Please enable JavaScript.

Coggle requires JavaScript to display documents.

CHEST PHYSIO - Coggle Diagram

- - - - The patient is instructed to take a deep inspiration and then chest compression with vibration/shaking/rib springing is performed throughout exhalation, following the movement of the chest wall. (repeated for 6 breaths)
        
        For patients with rapid respiratory rates, these maneuvers can be performed on alternate breaths, which may help reduce the breathing rate & allow better therapist coordination with exhalation.
        
        Performed during exhalation only, these techniques are purported to achieve more rapid & efficient mobilization of secretions by moving the secretions that were dislodged during percussion toward the larger airways in the bronchial tree, from which they can be expectorated.
        
        Vibration increases peak expiratory flow rates (PEFRs) by 50% relative to relaxed expiration, which is greater than that achieved through chest wall compression or chest wall oscillation alone, & can affect a decrease in the viscoelastic properties of mucus
    - - definition
        
        Precaution and contraindications
        
        Percussion should be continued for 2 to 5 minutes per lung segment followed by vibration and coughing or suctioning.
        
        When chest radiography or clinical assessment reveals a new atelectasis, treatment is continued with repeating cycles of percussion, vibration, and coughing/suction until
        resolution is clinically apparent. (Eg: improved breath sounds, resolution of crackles, return of normal midline position of the trachea)
        and coughing/suctioning is no longer productive.
        
        Percussion is performed with the patient in the appropriate bronchial drainage position for each segment although modified positions may be indicated.
        
        Percussion should be performed over a layer of thin cloth such as a hospital gown or T shirt. A towel will damper most of the force of percussion and drastically reduce the effectiveness of cupping.
        
        1 more item...
        
        Rib fractures or flail chest
        
        Osteoporosis
        
        Avoidances of bony prominences
        (clavicle, spine of scapula, spinous processes of the vertebrae)
        and breast tissue
        
        Metastatic cancer to the ribs
        
        Recent spinal fusion
        
        Unstable cardiovascular status
        
        Subcutaneous emphysema of the neck and thorax
        
        Fresh burns, open wounds, skin infections in the thoracic area
        
        Untreated pneumothorax
        
        percussion is a treatment technique that consists of rhythmically and alternately striking the chest wall with cupped hands to mechanically jar and dislodge retained secretions in underlying lung segments.
        
        The therapist molds his/her hands to fit the contour of the area being treated and applies a force that is appropriate to the individual patient
        .
        The hand should be cupped with the fingers and thumb adducted so that a hollow “popping” sound is produced
        .
        It is important to keep the wrists “loose” and flexible during the procedure to allow more comfort for both the patient and the therapist
  - - - postural drainage
        
        vibration
        
        percussion
        
        huffing
        
        coughing
        
        thoracic squeezing
        
        Vibration
        
        Shaking
        
        Rib springing
        
        is a more vigorous form of shaking in which the ribs are “pumped” in a springing fashion 3- or 4-times during exhalation
        
        involves a more pronounced bouncing chest compression
        
        consists of gentle, high frequency oscillations combined with compression of the chest wall produced by tensing all muscles in the upper extremities in co-contraction
- - - - Caution is indicated when performing vibration & shaking in patients with a stiff inelastic chest wall or a history of osteoporosis, as the risk of rib fracture is increased with these techniques
        
        Rib springing is contraindicated in these patients as well as in those with rib or spinal fractures, other bone abnormalities involving the chest or with pain.
        
        Premedication for pain is important in post-surgical surgical patients and others in whom ventilation and cough are limited by discomfort.
        .
        Allow at least 20 to 30 minutes for analgesics to take affect before initiating treatment. Incisional pain may be reduced by having the patient hold a pillow or rolled travel over the painful site during percussion.
        
        The therapist should monitor the patient’s oxygen saturation as it may fall during percussion. This can be eliminated by implementing thoracic mobility exercises ( as described earlier in this chapter) and pausing for breath control.
        
        For patients whom percussion is contraindicated or poorly tolerated vibration can be used effectively.
- - - - positive expiratory pressure mask
        
        continuous positive air pressure (CPAP)
        
        bubble CPAP
        
        flutter
        
        incentive spirometer