Treatment for inspiratory crackles
- Indicates atelectasis (likely post op)
- Mobilise or MOS
- TEE x6 + SMI x2 (x6 cycles)
Treatment for expiratory crackles / wheezing
- Indicates sputum retention
- ACBT
- Bottle PEP
AECOPD Treatment
- Low intensity mobilisation (1-3 BORG)
- ACBT (no SMI)
Cardiac Surgery Precautions
- Sternal instability
- No UL movement over shoulder height
- No lifting >2kg
- ‘Move in the tube’ visualisation
Cardiac Surgery Post Op Exercises
0-4 weeks post op:
- Shoulder shrugs
- Tx rotation + lat flexion
- Cx rotation + lat flexion
- Elbow circles
Dosage = x5-10 reps, x2 daily.
Thoracic Surgery L1 Exercises
- Shoulder shrugs
- Elbow flexion / extension
- Wrist flexion / extension
- Hand squeeze
Thoracic Surgery L2 exercises
- Arm forward lift to shoulder height
- Arm overhead lift
- Hands on head, elbows sideways
- Hands behind neck, pec stretch
- Wall crawl
Dosage = build to x10 reps, x3 daily
MRC Test for ICU AW
UL
- Shoulder abduction
- Elbow flexion
- Wrist extension
LL
- Hip flexion
- Knee extension
- Ankle DF
Scoring:
- 0-5 oxford scale
- score 60 = normal
- score <48 = indicates ICU AW
PFIT
STS
0 = max assist or unable
1 = x1 assist
2 = minimal assist
3 = no assist
MOS for 1 min
0 = <3 steps or unable
1 = 3-9 steps
2 = 10-19 steps
3 = >20 steps
Shoulder Flexion + Knee Extension
- Graded 0-5
PFIT SCORE:
<3 = severe impairment
3-6 = moderate impairment
7-9 = mild impairment
10-12 = minimal impairment
Pursed lip breathing
- SUIB and pillow on lap, hands on pillow facing up
- Relax shoulders
- Inhale 2 seconds
- Exhale 4-6s (longer than inhale) as if trying to blow out candle
-> avoid forceful exhale (can collapse airways),
-> recommended during stairs or walking
Dyspnoea Techniques
- Positions (tripod, forward lean)
- Encourage pt to use pursed lip breathing whilst in these positions
- Back against wall (relax shoulders, let tummy relax)
- Tell pt to do this with activities like walking or stairs, which make them SOB.
- Helps relax muscles around chest and allows our lungs to expand better.
Tripod Breathing
- SOOB in chair
- Hands on knees with arms straight and feet flat on floor
- Tell pt they can also perform standing up + demonstrate for @home use.
- helps better accessory muscle use (improved rib movement)
- better diaphragm movement
- reduced WOB***
Diaphragm Technique for Breathing
- Inhale and image pushing out your tummy as it fills up with air
- Then gently exhale
- ‘helps us to relax during our breathing so we can take deeper breaths’
- practice for 5-10mins daily and incorporate into ADLs like walking and stairs.
-> be weary of COPD pts who may require the abdominal pressure to exhale efficiently.
Venturi Set Up
- Humidified oxygen
- FiO2 fixed b/w 24-50%
- Place body into base + add Venturi and set to fIo2
- Add small tube onto top of venturi cylindrical attachment and then into O2 at wall
- Connect into saline
- Add big tube + connect into Hudson
AirVo Set Up
- Turn on and connect to wall
- Small tube into O2 (from corner of airvo)
- Other tube into saline (from centre piece)
- Large tube onto large connector and mouthpeice / mask onto patient
- Set at 45L/min to 5L O2
-> Flow rate 15-60L/min
-> must be set up MINIMUM 15L/min as it is a HF device
