opaque meniscus (think test tube) and blunting of costophrenic angle
14
Q
How does congestive heart failure appear on Xray?
A
Pulmonary oedema, fair floss appearance
15
Q
What is the typical approach for a thoracic surgery?
A
Posterolateral
16
Q
How does general anaesthesia affect the lungs?
A
- Decreased FRC
- Reduced lung compliance
17
Q
How does postop pain affect recovery?
A
Sympathethic responses- tachy and HTN
Impair Respiratory- weak cough, low tidal volumes
Biggest barrier to early mobs
18
Q
How does general anaesthesia impact mucociliary function?
A
Paralysed cilia, reduced humidification and thus dried airways, increased secretion viscosity as secretions cannot be cleared
19
Q
How does general anaesthesia impact atelectasis?
A
Usually tidal volume lies above closing capacity, general anesthesia lowers tidal volume causing it to fall below closing capacity and atelectasis
20
Q
What is PPC?
A
Pulmonary abnormality that produces disease or dysfunction following surgery
21
Q
What time period does PPC usually occur?
A
First three days postop
22
Q
How is PPC diagnosed?
A
Melbourne Group Score, 4 or more clininical, diagnostic or other factors in one day
e.g. ausc, sputum, collapse, WCC, pneumonia
23
Q
What are some risks for PPC pre, peri and postop?
A
Pre- age, smoking, resp disease, fitness, obesity (all increase closing capacity
Peri- haemorrhage, surgery length
Post- delayed mobs
24
Q
Where is atelectasis the greatest typically?
A
Regions close to diaphragm
25
What is acute cardiopulmonary dysfunction and how does it occur?
- Impairment in one or more steps of oxygen transport system
- Impact of acute illness and prolonged bed rest
- Incl. CV, resp, MSK and other changes (cognitive, metabolic)
26
What are the CV aspects of acute cardiopulomary dysfunction?
- Fluid moving from periphery to thorax
- Impaired blood flow regulation
Risk of DVT
Blood viscosity
Increased filling pressure, reduced cardiac output and cardiac stress
Increased HR
27
What are the respiratory aspects of acute pulmonary dysfunction?
- Decreased VO2max
- Increased WOB
- Risk of pneumonia and atelectasis
- Decreased exercise tolerance
28
What are the MSK aspects of acute pulmonary dysfunction?
Reduced muscle mass, tone and strength and endurance
29
What are the other aspects of acute pulmonary dysfunction?
- Lowered immunity
- Decreased metabolism and appetite
- Anxiety and depression
30
What's the aim of mobs in acute cardiopulmonary dysfunction?
- Increase ventilation and lung volume
- Mucociliary clearance
- CV fitness
- Reduce cognitive issues and improve psychological wellbeing
- Optimise independence
31
What is the rationale behind exercise helping low lung volumes?
Exercise increases ventilation of atelectatic regions, inflating more alveoli which will in turn pull open adjacent alveoli
32
What is the rationale behind exercise for airway clearance?
- Increased ventilation to alveoli, with air going through collateral channels to clear obstructions
- Also an increased lung volume will increase power of cough
33
What drop in BP indicates postural hypotension?
Greater than 20/10 mmHg drop
34
What are some signs of postural hypotension?
Nausea, dizziness, fatigue, sweating
35
What are some strategies to manage postural hypotension?
Daily sitting, dangling legs and standing
36
What is the normal range of RR?
12-16
37
What is the normal, precaution and contraindication range of Hb?
12-18 g/dl
<10
<8
38
What pain level is okay to mobilize?
Below 7
39
What are the intensity guidelines for mobs?
10-20 beats above resting HR
3-5 on Borg exertion, somewhat hard
40
In ausc, what does reduced or absent sound indicate?
Atelectasis, postop
41
In ausc, what does fine inspiratory crackles indicate?
A/ways opening up
42
In ausc, what does coarse crackles indicate?
Secretions/sputum
May be COPD or pneumonia
43
In ausc, what does wheeze indicate?
Brochnospasm e.g. asthma
44
What are instructions for ausc?
SOOB, breathe in and out through mouther slightly deeper and faster than normal, rest if feeling dizzy, 5-6 breaths at a time
45
What is the dosage for TEEs?
