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Textbook of Physiotherapy for Cardio-respiratory Cardiac Surgery and Thoracic Surgery Conditions
GB Madhuri
CHAPTER 1:
Cardio-respiratory System
ANATOMY OF RESPIRATORY SYSTEM
PLEURAE
Layers of Pleura
APPLIED ANATOMY
The Lung
Features
Fissures and Lobes
Bronchial Tree
Nerve Supply
Bronchopulmonary Segments
Clinical Significance
RELATIONSHIP OF BONY THORAX AND LUNGS
The relationship of the bony thorax and lungs to each other and to the abdominal contents
THE THORACIC CAGE
Anteriorly by the Sternum
Ribs
Shape of the Thorax
APPLIED ANATOMY
The Inlet of the Thorax or Superior Aperture of the Thorax
Large Vessels
APPLIED ANATOMY
Thoracic Inlet Syndrome
Outlet of the Thorax
Boundaries
Diaphragm Passing through the Outlet
THE VARIATIONS IN THE BONY CAGE IN THE FOLLOWING CONDITIONS
NUTRITIONAL RICKETS
Pathology
Clinical Features
3. Pigeon Chest or Pigeon Breast or Pectus Carinatum
Physiotherapy Treatment
Definition
Causes
Symptoms
Deformity
Treatment
4. Funnel Chest
Causes
Clinical Features
Treatment
SPINAL CURVE
Functions of Spinal Curves
Applied Anatomy
5. Scoliosis
Types
Postural or Non-structural Scoliosis
Structural Scoliosis
Classification
Postural or Idiopathic Scoliosis
Paralytic Scoliosis
Congenital Scoliosis
The Course and Prognosis
Prevention
TREATMENT
Grade I—Management of Postural Scoliosis
Grade II
Grade III—Severe Structural Curves
6. Kyphosis
PHYSIOTHERAPY MANAGEMENT
First Degree Kyphosis
Second and Third Degree Kyphosis
Surgical and Post Surgical Management
THE MOVEMENTS OF THE THORAX
RESPIRATORY MOVEMENTS
PRINCIPLES OF MOVEMENT
Inspiration
Expiration
APPLIED ANATOMY
Dyspnoea
RESPIRATORY MUSCLES
BREATHING
Quiet Breathing
Deep Breathing
Force Breathing
HEART
NERVE SUPPLY OF THE HEART
Parasympathetic Nerve Supply
Sympathetic Nerve Supply
Clinical Aspects
Applied Anatomy
ELECTRICAL ACTIVITY OF THE MYOCARDIUM
Conducting System of the Heart
Applied Anatomy
ELECTROCARDIOGRAM
Electrocardiography
Electrocardiograph
PHYSIOLOGY
RESPIRATORY CENTERS
CONTROL OF RESPIRATION
BLOOD PRESSURE
CONTROL OF BLOOD PRESSURE
Baroreceptors
Chemoreceptors
Higher Centers of Brain
THE COUGH REFLEX
BREATHING, LUNG COMPLIANCE AND AIRWAY RESISTANCE
BREATHING
Factors Affecting the Breathing
LUNG COMPLIANCE
Definition
Factor Affecting the Compliance
AIRWAY RESISTANCE
DIFFUSION, VENTILATION-PERFUSION
DIFFUSION
The Values of the Diffusion
CLINICAL APPLICATION
Hypoxia
Hypoxaemia
Hypoventilation
Diffusion Abnormalities
Ventilation
Perfusion
Ventilation-perfusion Ratio
Variation
ENERGY EXPENDITURE
BASAL METABOLISM
PULMONARY FUNCTION ASSESSMENT TESTS—BLOOD GAS ANALYSIS
PULMONARY FUNCTION ASSESSMENT
Assessment of the Pulmonary Patient
NOTES AND CHARTS
Subjective Assessment
Symptoms
Functional Limitation
Observation
Apparatus
Sputum
Colour
Hands
Chest Shape
Breathing Rate
Breathing Pattern
Jugular Venous Pressure
Exercise Tolerance
Chest X-rays
PULMONARY FUNCTION TESTS
Indications
Importance
Suggestions to the Patient
Aim
Guidelines
TESTS PERFORMED BY THE PHYSIOTHERAPIST
Measurement of the Pulmonary Function
Spirometer
Helium Dilution Technique
Nitrogen Wash out Method
Gas Transfer Tests
Exercise Testing
Quantitative Perfusion / Ventilation Scanning
Six-minute Walk
Stair Climbing
CARDIOVASCULAR STRESS TESTING
PRINCIPLES
Contraindications
Procedure
Other Tests
Treatment
ARRHYTHMIA AND SYNCOPE
DEFINITION
Types
