1 / 47

PHYSIOTHERAPY ADJUNCTS

PHYSIOTHERAPY ADJUNCTS. Billie Hurst Part-Time Lecturer QMUC. Content. Oxygen therapy Humidification Non Invasive ventilation - BIPAP/CPAP Bronchoscopy. Oxygen therapy. For over 200 years oxygen therapy has often been used and sometimes misused (Hough 2001). Oxygen Therapy.

johana
Download Presentation

PHYSIOTHERAPY ADJUNCTS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PHYSIOTHERAPY ADJUNCTS Billie Hurst Part-Time Lecturer QMUC

  2. Content • Oxygen therapy • Humidification • Non Invasive ventilation - BIPAP/CPAP • Bronchoscopy

  3. Oxygen therapy For over 200 years oxygen therapy has often been used and sometimes misused (Hough 2001)

  4. Oxygen Therapy • Should be prescribed • Acute and chronic respiratory conditions • Personnel should be trained in its use • Protocols

  5. Oxygen therapy - Indications • Hypoxaemia (PaO2<8KPA, O2sats<90%) • Acute or chronic respiratory condition • Pre and post suction • Routinely post operatively • Optimise oxygen delivery

  6. Oxygen therapy - limitations • Giving oxygen does not guarantee it’s arrival at the mitochondria • Oxygen does not improve ventilation directly (Hough 2001)

  7. Oxygen therapy – complications/cautions • Respiratory depression if hypoxic drive • Pulmonary oxygen toxicity • Tracheobronchitis • Absorption atelectasis • Fire • Variable delivery

  8. Oxygen Therapy - Monitoring • Oxygen saturations continuous/intermittent • Arterial blood gases • Observation

  9. Oxygen Therapy - Delivery • Piped oxygen • Portable oxygen • Compressors/concentrators

  10. Oxygen therapy – delivery devices • Low Flow masks (variable performance) • High flow masks (fixed flow)/venturi • Nasal cannulae • Mask and reservoir bag • Tracheal mask/t-piece • Tracheal speaking valves • Mechanical ventilator

  11. Oxygen Therapy - low flow masks • Commonly used • Variable performance

  12. Oxygen therapy – high flow masks • Guaranteed percentage of oxygen • Venturi system • More expensive • Up to 60%

  13. Nasal cannulae • 1l/min 24% oxygen • 2l/min 28% oxygen • 3l/min 32% oxygen • 4l/min 36% oxygen

  14. Oxygen therapy – bag and mask • High concentrations of oxygen • Mask and reservoir bag • 55-90%

  15. Oxygen Therapy tracheostomy • T-piece • Mask • Swedish nose • Speaking valve

  16. Long term oxygen therapy • Chronic hypoxaemia • Increases survival • Aim to raise PaO2 to >8Kpa • Worn as much as possible >15hours • Cylinders/concentrators/liquid

  17. Oxygen Therapy - Implications • Assessment • Limitations to physiotherapy techniques

  18. Humidification • Mucocillary escalator • Adequate hydration is vital • Bacterial contamination!!!

  19. Humidification - indications • URT bypassed • Thick retained secretions • High flow oxygen/non-invasive mechanical aids

  20. Humidification - Cautions • Hyper-reactive airways - bronchospasm • Infection • Burns

  21. Humidification - Types • Nebulisers Large/Small/Ultrasonic • Steam

  22. Humidification - Humidifiers Hot • - Increases moisture content • - Increases risk of infection Cold • - Poor moisture content

  23. Humidification - HME • Heat moisture exchangers • Hygroscopic • Hydrophobic • Swedish nose • Tracheostomy bibs

  24. Non-invasive ventilation • BiPAP • CPAP • IPPB

  25. Contraindications/Cautions to non- invasive ventilation • Undrained pneumothorax,surgical emphysema • Unstable Cardiovascular system • Frank haemoptysis • Facial fractures • Vomiting • Raised ICP • Active TB • Lung abcess • Recent GI surgery • Pneumonectomy/lobectomy with poor stump

  26. Continuous Positive Airway Pressure • Constant flow of gas through inspiration and expiration • Invasive/non-invasive • Endotracheal/tacheostomy/mask • Improve oxygenation not ventilation

  27. CPAP - indications • Type I respiratory failure • Volume loss • Sleep apnoea • Pulmonary oedema • Flail segment

  28. CPAP - Problems • Tolerance • Discomfort/fit • Air swallowing • Difficulty coughing • Aspiration • Mild haemodynamic changes • Note pneumothorax

  29. Bilevel positive airway pressure • BiPAP • Invasive/Non-invasive ventilation • Endotracheal tube/tracheostomy/mask • Constant pressure with independent inspiratory pressure and expiratory pressure

  30. BiPAP - Indications • Respiratory type II failure • Weaning

  31. BiPAP - Problems • Tolerance • Discomfort/mask fit • Air swallowing • Mild haemodynamic changes • Expectoration

  32. NIV – Implications for treatment YES • Positioning • Manual techniques • Thoracic expansion exercises • ACBT? NO • Mobilisation • Incentive spirometry

  33. Bronchoscopy • Fiberoptic bronchoscope • Diagnostic • Therapeutic • Bronchial lavage

More Related