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Cardiopulmonary Physiotherapy

I am searching for someone to help assist me with the important factors in these cases. I have no experience with patients with serious cardiopulmonary issues. ANy key factos that i should have to consider in regards to the patient from a physical therapist point of view I would appreciate. My teacher is way over my head in the cardiopulmonary field and i need to understand the concepts and flags before my final in 3 weeks. These are practice cases and I feel very overwhelmed. I do not know what a PEEP level is - the book we use only has 2 small chapters and it does not go into this material.

Case A:

23 y/o male s/p motor vehicle accident. Arrived unconscious with a left tension pneumothorax, fractured pelvis, and left femur, absent bowel sounds and hematuria. CxR showed fracture of first and second right ribs. Pt. went to OR for laparotomy which revealed a ruptured spleen and renal contusion, he also underwent placement of ICP monitor (intracranial pressure) secondary to cerebral contusion. Nine days after admission Pseudomonas aeruginosa was grown out of tracheal cultures. Pt. is unconscious. On the twelfth day Physical Therapy was consulted. The patient is in the ICU, on a ventilator with IMV 4, PEEP 5, FiO2 = 40%, RR = 16. CxR shows infiltrates in the right middle and lower lobes. Temperature is 101.2. MEDS included: tobramycin and ticarillen (both antibiotics). Lab values were significant for leukocytosis.

What PT interventions will you consider for this patient? Are these for short term benefit, for long term benefit, or both? How will you monitor progress?

Case B:

22 y/o male with C4 quadraplegia admitted with sudden onset of SOB and diaphoresis after one week of low grade temp. He was being treated at home with antibiotics for an upper respiratory infection (URI) and receiving his standard pulmonary hygiene by his PCA (personal care attendant). On admission has absent breath sounds in the left lung, there is dullness to percussion. CxR reveals complete left lung atelectasis. Temp = 101, ABG's = PaO2 55, PaCO2 50, pH 7.33. He is treated with nasal O2. Physical therapy is consulted for chest PT in the ER. The patient reveals to you that he has missed his last few pulmonary hygiene treatments by the PCA.

What do you think the problem is based on the above information? (incorporate all info; CxR, ABG's, percussion, breath sounds, recent history, etc.)
What do you (based on the above information) plan on doing during PT for this problem? What are your priorities?
How will you monitor for improvement? (think about what you are treating at this point)

Solution Preview

Case A:

23 y/o male s/p motor vehicle accident. Arrived unconscious with a left tension pneumothorax, fractured pelvis, and left femur, absent bowel sounds and hematuria. CxR showed fracture of first and second right ribs. Pt. went to OR for laparotomy which revealed a ruptured spleen and renal contusion, he also underwent placement of ICP monitor (intracranial pressure) secondary to cerebral contusion. Nine days after admission Pseudomonas aeruginosa was grown out of tracheal cultures. Pt. is unconscious. On the twelfth day Physical Therapy was consulted. The patient is in the ICU, on a ventilator with IMV 4, PEEP 5, FiO2 = 40%, RR = 16. CxR shows infiltrates in the right middle and lower lobes. Temperature is 101.2. MEDS included: tobramycin and ticarillen (both antibiotics). Lab values were significant for leukocytosis.

What PT interventions will you consider for this patient?

This 23 y.o. male with a left tension pneumothorax, rib fractures and multiple other trauma now has ventilator associated pneumonia. Ideally, the goal should be to wean the patient of the ventilator as soon as appropriate to avoid further ...

Solution Summary

Case involving inpatient evaluation and recommendations by PT.

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