6x6 2-3 times a day
46
What is the dosage for SMI?
2-3 reps
47
What does open heart surgery on pump mean?
Cardiopulmonary bypass, blood is removed, oxygenated and then mechanically pumped back into the aorta
48
What are the pros and cons of open heart surgery off pump?
Less operative time and risk of cerebral emboli
Harder to access posterior heart and maintain haemodynamic stability
49
What is an example of a peripheral procedure and when is it used?
Catheter finds occlusion, inflate balloon to allow reperfusion. Done in STEMI with no comorbidities
50
What are some surgery requirements for coronary artery bypass grafting?
Hypothermia: protect myocardium by reducing O2, rewarmed after surgery
Cardioplegia: induced asystole
51
What are the considerations for postop support in cardio surge?
- Organ perfusion
- Minimize cardiac demand
- Maintain gas exchange
- Reduce PPC
52
What are some preop, periop and postop risk factors?
Pre- fraility, 65+, low PA
Peri- non-elective, intraoperative bleeding, surgery >4-6 hours
Postop- delirium, delay mobs, ICU LOS >5 days
53
What does the literature say about UL exercises in cardiac surgery?
Less sternal pain post discharge
54
What does the literature say about moderate intensity exercises in cardiac surgery?
Higher function (6MWD) at D/C
55
What are cardiac surgery sternal precautions?
- Do not lift arms above 90
- No objects 2kg+
- Do not reach backwards
- Do not push through arms
4-6 weeks from time of op
56
What is temporary pacing?
Helps heartbeat go back to regular pace after surgery
57
How to treat low lung volumes?
Mobs
Deep breaths
SMI/TEE
Inspiratory Muscle Training
NIV
58
How to treat excessive secretions?
ACBT
Gravity Drainage
PEP
Flutter
Exercise
59
How to treat dyspnoea?
Relaxation positions
Pursed lip
Breathing control
60
How to treat exercise tolerance?
Prehab, rehab and exercise
61
How long are SMIs held?
3 seconds
62
What is the physiological explanation of SMI?
Expands to TLC, gas enters areas of low lung compliance and re-expand collapsed alveoli
Go through collateral ventilation to clear any secretions
63
What is the dosage for breathing exercise?
5 breaths to TLC/hour
64
What is the reasoning behind IMT?
Strengthen muscles to assist with inspiration
65
What occurs in respiratory prehab?
Education e.g. PPC
Explain postop mobility
Teach ACBT
66
What is the reasoning behind CPAP?
Positive airway pressure on insp and exp, keeping air in lungs and increasing FRC
67
What does high flow O2 allow?
Reduced RR
Increased end expiratory and tidal lung volume
Reduced WOB
Improved mucus clearance
68
Whats a lobectomy and pneumonectomy?
Taking out a lobe and taking out a lung
69
What are the two thoracotomies?
Posterolateral- divides lats
Anterior- muscle sparing
70
What are the adv and dadv of video assisted thorascopy?
A- Minimal trauma, option for higher risk pts, less pain
D- takes longer, higher risk pt
71
What are the three chambers of UWSD?
1st- collects fluids
2nd- underneath level of water, controls air unilaterally
3rd- suction, regulates negative pressure
72
What 4 things in UWSD are Ax?
Swing- no swing = all fluid drained or occlusion
Bubbling- air leak
Volume drained
Suction with balloon, should peak out to show adequate suction
73
What does 1 pack year mean?
1 pack a day for a year
74
Where does oesophageal cancer appear?
Generally appear near gastro oesophageal junction or middle and upper oesophagus
Spreads deeper into layers of stomach and then beyond
75
How is oesophagus cancer treated?
Chemoradiotherapy
Oesophagectomy (always on right)
76
What is the precautions of oesophagectomy?
- No head tip down
- Avoid neck extension
- Avoid suction or high PAP
77
What are common vascular presentations?
- Ulcers
- Necrosis
- AAA
78
What are common surgeries for vascular issues?
- Revascularization (angioplasty balloon dilate, stenting, bypass)
- Amputation
- AAA repair
79
What are considerations for amputation?
