ROLE OF PT IN ICU - PowerPoint PPT Presentation

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ROLE OF PT IN ICU

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ROLE OF PT IN ICU Hazards of ... Manual hyperinflation Airway suctioning Chest Mobilization Physiological effects of Positioning Optimizes oxygen transport by ... – PowerPoint PPT presentation

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Title: ROLE OF PT IN ICU


1
ROLE OF PT IN ICU
2
Goals of PT in ICU
  • Improve / maintain normal or baseline ventilation
    and oxygenation
  • Improve / maintain musculoskeletal system within
    functional limit
  • - Improve range of motion
  • - Improve muscle strength and
    endurance
  • - Prevent joint deformities and
    contractures

3
Goals-contd...
  • 3. Improve circulatory system function
  • 4. Improve / maintain neurological system and
    cognitive status within the functional limits.
  • 5. Improve / maintain level of functional status
    within patient tolerance

4
Assessment
  • Cardiovascular system
  • Respiratory system
  • Neurological system
  • Renal system
  • Hematological system
  • Gastrointestinal system

5
Cardiovascular system
  • Heart rate and rhythm
  • Arterial BP
  • Central Venous pressure
  • Pulmonary Artery pressure (PAP) and pulmonary
    artery wedge pressure (PCWP)

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10
Neurological system
  • Level of consciousness (Glascow coma scale)
  • Pupils
  • Size
  • Reactivity
  • Equality
  • Cerebral perfusion pressure (gt70mmHg)
  • CPP MAP- ICP (Mean arterial
    pressure-Intra
    cranial pressure)
  • Intracranial pressure (lt10mmHg)

11
Intracranial pressure measurement
12
Renal system
  • Assessment of fluid balance
  • Measure of Intravascular volumes
  • Urine output
  • Serum electrolytes
  • ABG

13
Gastrointestinal system
  • Nutritional support
  • Routes of administration
  • Enteral ( Ryles tube)
  • Parentral ( Venous line)
  • Oral

14
CARDIO PULMONARY DYSFUNCTION
  • 1. PRIMARY
  • - Respiratory failure
  • - Heart failure
  • - Cardiac surgeries
  • - Thoracic surgeries

2. SECONDARY - Burns - Head injuries
- Musculoskeletal trauma - Neuro muscular
dysfunctions - Acute spinal cord injuries
- Renal failure - Complicated general
surgeries
15
Respiratory system
  • Auscultation
  • Percussion
  • Expansion
  • Chest X-ray
  • Mode of ventilation
  • Humidification
  • Oxygen therapy
  • Respiratory rate
  • Airway pressures
  • ABG
  • Sputum

16
Assessment
  • General Observation
  • Patient Position
  • Respiration - Airway Endo Tracheal /
    Tracheostomy Ventillator Mode FiO2
  • Vital Signs Temperature, BP, RR, HR SpO2,GCS,
    ICP
  • Tubes - CV line, Peripheral line, Chest tubes,
    Catheters
  • Drugs

17
  • Examination
  • Auscultations
  • Respiratory pattern
  • Cyanosis
  • Clubbing
  • Radiograph

18
Goals
  • Prevent accumulation of secretions
  • Improve mobilization and drainage of secretions
  • Promote relaxation to improve breathing patterns
  • Promote improved respiratory function
  • Improve cardio-pulmonary exercise tolerance

19
Precautions
  • Untreated tension pneumothorax
  • Status asthmaticus
  • Immediately following intra cranial surgery
  • Head injury with raised ICP
  • Osteoporotic bones
  • Recent acute myocardial infarction, unstable
    vitals
  • Sutures and Intercostal drainage

20
Physiotherapy Techniques
  • Gravity-assisted Positioning
  • Manual techniques
  • Manual hyperinflation
  • Airway suctioning
  • Chest Mobilization

21
Physiological effects of Positioning
  • Optimizes oxygen transport by improving V/Q
    mismatch
  • Increases lung volumes
  • Reduces the work of breathing
  • Minimizes the work of heart
  • Enhances mucociliary clearance (postural
    drainage)

22
Chest Mobilization
  • Chest Vibrations
  • Chest Percussion/Clapping
  • Postural drainage

23
Chest Percussion / Vibration
  • PERCUSSION consists of rhythmic clapping on the
    chest
  • with loose wrist cupped hand.
  • Effect Dislodges loosens secretions from the
    lung
  • VIBRATIONS consists of a fine oscillation of the
    hands
  • directed inwards against the chest, performed on
    exhalation
  • after deep inhalation.
  • Effects Helpful in moving loosened mucous plugs
    towards larger airway

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Manual Hyperinflation (MH)
  • This is inflating the lungs with oxygen and
    manual compression to a tidal volume.
  • Indications
  • To aid removal of secretions
  • To aid reinflation of atelectatic segments
  • To assess lung compliance
  • To improve lung compliance

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Hazards of Manual Hyperinflation
  • Reduction in blood pressure
  • Reduced saturation
  • Raised intracranial pressure
  • Reduced respiratory drive
  • Hemodynamic and metabolic upset
  • Risk of barotrauma
  • Discomfort and anxiety

29
Contraindications
  • Undrained Pneumothorax
  • Severe bronchospasm
  • Cardiac arrhythmias
  • Unexplained Hemoptysis
  • Patient on High PEEP (Positive end expiratory
    pressure)

30
Advantages of MH
  • Reverses atelectasis
  • Improves oxygen saturation and lung compliance
  • Improves sputum clearance

31
Suctioning
  • Suctioning is the mechanical aspiration of
    pulmonary secretions from a patient with an
    artificial airway in place.
  • Indications
  • Inability to cough effectively
  • Sputum plugging
  • To assess tube patency

32
Contraindication
  • Frank hemoptysis
  • Severe brochospasm
  • Undrained pneumothorax

33
  • The suction catheter used must be less than half
    the diameter of endotracheal tube.
  • The vacuum pressure should be as low as possible.
    (60-150mmHg)
  • Suction should never be routine, only when there
    is an indication

34
Hazards of suctioning
  • Mucosal trauma
  • Cardiac arrhythmias
  • Hypoxia
  • Raised intracranial pressure

35
ROUTE OF SUCTION
  • Nasal and oral suction
  • Endotracheal suction
  • Tracheostomy suction

36
Mobilisation
  • Critically ill
  • (Frequent Position changes, Kinetic Kinematic
    Therapy)
  • Stable
  • (Progressive tilting Ambulation)

37
Mobilization
  • ICU rehabilitation has been shown to accelerate
    recovery
  • Early mobilization for unconscious patients
    starts right from turning the patient every two
    hours.
  • Graded exercises can be started as soon as the
    patient regains consciousness.

38
  • Activity is required to maintain sensory input,
    comfort, joint mobility and healing ability.
  • Activity minimizes the weakness caused by loss of
    muscle mass
  • Graded ambulation can be started depending on
    patients condition
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