Complete Heart Block or Third Degree Heart Block
Extrasystole
Paroxysmal Tachycardia
Ventricular Paroxysmal Tachycardia
Others
SYNCOPE AND ITS MANAGEMENT
Definition
Types
ECG
FUNDAMENTALS OF THE ECG RECORDING AND BASIC INTERPRETATION
Definition
Electrical Changes During Muscle Contraction
Resting Membrane Potential
Action Potential
Electrographic Grid
Time
Amplitude
Speed of the Paper
Waves, Intervals and Segments of Normal EGC
ECG Leads
Bipolar Leads
Unipolar Leads
1. avr
2. avl
3. avf
Unipolar Chest Leads
CHAPTER 2:
Cardiac Surgery
A. MITRAL STENOSIS
PATHOLOGY
Types of Mitral Stenosis
Clinical Features
Complications
INVESTIGATIONS
X-ray Chest
ECG
Echocardiogram
Diagnosis
Treatment
Medical Treatment
Surgical Treatment
B. AORTIC STENOSIS
INVESTIGATIONS
X-ray Chest
ECG
Echocardiogram
Complications
Treatment
A. PATENT DUCTUS ARTERIOSUS
B. COARCTATION OF AORTA
ATRIAL SEPTAL DEFECT
VENTRICULAR SEPTAL DEFECT
PULMONARY STENOSIS
TETRALOGY OF FALLOT
TRANSPOSITION OF THE GREAT VESSELS
AV-MALFORMATION OR ARTERIO- VENOUS MALFORMATION
MITRAL STENOSIS
MITRAL REGURGITATION
AORTIC STENOSIS
AORTIC REGURGITATION
CORONARY ARTERY DISEASE OR ISCHAEMIC HEART DISEASE
ANGINA PECTORIS
Types
CARDIAC FAILURE
Acute Cardiac Failure
Chronic Cardiac Failure
Congestive Cardiac Failure
Risk Factors
Diagnosis
Prevention
Management
PHYSIOTHERAPY REHABILITATION PROGRAMME FOR THE CARDIAC REHABILITATION PROGRAMME
CHAPTER 3:
Thoracic Surgery
FRACTURE RIBS
FLAIL CHEST
STOVE IN CHEST
PNEUMOTHORAX
CLOSED PNEUMOTHORAX
Causes
Clinical Features
Treatment
OPEN PNEUMOTHORAX
Definition
Clinical Features
Diagnosis
Treatment
Procedure
TENSION PNEUMOTHORAX
Definition
Clinical Features
Treatment
SPONTANEOUS PNEUMOTHORAX
Definition
Cause
Clinical Features
Treatment
CHRONIC PNEUMOTHORAX
Treatment
HAEMOTHORAX
HAEMOPNEUMOTHORAX
LUNG CONTUSION AND LACERATION
INJURY TO HEART, GREAT VESSELS AND BRONCHUS
ASCENDING AORTA / MAIN PULMONARY ARTERY INJURY
Cause
Complication
Treatment
AORTIC ARCH-THORACIC OUTLET VASCULAR INJURY, DISTAL INNOMINATE ARTERY AND VEIN
Cause
Treatment
SUBCLAVIAN VASCULAR INJURY
Treatment
DESCENDING THORACIC AORTA
Cause
Clinical Features
Treatment
BRONCHIAL INJURY
Causes
Complications
Treatment
PENETRATING CARDIAC INJURY
Site
Treatment
STAB WOUND OF HEART
Causes
Clinical Features
Treatment
CORONARY ARTERY INJURY
EMPYEMA
TREATMENT
Aim
Stage-I
Stage-II
DECORTICATION
WINDOW OPERATION/OPEN FLAP PROCEDURE
PULMONARY TUBERCULOSIS
TUBERCULOMA
BRONCHIECTASIS SICCA
BRONCHOSTENOSIS
MASSIVE HAEMOPTYSIS
MANAGEMENT OF SUPPURATIVE LESIONS OF THE LUNG
BRONCHIECTASIS
LUNG ABSCESS
BRONCHO-PNEUMONIA
ASPERGILLOSIS
LUNG CARCINOMA
CARCINOMA OF LUNG
Aetiology
Clinical Features
Diagnosis
Management
Post-operative Radiotherapy
Pallative Radiotherapy
Brachy Therapy
Complications
Chemotherapy
Chemotherapeutic Agents
Combination Therapy
Post-operative Chemotherapy
Induction Chemotherapy
Concurrent Chemoradiotherapy
Surgical Treatment
Surgical Principles
THORACIC INCISIONS
EXTENT, USE AND COMPLICATIONS OF THE THORACIC INCISIONS
Thoracic Cage
Thoracic Cage Musculature
Thoracotomy
LATERAL INCISIONS
Antero-lateral Thoracotomy
Postero-lateral Thoracotomy
Advantages
Disadvantage
MEDIAN STERNOTOMY
Indications
Technique
Advantage
Disadvantage
ATELECTASIS
Definition
Clinical Features
Treatment
CARDIAC ARREST
Definition
Clinical Features
Treatment
CARDIAC DYSRHYTHMIA
Definition
Clinical Features
Treatment
CARDIAC TAMPONADE
Definition