- Healing before mobs
- Prevent contractures (elevate stump, rigid dressing)
- Phantom limb
- Impaired balance/falls risk
- Stump care
80
How is amputation managed?
- Preop counselling and education
- Prosthetic training
- T/F options, avoid hopping
81
What is the highest priority for vascular surgery postop?
Preserve contralateral limb
82
What areas are the dermatome tests?
L1 Lateral groin
L2 Slightly lower
L3 Medial near knee
L4 Medial calf
L5 Lateral anterior
S1 Heel
S2 Popliteal Fossa
83
What are potential causes of dyspnoea?
Resp- pneumonia, atelectasis, COPD
CV- congestive heart failure
Neurological- resp m. weakness
Psychological- anxiety, depression
84
What are clinical features of dyspnoea?
- Breathing rate
- Pursed lips
- Reduced exercise tolerance and communication
- Fatigue
- Overuse of accessory muscles => weight loss
- Panic and anxiety
85
How should you behave around dyspnoeic pts?
Talk quietly, slowly
Yes/no Q's
Do not make dyspnoea worse
86
What is the modified Borg?
Measures shortness of breath 1-10
87
What positions help dyspnoea?
Tripod- fix shoulders reverse attachment, employs accessory muscles
Forward lean- hands on either side of table, relax shoulders, contraindicated for back issues
Supported lean- anchor chest to hard surface allows postural muscles to relax, conta for balance
High side lying- push up abdominal content, diaphragm in better position, for sleep
88
What is the rationale of pursed lip breathing and the dosage?
PEP splints open airways, prevents gas tapping
2 s inhale, 4 s exhale
89
What's the rationale behind pulmonary rehab?
- Less ventilation for same work
- Reduced hyperinflation
- Improved overall body funcitoning
90
What are normal values for ABG?
pH 7.35-7.45
CO2 35-45
O2 80-100
HCO3 22-26
91
What distinguishes respiratory and metabolic acidosis/alkalosis?
Acidosis- resp acidotic CO2
metabolic acidotic HCO3
92
When is O2 therapy required?
- Hypoxaemia/hypoxia
- Resp distress
- Cardiac arrest
93
Distinguish between hypoxaemia and hypoxia?
Hypoxaemia- low O2 in blood
Hypoxia- low O2 in tissue
94
Distinguish between Flow and FiO2
FiO2- concentration of O2 that a person inhales
Flow- steady continuous supply
95
What is peak inspiratory flow demand?
Maximal inspiratory flow required during tidal breathing
Normal 25-35 L/min
96
How do you work out average FiO2?
Av FiO2 = FiO2/PIFD
97
What does high flow mean?
Matching or exceeding PIFD
98
Distinguish between variable and fixed performance devices
Variable- flow less than patients minute volume, vary with rate and volume of breath
Fixed- known concentration of O2 at a higher flow rate
99
What is a standard variable O2 therapy?
Nasal prongs
Hudson mask- min 6L/min
100
What is a standard fixed O2 therapy?
Venturi- humidified, <15L/min
101
What is a fixed high flow O2 therapy?
AIRVO- humidified, 2-60 L/min
102
What are signs of COPD?
Barrel chest
Wheeze
High RR
Tachycardia
Fatigue
103
What is a physios' role in COPD?
- Pulmonary rehab
- Breathing exercise
- A/way clearance
- Manage exacerbation
104
What are causes of ILD?
Infection/virus
Occupation exposure
Radiation
Mostly idiopathic
105
What are features of ILD?
Dypsnoea on exertion
Dry cough
Fatigue
106
How is ILD treated?
- Pulmonary rehab
- Anti-fibrotics
- Smoking cessation
- Breathing exercise
107
What is Equal Pressure Point and why is it relevant?
Point at which pressure in pleura is higher than that in alveoli, compressing airways
This is the rationale for FET moving secretions
108
When is each phase of AD progressed?
3 breaths, 3 huffs
ERV, move when crackles at end of expiration
TV, prolonged crackles
IRV, coughing
109
What are contra for GAD?
Post eating
Reflux
Head or neck surgery
110
What is the rationale behind high flow?
Reduce physiological dead space
Reduced WOB
Humidification
111
Why is humidification needed in high flow?
- Inhalation of dry gas reduces humidity
- Prevents drying of sputum
112
What is type I and II respiratory failure?
