ICU physiotherapy techniques

Question 1

physio aims in ICU

Answer 1

maintain function of Pt
prevent complications with intubation, mechanical ventilation and imbolisation
treat acute respiratory impairments
rehab and recover

Question 2

treatment to improve oxygen gas movement non-intubated

Answer 2

DBE
Mask: CPAP or NIV
positioning
mobilisation

Question 3

treatment to improve oxygen movement problem intubated patient

Answer 3

Manual ventilator/ hyperinflation

positining

mobilisation

Question 4

treatment to improve secretions in non intubated patient

Answer 4

PEP/ OPEP

ACBT

GAD/ mGAD

Manual technqiues

nebulisers

mobilisation

suction

cough assist

Question 5

improve secretion movement in intubated

Answer 5

manual hyperinflation
mGAD
manual techniques
Neubuliser
mobilisation
suction

Question 6

effects of mGAD and GAD

Answer 6

alters distibution of ventilation gas
increase lung compliance
decrease complication

Question 7

position precautions

Answer 7

spinal chord injuries
skeletal tracion
acute brain injury
craniotomy without bony flap
fracture ribs

chest drains
IABP
haemodialysis
ECMO

Question 8

manual hyperinflation

Answer 8

larger tidal volume of breath with anesthetic or resuscitation cricut

inspiration- slow deep
expiration- rapid relese

Question 9

MHI components inspiration

Answer 9

slow rate: reduce effect of airway resistance on distribution of ventilation

deep breath: alveolar stretch promotes surfactant production= increase lung compliance

inspiratory hold: increase alveolar recruitment via colletral channel ventilation

Question 10

MHI components expiration

Answer 10

rapid release
increase EFR
INCREASE MOVEMENT OF SECRETIONS

Question 11

MHI possible detrimental effects

Answer 11

positive intrathroacic pressure: decrease venous return to the heart// decrease venous drainage from head- increase intracranial pressure

disconnect from mechanical ventilator

risk of absoption of atelectasis
reduced respiratory drive

Question 12

self inflating circut

Answer 12

adv
-commonly avaliable
-less risk of VIBI trauma because valve open automactically

limit
-exp flow rate is lower decrease secretion clearance
- unable to inpiratory holds

Question 13

anaesthetic circuits

Answer 13

adv
- inspiratory hold
-deliver large oxygen volume
-allow quick release

limit
-Co2 re-breathing potential
cause Barotrauna
can’t add peep valce

Question 14

MHI precautions and contraindications

Answer 14

undrained pneumothorax
hyperinflated lungs
acute serve bronchospasm
low CO
high or uncontrolled ICP
on nitric oxide treatment
acute pulmonary oedema

Question 15

ventilator hyperinflation

Answer 15

don’t need to disconnect patient
alter volume or pressure

increase Vt by 200ml increments under airway pressure in 40

6 Mech vent vreaths and rest patient for 30 seconds
then repeat 6 times

Question 16

secretion removal saline instilation

Answer 16

lubricate secretions

Question 17

suction indication

Answer 17

neuromuscular disease
head injury/ coma
too weak to cough/ cooperate

Question 18

suction detrimental effects

Answer 18

hypoxaemia
arrythmias
hypotension
muscosal truma
atelectasis
bronchospasm
increase ICP

Question 19

suction precautions

Answer 19

serve hypoxaemia
unstable CVS
low platlets
frank haemoptysis

Question 20

contraindications suctioning

Answer 20

high ICP
pulmonary oedema
serve bronchospasm

non-intubated
laryngeal stridor
fracterues
CSF leak into nasal
oropharyngeal surgery
immediately following meal