Clinical Features
Treatment
CONGESTIVE CARDIAC FAILURE
Definition
Clinical Features
Treatment
EMPYEMA
Definition
Clinical Features
Treatment
HEMOTHORAX
Definition
Clinical Features
Treatment
HYPERCAPNIA
Definition
Clinical Features
Treatment
HYPOXIA
Definition
Clinical Features
Treatment
PLEURAL EFFUSION
Definition
Clinical Features
Treatment
PNEUMONIA
Definition
Clinical Features
Treatment
PNEUMOTHORAX
Definition
Clinical Features
Treatment
POST CARDIOTOMY SYNDROME
Definition
Clinical Features
Treatment
PULMONARY EMBOLISM
Definition
Clinical Features
Treatment
RESPIRATORY ARREST
Definition
Clinical Features
Treatment
RESPIRATORY DISTRESS
Definition
Clinical Features
Treatment
SUBCUTANEOUS EMPHYSEMA
Definition
Clinical Features
Treatment
CARDIOGENIC SHOCK
Definition
Clinical Features
Treatment
DEEP VEIN THROMBOSIS
Definition
Clinical Features
Causes
Prevention
Treatment
SOME OTHER COMPLICATIONS
Respiratory
Circulatory
Wound
Joint Stiffness
Muscle Weakness
Postural Deformity
Digestive Complications
Renal Complications
POST-OPERATIVE MANAGEMENT OF THE FOLLOWING
SEGMENTECTOMY
Definition
Complications
LOBECTOMY
Definition
Indications
Complications
PNEUMONECTOMY
Definition
Indication
Complications
Pleuropneumonectomy
TRACHEOSTOMY
VENTILATORS
PRINCIPLES OF THE VARIOUS VENTILATORS AND THEIR USES
Definition
Indications
Types of Ventilators
Modes of Ventilation
Advantages
Pressure Support Ventilator
Controlled Mechanical Ventilator
Assisted Mechanical Ventilator
Assisted Controlled Ventilator
Intermittent Mandatory Ventilator
Synchronised Mandatory Ventilator
Pressure Ratio Mandatory Ventilator
Inverse Ratio Ventilator
Independent Lung Ventilator
Setting up the Ventilator
Factors to be observed in case of ventilation
Classification of ventilator on Phases
Complications
THORACOTOMY
PRE-OPERATIVE ASSESSMENT AND MANAGEMENT OF A PATIENT POSTED FOR THORACOTOMY
Pre-operative Assessment
Pre-operative Condition
Rationale for Treatment
Surgical Procedure
Monitoring and Supportive Devices
Pre-operative Treatment
MANAGEMENT OF THE FOLLOWING
TRACHEOSTOMY
Definition
Oral Intubation
Nasal Intubation
Tracheostomy
Functions of Endotracheal or Tracheostomy Tube
Disadvantages
Description of Tube
Uses
Arrangement
ENDONASAL TUBES
Definition
Variety
Types
Steps of Intubation
Complications
Naso-gastric Tube Complications
SUCTION
Definition
Suction Equipment
Suction Tubing
Suction Technique
Aim
Types
Minitracheostomy or Tracheal Suction
WEANING
Definition
Weaning is Successful
Method
EXTUBATION
Steps for Extubation
CARDIO-PULMONARY RESUSCITATION
ARTIFICIAL VENTILATION / RESPIRATION: ARTIFICIAL RESPIRATION IS A LIFE SAVING MEASURE
Indications
Importance
Method
Advantages
Procedure
MECHANICAL RESPIRATORS
Indications
Complications
PHYSIOTHERAPY MANAGEMENT FOR THE THORACIC SURGERY
PRE-OPERATIVE PHYSIOTHERAPY
POST-OPERATIVE PHYSIOTHERAPY
CHAPTER 4:
Miscellaneous
MYOCARDIAL INFARCTION
MANAGEMENT A PATIENT AFTER A MYOCARDIAL INFARCT
Definition
Clinical Features
Signs
Investigations
Treatment
Complication
Surgery
MYOCARDIAL INFARCTION—PHYSIOTHERAPY MANAGEMENT
CHRONIC OBSTRUCTIVE AIRWAY DISEASE
COPD
Definition
Aetiology
Pathology
Treatment
Complications
Prognosis
CHRONIC BRONCHITIS
Definition
Aetiology
Causes
Pathology
Clinical Features
Diagnosis
Treatment
EMPHYSEMA
Definition
Aetiology
Types
Clinical Features
Diagnosis
Complications
Treatment
ASTHMA
Definition
Aetiology
Types