I- Hypoxaemia PaO2 <60
II- Hypoxaemia and hypercapnia PaCO2 >45 PaO2 <60
113
What is the rationale of CPAP?
Treats Type I respiratory failure, positive pressure on insp and exp
Collateral ventilation, opens alveoli, increasing FRC, increased gas exchange
114
Who should receive CPAP?
Postop
Immobilized
Chest wall abnormalities
115
What are precautions/contra of CPAP and BiPAP?
Oesophageal surgery
Vomiting
Prescence or risk of pneumothorax
Facial trauma/burns
Facial Fracture
116
What is the rationale of BiPAP?
Treat Type II respiratory failure, PAP throughout but different levels of pressure with exp lower than insp
Lower PaCO2 by increasing tidal volume
Lower WOB
Lower RR, longer expiration
117
Who should receive BiPAP?
Hypercapnic- COPD, bronchiectasis, CF
118
What are the three types of bronchiectasis?
Cylindrical- enlarged and cylindrical
Irregular- some dilated some constricted
Saccular- clusters or cysts
119
What is the pathophys of bronchiectasis?
Infection (potentially from COPD or CF) -> Inflammation -> Airway Damage (elastic and muscular tissue, high mucus production) -> Impaired Clearance -> Infection
120
What are features of bronchiectasis?
Fatigue
Cough
Chest pain
Dyspnoea
121
How is bronchiectasis Ax?
Spirometry
Sputum
ABG
Imaging
122
How is bronchiectasis Mx?
- Antibiotics, bronchodilators, mucolytics
- A/way clearance lit
- Pulmonary rehab lit
123
What is the rationale of PEP?
- Breath towards a resistor, positive pressure
- Increase FRC, slightly larger insp volumes
- Elastic recoil increases and uses collateral ventilation to get behind secretions
124
What is dosage of PEP?
6x6, 6 breaths followed by FET and cough
2-3 s in, hold 1-2, out 3-4s
125
What are precautions for PEP?
Facial #
Pneumothorax
Post lung lobectomy
126
What is Hi PEP?
Same equipment with mask but 8-10 breaths, FET against mask
127
What benefit does OPEP have?
Creates vibrations, further mobs of secretions
128
How is bottle PEP set up?
10-12 cm deep (threshold resistance), tube cannot touch bottom
Water discarded after each treatment, wash bottle
129
How can exercise act as an ACT?
- Increases RR, recruitment of lung units
- Increase flow speed, more sheering
130
How does CF occur?
CFTR mutation
131
What is the pathophys of CF?
- Mucociliary escalator impaired, cannot clear mucus
- Infection
- A/way damage
- Further impaired cilia Fx and destruction
132
What are the features of CF?
- Chronic cough
- Dyspnoea
- Haemoptysis
- Coarse insp crackles
- Reflux
- MSK pain
133
How is CF managed?
- ACBT, PEP, AD, GAD
- Exercise, strength, fitness, spinal mobility
- MSK Mx, posture advice, weight bearing activity
- Mucolytics
- Pelvic floor strength/endurance for continence
134
How can you adapt Rx in CF children?
- Less percs and vibes
- Assisted AD
- Creative to keep engaged
135
What is dosage of IMT?
2 X 15
Aim 20mmHg
136
What is the pathophys of diastolic and systolic heart failure?
Diastolic- too little blood into stiff ventricles, barely filled thus little blood pumped out, stretch stimulus encourages hypertrophy
Systolic- filling enlarged ventricles, not enough pressure to pump out blood
137
How is heart failure Mx?
- Pharmaco, ACE, beta blockers
- Life style, salt intake, weight, diet
- Pacemaker
- Exercise, no guidelines, early ambulation in stable pts, reduced LOS and readmission
138
Describe the phases of cardiac rehab
Phase 1: inpatient, 1-3 times daily 5-20 min, resting HR +20, 3-4/10 Borg
Walking, stationary cycling, prevent PPC
Phase 2: outpatient 4-12/52,
5-7 times/week, moderate intensity, 60 min
Max exercise capacity
Ax, education, nutrition
Phase 3: LT maintenance, behaviour change
139
What are the benefits of HF exercise?
