PT Diagnosis & Management of Cardiopulmonary Dysfunction (RS377)

1 Prof. Alice Jones

Time-table: Team members :

Prof. Alice Jones (Specialist in Cardiopulmonary Physiotherapy) Dr. Shamay Ng (Subject leader) Dr. Shirley Ngai Ms Sharon Tsang

Teaching format:
Lecture Tutorial Practical

Blackboard site
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Teaching material:
self learning packages (pdf)

tutorial handouts ppt in pdf format videos DVD on Chest x-ray

Required text:
Pryor and Prasad 2008: Physiotherapy for Respiratory and cardiac problems 4th ed. * Bourke 2007: Lecture notes on respiratory medicine. 7th ed. West J (2008): Respiratory Physiology The essentials 8th ed. West J (2008): Pulmonary Pathophysiology- the essentials 7th ed. Corne et al 2010: Chest X-ray made easy. 3rd ed. Hampton 2008: ECG made easy. 7th ed. Gray et al 2008: Lecture notes on Cardiology 5th ed.
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Assessment: clinical question test 25% practical test 30% MCQ 30% debate 10% short quiz & participation in tutorial and practical class 5%
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Tutorial participation
1% - attendance of over 80% 2% - attendance of over 80% and occasionally contribute 3% - full attendance and occasionally contribute 4% - full attendance and frequently contribute 5% - full attendance and regularly contribute

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The role of physiotherapy

in the management of cardiopulmonary disorders maintenance improvement

of the function of the cardiopulmonary system

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The new role of a cardiopulmonary physiotherapist

Promotion of cardiopulmonary fitness Prevention of cardiopulmonary diseases
Normal Healthy Clients Patients

Promotion & Maintenance of Health

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Treatment of dysfunction
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Evidence based practice (EBP)

5-step process of EBP Ask (the right question) Patient Acquire information assessment Analyse retrieved information Appraise Apply (application of evidence to
practice)
Appropriate treatment techniques

Evaluate (effectiveness of practice) Appropriate clinical decision

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Intervention cycle
Assessment

Evaluation

Formulate hypothesis Management plan

Interventions Technique(s)
Indications Precautions Contraindications Modification
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Knowledge base
Function Anatomy & physiology

of the cardiopulmonary system

Pathology of Cardiopulmonary disorders Monitoring of cardiopulmonary functions

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Functional Anatomy of the respiratory system

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The respiratory system

Respiratory tract Lungs Alveoli Pleura Ultimate function
allow adequate/efficient gas exchange
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Respiratory anatomy
Position of the airway
posture of the head & neck

Surface anatomy
lungs and pleura

Muscles of respiration
intercostals, diaphragm
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Relaxed breathing
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Conscious spontaneous breathing

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Forced mouth breathing

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Swallowing

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Normal glossopharyngeal tone

Hypo-glossopharyngeal tone
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Airway patency & Sleep disorders

a problem common in subjects with: Obesity Chronic respiratory diseases

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Obstructive Sleep Apnoea

Hypoventilation during sleep
CO2 and SaO2

sleepiness / non-refreshed sleep headache fatigue lack of concentration

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road traffic accident

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Extension of the head

Jaw-lift

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Management of Obstructive Sleep Apnoea

Positive airway pressure (to keep the airway open during sleep and allow optimal ventilation) Surgical management
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Larynx - airway and voice box Epiglottis Hyoid bone Epiglottis

Vestibular fold

Corniculate

Vocal fold Trachea Posterior Side

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Arytenoid Anterior Prof. Alice Jones

The upper airway

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Clinical relevance

Postural / gravitational Drainage

positioning of the bronchial tree to facilitate draining of pulmonary secretions by gravity
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Function of the Upper Respiratory Tract

filters inspired air humidifies inspired air warms inspired air smell, articulation, resonance produce mucus (goblet cells) mobilise mucus (ciliated cells)

epithelial lining

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The lower airway peripheral smaller participate in gas exchange

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Collateral ventilation

pores of Kohn

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Alveolar cells
Pneumocytes
Type I cells
alveolar lining (prevent protein leak)

Type II cells
for storage of surfactant

Marcophages
Immune function
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epithelial lining Type I Type II

endothelial cells

alveolus
oxygen
macrophages neutrophils mast cells clara cells
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Clinical relevance
oxygen diffusion capacity
alveolar membrane thickness

fluid balance in the lungs

capillary (hydrostatic pressure) /alveolar pressure/osmotic pressure

alveolar expansion
effect of surfactant on surface tension
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The respiratory muscles diaphragm internal and external intercostals abdominal muscles
forced expiration coughing
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The diaphragm muscle

ventilation lung volume stablization of back muscles

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normal

inspiration

maximal inspiration

effect on lung volume

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Work of breathing is affected by: Efficiency of the respiratory muscles

weakness/fatigue compliance of the chest wall (obesity; pleural restriction)

Position of the diaphragm

Obesity Postural changes
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Function of the respiratory system Gas exchange Oxygenation Efficient removal of CO2
Affected by Airway diameter Lung volume
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Monitoring of the function of the respiratory system

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Lung volume Expiratory flow rates Oxygen level (PaO2, SaO2) Expired CO2 level Chest radiographs Lung sounds Functional capacity
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Summary
Surface anatomy Position of the airway Position / direction of the bronchial tree Factors affecting lung function
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