Symptoms
Clinical Features
Diagnosis
INTRINSIC ASTHMA OR NON-ATROPIC ASTHMA
Aetiology
Pathology
Clinical Features
Diagnosis
Treatment
BRONCHIECTASIS
Definition
Aetiology
Clinical Features
Pathology
Clinical Features
Investigations
Complications
Treatment
Surgery
CYSTIC FIBROSIS OR MUCOVISCIDOSIS
Definition
Aetiology
Pathology
Clinical Features
Complications
Treatment
Chest Physical Therapy
CHAPTER 5:
Physiotherapy Rehabilitation Programme
CARDIAC REHABILITATION
EXERCISE TEST PROTOCOL
Maximal Exercise Test (MET)
Maximal Exercise Testing
Metabolic calculation
Valid Estimation: ACSM Metabolic Equation to Estimate VO2
ACSM Walking Equation
Bicycle Ergometer Maximal Exercise Tests
Advantages of Ergometer
ACSM leg ergometer equation
Bench Stepping Maximal Exercise Tests
ACMS Stepping Equation
SUBMAXIMAL EXERCISE TEST
a. Treadmill Submaximal Exercise Test
b. Bicycle Ergometer Submaximal Exercise Test
c. Bench Stepping Submaximal Exercise Test
d. Other Submaximal Exercise Test
e. Field Tests
f. Distance Run Tests
g. Nine or Twelve Minute Run Test
h. One and 1.5 Mile Run/Walk Test
i. One Mile Jogging Test
j. Walking Test
k. Step Test
l. Additional Field Test
m. Twelve Minutes Swimming Test
n. Wait Test
Graded Exercise Test Protocols
Aerobic Capacity or Cardiorespiratory Fitness–graded Exercise Testing
Advantages of all the Tests
Exercise Prescription
CARDIAC REHABILITATION EXERCISE PROGRAMME
1. Phase –I or Inpatient Cardiac Rehabilitation
Phase –II or Convalescent Stage and Recovery Stage
Phase–III or Maintenance Stage or Maintenance Programme
Phase –IV or Commitment Phase or Ongoing for the Life Phase
The Cardiac Response to the Exercise
Risk Factors
Guidelines for the Management of the Risk Factors
PULMONARY REHABILITATION
MEASUREMENT OF THE PULMONARY FUNCTION
Spirometer
Helium Dilution Technique
Nitrogen Wash Out Method
2. Gas Transfer Tests
Exercise Testing
Quantitative Perfusion /Ventilation Scanning
Six-minute Walk
Stair Climbing
Clinical Application
Disability
Handicap
Aim
Uses
Pulmonary Rehabilitation Programme–Respiratory Care
The Type of Manipulations Used are
Physiological Uses
Position of the Patient
Uses
Contraindications
BREATHING EXERCISES
Aims
Indications
Principles
Precautions
CLASSIFICATION
1. Diaphragmatic Breathing
2. Segmental breathing
Lateral Costal Breathing
Procedure
3. Ventilatory Muscle Training
4. Glossopharangeal Breathing
5. Pursed Lip Breathing (Fig. 5.19)
POSTURAL DRAINAGE
THORACIC EXPANSION EXERCISE
Aim
INHALATION THERAPY
Other Types of Inhaling Devices
Nebulizer
Types of Nebulizer
HUMIDIFICATION
Indications
Choice of Humidifiers
Methods
Types
INTERMITTENT POSITIVE PRESSURE BREATHING
TO REMOVE THE SECRETIONS
Effective Coughing
Huffing
Forced Expiratory Technique (Fig. 5.30)
Active Cycle Breathing Technique
Suction
TO INDUCE RELAXATION
Relaxation Definition
Practicing Relaxation
Relaxation Techniques
Procedure
Advantages
BREATHING CONTROL
Aims
Indications
Various Positions to Practice Breathing Control
To Bring Awareness of Posture (Fig. 5.40)
Neck Exercises
Shoulder Girdle Exercises
Shoulder Exercises
Long Lever Exercises
Side-lying: The Top Shoulder Should be Moved
Short Lever Exercises
Standing
Trunk Exercises
Pelvic Girdle
Pelvic Bridging Exercise (Fig. 5.80)
Lower Limb
Knee Exercises
Ankle and Foot
To Teach Home Management
Bibliography
Glossary
INDEX
TOC
Index
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