- Improve QoL
- Increase VO2 Max (associated with survival
- Reduce fatigue
- Improve dyspnoea
140
How do you prescribe aerobic intensity for walking?
80% x (6MWT distance/ 6x prescribed duration)
e.g. 220m 6MWT, 36.7m in 1min
30 min distance 1101m
80% of 1101m = 881 m in 30 min
141
How do you prescribe aerobic intensity for treadmill speed?
Speed= 80% 6MWT average speed
e.g. 300 m in 6min, 0.3 km in 0.1 hr = 3km/hr
80% of 3= 2.4km/hr
142
What is the dosage for resistance training 0-4 weeks post surgery/HF and 4+ weeks?
0-4: 12-15 reps, 1-3 RPE
4+: 8-12 reps, <5 RPE
143
How do you determine target HR?
THR = ((max HR - resting HR) x intensity) + resting HR
Max HR 220-age
THR = ((197- 50) x 50%) + 50
THR = (147 x 50%) + 50
= 73.5 + 50 = 123.5
144
What are indications to stop exercise?
- Excessive sweating
- Palpitations
- Dizziness, breathlessness
- Physical inability to continue
145
What are the five malignancy types?
Carcinomas- epithelial
Sarcinomas- muscle/bone
Melanomas- skin
Lymphoma/leukemias- blood cells
Germ cell tumours
146
What are the side effects of cancer surgery?
- Pain
- Low mobility/Fx
- PPC
147
What is radiotherapy and its side effects?
Electron radiation, free radicals damage cancer cell DNA
Damage to healthy cells and inflammatory response causes
- Fatigue
- Flulike symptoms
- Joint stiffness
148
What is chemo and its side effects?
Chemical substances that interfere with mitosis
- Anaemia
- Fatigue
- Nausea
- Cognitive problems
149
What are cancer guidelines?
Moderate intensity 3 times a week for at least 30 min
Resistance at least 2 times a week
150
What are the benefits of exercise in cancer?
- Reduce fatigue, anxiety, depression
- Prevent deconditioning
- Increase tolerance to treatment
- Higher recovery profile
Lit
151
What are precautions for exercise in cancer pts?
- Avoid activities with significant balance and coordination
- Mild intensity
- Fatigable pts, break down into smaller parts
152
What are some prehab for cancer exercises and their dosage?
Walking, cycling, STS, resistance, inspiratory muscle
4-6 RPE, at least 2 weeks, 4 weeks best
153
What are the aims of pulmonary rehab?
- Reduce symptom burden
- Increase participation
- QOL
- Promote autonomy
153
What are considerations for pulmonary rehab with COPD pts?
- Limited due to dyspnoea, dynamic hyperinflation, resp load, may be deconditioned
- Improve oxidative capacity, reduce ventilation requirement, reduce hypercapnoea
154
What is the dosage for Phase 2 Pulmonary Rehab?
6-12/52
4-5 x week
60 mins
Moderate intensity
Endurance + resistance
155
What are some resistance exercises in pulmonary rehab?
- Leg extension, squat, step ups
- Abduction, rows
156
What is the dosage for Phase 1 Pulmonary rehab?
1-3 x day
5-20 min
Light intensity
Walking, cycling, functional
157
What is a common problem for axilla node dissection pts?
MSK dysfunction, pain and numbness
158
What is 1' and 2' lymphoedema?
1' excessive accumulation of lymph fluid due to genetic malformation
2' same but due to damage or destructions of lymph nodes (surgery or cancer)
159
What are some dissection precautions?
Limit ROM and WB for LL
160
Why is neuropathic pain seen in neck lymph node dissection?
Spinal accessory nerve may have to be sacrificed
161
What are the greatest risk factors for ENT cancer?
Tobacco and alcohol
162
What are some complications of flap reconstruction?
Ischaemia, haemotoma, infection, wound healing failure
163
What are some considerations for surgeries around the face?
Vestibular issues
Facial nerve palsy
Tracheostomy
CSF leak
164
What are some considerations for laryngectomy?
Humidification and coughing issues due to absent glottis
Communication
165
What are the 4 categories in the gen med ward?
