SUBMITTED BY; KIRAN SHAHZAD

STUDENT ID: 2217-2018

SEMESTER: 9th

SUBJECT: CARDIOPULMONARY PHYSICAL THERAPY

DATE: 2-mAY-2023

SUBMITTED TO;

Dr. BUSHRA MEHWISH

ASSIGNMENT#1
1. Explain non invansive hemodynamic
monitoring?
Monitoring: It is the ability to detect and can rapidly react to changes in
physiology is now possible, and it is this that has become the essence of modem
intensive care. 1

Hemodynamic Monitoring: ( Haem + Dynamo=Measure perfusion to

the whole body) It means to measurement of pressure, flow and oxygenation of blood
within the cardiovascular system. 2

Non Invansive Hemodynamic Monitoring: Non-invasive

monitoring of a variety of parameters is now routinely usiny in many areas, especially
ICUs and operating theatres. Commonly including monitored parameters indude
temperature, ECG, level of Consciousness, heart rate, blood pressure and pulse
oximetry. Respiratory rate might be measured by some monitoring systems, and in
certain circumstances end-tidal C0 2 and transcutaneous PO2 and PCO2 monitoring may
be performed. These all has to be displayed on a single monitor screen. Some Technical
problems and artefacts can occur with the display of any of these parameters, therefore
it is needed that the patient's clinical status must be checked before acting on a monitor
display abnormality.

Temperature: Temperature is continuously monitored by means of an oesophageal or

rectal probe which determines core temperature, and is usually at least 1°C higher than
axillary temperature and may be more in shock. The oesophageal temperature may be
lower if the gases for respiratory support are unwarmed and if the rectal probe
occasionally fall out without being noticed, is often leading to an erroneously low
temperature being displayed.

Heart rate: Heart rate is measured from the electrocardiogram (ECG) trace. Where
Artefacts are common. Interference (usually from patient movement or a warming
blanket) may confuse the monitor into showing the presence of a tachycardia or
arrhythmia, while small complexes may be interpreted as asystole. Physiotherapy is
causing movement artefacts. On the ECG trace, large T waves (and occasionally P waves
or a pacemaker spike) may be interpreted as QRS complexes, causing the displayed
heart rate being double the actual rate. Detached or dried-out electrodes will lead to
asystole being displayed.

Respiratory rate: Respiratory rate may be measured by making use of the changing
impedance across the chest wall as it moves with respiration. In systems which offer this
parameter, the sensors are built into the ECG leads. The heart rate and other
movements of the chest can cause overreading of respiratory rate, while electrodes
placed too far apart may not give a reading at all. Appropriate physiotherapy treatment
such as for lobar lung collapse may reduce a rapid respiratory rate, but it is important to
be emphasized that an already tachypnoeic patient should not be allowed to become
exhausted during treatment as he may rapidly decompensate. This may even
necessitate emergency intubation.

Blood pressure: Blood pressure is monitored with a pressure cuff around the upper
arm. An oscillometric method is used to measure blood pressure, with the help of
automatic cuff inflation and deflation. The accuracy of this like systems is generally
good, but the cuff needs to be applied correctly and be of the appropriate size for the
arm. The system also needs to be calibrated correctly against a mercury column. Non-
invasive blood pressure monitoring is performed intermittently, but to be noted is that
the interval between readings may be as short as 1 minute. While Physiotherapy
treatment sometimes cause a patient to become hypertensive, especially if the
treatment causes pain or anxiety. The hypotensive patient may occasionally become
more unstable, and here the risks and benefits of treatment need to be carefully
balanced.

End-tidal CO2: End-tidal CO, (ETCO,) may be measured on an intubated patient. The
method works by the principle of absorption of infrared light. Its work by a probe from
the monitor is inserted into the ventilator circuit close to the end of the endotracheal
tube. ETCO, correlates well with PCO, in normal lungs, but less well in diseased lungs
(Clark et al 1992). It is used widely in anaesthesia and for the ventilation of head-injured
patients, but its use in other contexts is less well defined. In paediatric (especially
neonatal) patients, transcutaneous P0 2 and PC0 2 measurements are practised in many
centres. The transcutaneous electrode is fixed to the skin which it heats and makes
permeable to gas transport. Local hyperaemia arterializes the capillary blood. Good
correlation between transcutaneous and arterial measurements has been shown.
However, transcutaneous measurements rements have been shown to be sensitive but
not specific indicators of blood gas status as they may be influenced not only by the
partial pressure of the gas but also by a reduction in cardiac output or local blood flow.
They have not gained acceptance in adult critical care practice. 1

