spinal cord injury 11 - respiration

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shmvii
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214650
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spinal cord injury 11 - respiration
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2013-04-20 16:00:39
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spinal cord injury 11
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spring rosen and karpatkin
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  1. respiratory muscles available in a C1-2 injury
    SCM, upper traps, cervical extensors
  2. respiratory muscles available in a C3-4 injury
    • (C1-2) SCM, upper traps, cervical extensors
    • (C3-4): scalenes, levator scap, partial diaphragm
  3. respiratory muscles available in a C5 injury
    • (C1-2) SCM, upper traps, cervical extensors (C3-4) scalenes, levator scap, partial diaphragm
    • (C5): diaphragm, pec major, serratus, rhomboids
  4. respiratory muscles available in a C6-8 injury
    • (C1-2) SCM, upper traps, cervical extensors
    • (C3-4) scalenes, levator scap, partial diaphragm
    • (C5) diaphragm, pec major, serratus, rhomboids
    • (C6-8): pec minor, lats
  5. respiratory muscles available in a T1-4 injury
    • (C1-2) SCM, upper traps, cervical extensors
    • (C3-4) scalenes, levator scap, partial diaphragm
    • (C5) diaphragm, pec major, serratus, rhomboids
    • (C6-8) pec minor, lats
    • (T1-4): upper intercostals and abs
  6. respiratory muscles available in a T5-10 injury
    • (C1-2) SCM, upper traps, cervical extensors
    • (C3-4) scalenes, levator scap, partial diaphragm
    • (C5) diaphragm, pec major, serratus, rhomboids
    • (C6-8) pec minor, lats
    • (T1-4) upper intercostals and abs
    • (T5-10): more intercostals and segmental abs
  7. respiratory muscles available in a T11 and below injury
    • (C1-2) SCM, upper traps, cervical extensors
    • (C3-4) scalenes, levator scap, partial diaphragm
    • (C5) diaphragm, pec major, serratus, rhomboids
    • (C6-8) pec minor, lats
    • (T1-4) upper intercostals and abs
    • (T5-10) more intercostals and segmental abs
    • (T11 and below): all of the above
  8. nerve roots for SCM and upper traps, basic role of these two muscles
    • CN 11, C2-4
    • superior expansion of chest
  9. scalenes - attachments and nerve roots
    • TPs of C-spine 3-6 --> 1st and 2nd rib
    • C3-8
  10. serratus ant nerve roots
    C5-7
  11. pec major nerve roots
    pec minor
    • major: C5-7 upper pec, C8-T1 lower pec
    • minor: C8-T1
  12. forced vital capacity def
    • max air a person can expel from the lungs after a max inhalation
    • It is equal to the sum of inspiratory reserve volume, tidal volume, and expiratory reserve volume
  13. FVCs for C1-2; 3-4; 5; 6-8; T1-4; 5-10; 11 and below
    • C1-2: <10% (on a ventilator)
    • C3-4: 10-40% (prob on a vent, at least at night?)
    • C5: 35-55%
    • C6-8: 40-70%
    • T1-4: 45-75%
    • T5-10: 60-95%
    • T11 and below: >80%
  14. at what level does breathing stop being paradoxical?
    • T1-4 (at C6-8 it's still paradoxical)
    • reasoning: until abs are involved the energy cost of breathing is so high
  15. 6 cough assist strategies
    • abdominal thrust: heimlich -- stand post to seated pt or over supine pt, find costosternal angle, push in on exhalation to stim glottal closure and ask pt to cough or huff - pt can do this with own fist
    • costophrenic assist: heimlichish but w quick-stretch -- hands on lat ribs doing lat to med force with a quick stretch right before inhalation, then apply pressure to help push air out on exhalation
    • anterior chest wall compression: pressing on chest to force air out
    • counter-rotation assist: sidelying, sup arm on thight, PT's hands on shoulder and hip, wring out the body -- exhale when shoudler goes ant and hip goes post
    • insp/asist/Glossopharyngeal breathing: gulping air
    • insufflation/exsufflation: mechanical device plugged into trach or over mouth to in/deflate lungs
  16. 2 self-assist cough methods
    • abd thrust using a fist or object
    • long sit - using head-hip rel, sit up straight to inhale, through head forward to help exhalation
  17. what's a P-flex?
    • toy to help w breaghing -- looks like a kazoo
    • has apertures you can narrow
    • it's exercise, breathing thru smaller and smaller holes - this increased the resistance
    • only gives resistance on insp
  18. what's a Breather device? compare to a Threshold Trainer?
    • like a P-flex but gives resistance both to insp and exp
    • the threshold trainer is similar, but resistance is via a
  19. what's an abdominal binder for?
    maintain position of diaphragm
  20. why is oss of supraspinal cardiac control less problematic than loss of supraspinal control or resp muscles?
    heart has autonomous function
  21. results of losing abs and intercostals?
    impaired cough, mucuciliary transport, airway clearance
  22. goals fo PT cardiopulm management
    • maximize QOL by optimizing resp fxn
    • edu the pt
    • optimize: alveolar vent
    • optimize: lung volumes & capacities
    • optimize: ventilation and perfusion
    • increase or maintain: chest expansion
    • increase: cough effectiveness
    • train intact accessory muslces
    • coordination of breathing rate
    • increase: ability to maintain brochial hygein
    • reduce: work of breathing
    • reduce: work of heart
    • reduce: risk of aspiration
  23. what happens to intrathoracic pressure on inspiration?
    it decreases as the lung volume increases
  24. long list of effects of SCI on resp
    • decreased vital capacity
    • decreased cough effectiveness
    • diminished chest expansion due to orthopedic changes and intercostal spasticity--> contractures & less lung compliance
    • decreased bronchial hygeine
    • increased residual volume
    • fatigue of resp muscles (and person) due to increased energy demands of breathing
    • chest gets triangular (narrow flat upper, wide round lower)
    • paradoxical breathin
  25. paradoxical breathing
    • insp --> inward depression of ribs while abdomen expands
    • increased use of accessory muscles
    • more energy is consumed by resp muscles than is delivered
  26. phonation impaired, norm, optimal levels
    • 4-5 syllables a breath = impaired
    • 8-10 is norm
    • 12 is optimal
    • 20 sec prolonged phonation is also great
  27. what to look for in pt's resp eval
    • skin color (cyanotic?)
    • breath sounds - rales, rhonchi, absent
    • cough - is it functional? productive?
    • phonation - syllables per breath, seconds of phonation
    • chest wall shape - rect. vs triangular, excavatum chest
    • distress - dyspnea, DOE, tachypnea, dysphagia
    • nasal flaring
    • increased use of accessory muscles (necessary to a point, but don't want it overdone)
    • tachycardia
    • diaphoresis (profuse sweating)
    • expressions of fear/anxiety
  28. problem list for a pt w resp problems
    • decreased vital capacity
    • absent or impaired cough
    • decreased chest wall expansion
    • increased/present risk of resp complications
    • intolerance to sitting upright (this pos can make breathing harder)
    • resp ms fatigure
    • tachypnea
    • inefficient breathing pattern
    • chest wall stiffness
    • poor breathing mechanics
    • limited resp ms endurance and reserve

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