Palliative care- no longer responsive to curative treatment
Acute reversible conditions e.g. pneumonia
Non-acute patients with urgent needs e.g. falls
Exacerbation of chronic disease e.g. COPD
166
What is the main aim in palliative care?
Maximize QOL and manage symptoms
167
What are common symptoms in UTIs?
- Dysuria
- Increase urgency
- Haematuria
- Fever
- Confusion, drowsy, agitated
168
How can physios manage UTI pts?
- Education on IDC (in dwelling catheter)
- Pelvic floor retraining
169
What are the most common comorbidities?
HTN and T2D
170
How are exacerbations managed by physio?
- May alter Fx
- Smoking cessation
- Prevent readmission
171
Where does oedema occur in LHF and RHF?
LHF- pulmonary
RHF- LL
172
What are some symptoms of cardiac failure?
- Dyspnoea
- Fine crackless
- Peripheral oedema
- Pink, frothy sputum
173
How is cardiac failure managed?
- Diuresis (more urine) and fluid restrictions to lower volume for heart to pu,p
- Oxygen therapy and NIV to treat hypoxia
174
What is the age that falls risk is significant?
65
175
What is functional decline?
Decrease in physical/cognitive Fx, less likely to be able to complete ADLs
176
What are adverse outcomes of functional decline?
- Decreased indep
- Pressure areas
- Falls
- Delirium
177
What are the four aspects of functional decline maintenance program?
Physical- exercise, mobs
Nutrition
Cognitive- stimulation, prevent decline
Occupational performance- ADLs e.g. showering, feeding
178
What is delirium?
Disturbance of consciousness, attention, cognition and perception often caused by trigger
179
How is delirium diagnosed?
CAM ICU
180
How can delirium be managed?
- Regular mobs
- Family visits
- Reorientation (e.g. room with window for time orientation), reassurance
- Reduce stimulation and noise
181
What are some outcome measures used in gen med?
- DEMMI
- mILOA
- 5x STS
- SPPB
- Berg Balance Scale
182
What is PAC?
Therapy in home, 1-2 sessions over 4 weeks
Achieve ST goal or gap until community therapy
183
What is rehab in the home?
2-5 times per week, 4-12 weeks
ST and LT goals
184
What is commonwealth home support program?
65+, low level support
Meals, allied health, domestic assistance, transport
185
What is hospital in the home?
Daily visits 2-4 weeks medical and nursing
186
What is subacute@home?
Home based alternative to inpatient rehab, daily input but non-intensive therapy
187
What is inpatient rehab?
MDT goals, 2 sessions of PT daily, any age
188
What is GEM?
MDT goals, slower stream than IPR, 2-5 days a week
189
What is residential care and respite?
Resi: high care needs, PT mostly for maintenance
Respite: aims to return home after period of high care need
190
How do neural pathologies affect the respiratory system?
Degeneration of neurons may affect diaphragm for inspiration, or glottis and abdominals for cough
191
What is spinal shock?
Temporary areflexic state with impaired autonomic control and muscle tone below level of injury
192
What is neurogenic shock?
Reduction of thoracic sympathetic innervation resulting in bradycardia and vasodilation
193
What is paradoxical breathing?
Flaccid intercostals allow chest wall depression and flaccid abdominals expands stomach out and reduces expiratory force
194
How does a cough assistance machine (in/exsufllator) help resp issues?
Positive pressure on insp, volume restoration
Negative pressure on exp, increase exp, sucks out
Begin with low pressure and progress
Expiratory flow can create sheer forces
195
What are precautions for cough assistance machine?
Pneumothorax, contra without drain
Bronchospasm
Thoracic, gastric or oesophageal surgery
Contra- active airway obstruction, emphesema
196
What is a nippy?
Similar to cough assistance machine, volume restoration and aids sputum clearance
197
What is the positioning for manual assisted cough?
Hands over abdomen and chest wall, time compression with exp
198
What are precautions for manual assisted cough?
Spinal cord injury, #s, pregnancy, recently eaten
199
What is the carina?
Area of nerve fibre in trachea that stimulates cough
200
What are the implications of traches?
No air through upper airways
- Loss of voice
- Impaired cough
- Impaired swallow
201
What are indications for suction?