Electrocardiogram: The electrocardiogram (ECG) is a graphic representation of the

electrical activity of the heart. An electrocardiographic tracing demonstrates
depolarization and repolarization of the atria and ventricles. The position of the positive
(recording) electrode in relation to the spread of the electrical impulse is referred to as
the lead. In the critical care unit, patients are routinely monitored using only one or two
of several possible leads for heart rate and rhythm. An electrocardiogram monitors two
things: heart rate and heart rhythm. A single-channel ECG monitor with an oscilloscope,
strip recorder, and digital heart rate display is typically located above the patient at
bedside in the ICU. The ECG can often also be observed at a central monitoring console,
where the ECGs of all patients in the ICU can be observed simultaneously. The ECG
monitor allows for continuous surveillance of the patient. Heart rates above or below
the preset ranges will trigger an alarm. Electrodes are positioned on the chest to provide
optimal information regarding changes in rhythm and heart rate and thereby ensure
close patient monitoring. Problems with the monitor usually result from faulty
technique, electrical interference, or movement artifact. An erratic signal often results
from coughing and movement. The cause of any irregularity must be explained and
untoward changes in electrical activity of the myocardium ruled out. When treating
patients requiring continuous ECG monitoring it is important to know the reasons for
monitoring, the baseline rhythm, and have the ability to recognize rhythm changes and
implications. Some of the changes in rhythm that would indicate caution with physical
therapy intervention. Some Indications of Declining Cardiac Status:
• -T change (elevation or depression)
• Onset, increase, or change of foci of premature ventricular contractions (PVCs)
• Onset of ventricular tachycardia or fibrillation
• Onset of atrial flutter or fibrillation
• Progression of heart block
• Loss of pacer spike
Level of Consciousness: A bispectral index sensor (BIS) is used in patients to assess
level of consciousness and thereby monitor sedation levels in the ICU. There is minimal
evidence suggesting that it also might be useful in assessing pain. The BIS measures the
muscular and cortical activity using a single, small, flexible sensor that is applied to the
forehead and temporal region. The sensor provides rapid feedback for quick titration of
medication and an objective score. A value is produced every 15 seconds that ranges
from 0 (no cortical electrical activity and full suppression) to 100 (awake, aware, no
suppression). In the ICU, protocols have been developed for titrating sedatives to
maintain a BIS value within set parameters (usually 60 to 70) that correspond with the
manufacturer’s guidelines for light-to-moderate sedation.

Pulse Oximetry: Noninvasive measurement of arterial oxygen saturation (SaO2) by

pulse oximetry provides continuous, safe, and instantaneous measurement of blood
oxygenation. Pulse oximeters compute SaO2 by measuring differences in the visible and
near infrared absorbances of fully oxygenated and deoxygenated arterial blood. The
measurement is expressed as a percentage of oxygen that is bound to hemoglobin. Pulse
oximetry is based on two physical principles: (1) the presence of a pulsatile signal
generated by arterial blood, which is relatively independent of nonpulsatile arterial,
venous, and capillary blood and other tissues; and (2) the fact that oxyhemoglobin
(O2Hb) and reduced hemoglobin (Hb) have different absorption spectra. In ICU patients,
a probe is attached to the patient’s finger, forehead, or earlobe, and the reading is
displayed continuously on the monitor. For physical therapists the pulse oximeter
provides valuable information regarding the adequacy of available oxygen before, during,
and after exercise. The recommendation is to keep the O2 saturation above 90% during
exercise unless otherwise ordered by the physician. Supplemental oxygen can be titrated
to keep the O2 saturation within the appropriate range according to hospital guidelines. 3

2. What are paedriatic airway devices?

1) It is mechanical vibration delivered at a frequency above the

range of human
2) It is mechanical vibration delivered at a frequency above the
range of human It is the most effective treatment for venous
ulcers and can lessen lymphedema and chronic oedema as
well as prevent leg ulcers from returning. By promoting
venous blood flow returning to the heart, it combats the signs
and symptoms of venous insufficiency. Calf muscle pump
action promotes circulation and prevents blood from
collecting in lower limb veins by applying more pressure at
the ankle and gradually reducing it. A skilled professional
must apply compression bandaging; a novice risked damaging
the patient. Used in PAD and venous disease