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- immobilized critically ill patients suffer muscle deconditioning, increased risk of DVT, pressure sore
Cycle of PT program
Assessment / reassessment Analysis of findings Problems identification Implementation of treatment Planning of treatment
Retained secretions Partially occlude Uneven distribution of ventilation Vr/Qr mismatching Hypoxe mia Complete occlude Shunting blood Vr/Qr mismatching
vibration : fine tremorous action or fine shaking, manually performed by pressing in the direction that the ribs and soft fissure of chest normally move during exhalation
During percussion and vibration : PT must observed patient s facial expression because of pain or uncomfortable
The consequences of pain are - muscle splinting - increase work of breath - increase O2 consumption - breath holding - bronchospasm etc.
Active inspiration
Lung expansion in 3 directions - antero posterior - transverse - longitudinal Pump handle movement occurs at upper ribs Bucket handle movement occurs at lower ribs abdominal contents move downward
Patterns of BE
- Diaphragmatic BE - Costal BE (thoracic expansion exercise) - Pursed lips breathing (PLB) - Sustained maximal inspiration (SMI) - Deep BE etc.
Collateral ventilation
- Channels of Martin (interbronchiolar channel) - Channels of Lambert (bronchiole-alveolar channel) - Pore of Kohn (interalveolar channel)
- appropiate care
- raised airway pressure - high PAP - arrhythmia - vital sign - level of ICP - level of consciousness , sedation etc.
Summary
At the ICU bedside
- VS and ventilation parameters should be checked before Rx - Proper physical therapy techniques application - Closed observation and continuously monitored during Rx - Reassessed at the end of Rx - Before leaving a patient , PT must ensure that all alarms are reactivated, VS are stable, patient feels comfortable and secure.