- Moist cough or sounds gurgly
- Difficulty coughing
- Decrease in sats
202
When is nasopharyngeal indicated and contraindicated?
Central palpable fremitus
Contra- #s, facial trauma, burns
203
How is manual hyperinflation applied?
Bag inflates
Compress to coincide with insp
6x6
204
When is ventilatory hyperinflation used over MHI?
Avoiding disconnection of ventilation
205
What is a STUMBL score?
Predicts outcomes in those with rib #s
Age, number of #s etc.
206
What is flail chest?
Floating segment of thoracic cage due to fractures, sucked in during insp, blown out during exp
Reduces TV, increases RR and WOB
207
How is rib # managed?
- Analgesia
- Fixation
- Oxygen therapy
- Mobs
208
What is a pulmonary contusion and its consequences?
Injury to lung parenchyma in absence of any lung tissue or vascular laceration
- atelectasis, bronchial obstruction, decreased compliance and FRC, increased WOB
209
What is pneumothorax?
Air in pleural space
Can decrease lung volume and collapse lung impair gas exchange
210
How is PTx managed?
- ICC
- Pleuroextomy
211
What is pleural effusion and how is it managed?
- Fluid in pleural space, decreases chest movement, decreased breath sounds
- ICC, surgery
212
How does spinal cord injury affect resp?
Decreased ability to breathe deeply and cough forcefully, paradoxical breathing
213
What are treatments for spinal cord injury resp pts?
- Manual assisted cough and insufflation-exsufflation
- NIV
- Abdominal binders
- Resp muscle training
213
What is shock?
Imbalance between oxygen supply and demand
214
What is sepsis?
Vigorous inflammatory response to infection, can progress to septic shock where blood pressure drops and lactate rises which is life threatening
215
What is ARDS?
Collection of symptoms involving refractory hypoxemia and pulmonary oedema
216
What is ECMO?
Life support, external pump and oxygenator
217
What is continuous renal replacement therapy?
Dialysis, filters blood
218
What is evidence for hyperinflation?
Helps atelectasis, lung compliance and gas exchange
219
What is a MET call and when is it called?
Pt fulfils one or more predefined criteria
e.g. HR <40, >130, RR <8, >30
220
Why is proning performed in the ICU?
Gets air into posterior of lungs
221
What is the RIKER scale and what does it measure?
1-7- unarousable to dangerous agitated
4- calm, cooperative
Agitation and alertness
222
What is the RASS scale and what does it measure?
+4 Combative to -5 Unarousable
0 Alert and calm
Agitation and alertness
223
What are the 5 commands of De Jonghe and what does it measure?
Open (close) eyes
Look at me
Open mouth stick out tongue
Nod
Raise eyebrows when I reach 5
Alertness
224
When is the day of awakening?
When pt responds to 3/5 of De Jonghe on 2 consecutive tests in 6hour period
225
What are the 4 aspects of CAM ICU?
- Any changes from baseline, no, no delirium
- SAVEAHAART, squeeze hand when I say 'A', 0-2 errors no delirium
- RASS, other than 0, no delirium
- Disorganized thinking , 0-1 error, no delirium
226
What are the 4 questions of disorganized thinking in the CAMICU?
- Does a stone float on water
- Are there fish in the sea
- Does one pound weigh more than two pounds
- Can you use a hammer to pound a nail
227
What are the aspects of PFIT?
Assistance STS
Cadence
Sh F Grade
Kn E Grade
ACSK
228
What is ICU acquired weakness?
Detectable weakness developed in critical pt with no indentifiable cause
229
What is a sign of ICU AW?
<11 kg male grip strength
<7 kg female grip strength
<48/60 MMT
230
What movements are assessed in ICU AW MMT?
Sh Ab
Eb F
Wr F
Hp F
Kn E
DF
231
What is Post Intensive Care Syndrome?
Series of health problems following ICU stay
232
What are risk factors for PICS?
- Prolonged MV
- Sepsis
- Prolonged bed rest
- ARDS
- Delirium
- 50+
- Trauma
- HTN
233
What is the % of ICU survivors who experience PICS?
80%
234
What are recommendations for ICU exercise?
Early mobs, <72 hours of ICU admission
Break up sedentary time
Bed exercise
