role of physiotherapy in icu

7/21/2019 Role of Physiotherapy in ICU

1/68

^mca mi plysemtlarhpy eo EFQ


2/68

Rlysemtlarhpy hssassdaot eo EFQ

DA@EFHC FLH^P ^AH@EOJ; Ohda, Hja, Vax

LSM Rrasaot Eccoass

Rhst Da`efhc Lestmry

Rhst Vurjefhc Lestmry

@ruj Lestmry

Vmfehc/Mffuphtemohc Lestmry

Eovastejhtemo


3/68

NA@ FLH^P ^AH@EOJ /NA@VE@A DMOEPM^EOJ

Padparhtura

R^ NR

VpM>

Ln Rchtacats fmuot/EO^


4/68

FRR

EFR

FYR RHR/RFZR


5/68

Oaurmcmjefhc Hssassdaot

Cavac mi fmosfemusoass

JFV
http://n316%20-%20glasgow%20coma%20scale.flv/http://n316%20-%20glasgow%20coma%20scale.flv/


6/68

Rupec

Veza

^ahftevety

Aquhcety


7/68

FRR(Faranrhc Rariusemo prassura)

Omrdhc vhcua ?:2ddLj

Fretefhc vhcua312 dd Lj


8/68

EFR(Eotrh frhoehc prassura)

Omrdhc 382dd Lj

Fretefhc ?>1dd Lj

Rlysemtlarhpy wetl R^MD fho na usa` shiacy

eo phteaots wetl hfuta oaurmcmjefhc `esahsas,

avao ei EFR es acavhta` naimra tlarhpy.W8T

8.^mtl, F., at hc., Aiiaft mi ahrcy plysemtlarhpy mo eotrhfrhoehc prassura ho` faranrhc

pariusemo prassura.Oaurmfret Fhra, >286. 8


9/68

Aveàofa es fmdpacceoj tlht h rho`mdeza`-fmotrmcca` trehc es eoèfhta` tm tast tlalypmtlases tlht flast plysemtlarhpy dhy

hftuhccy rasuct eo slmrt-tard rasmcutemo mi lejleotrhfrhoehc prassura, ho` tlus prmveà moadmra fceoefhc tmmc eo tla dhohjadaot miacavhta` eotrhfrhoehc prassura.W>T

>Mcsmo, @.D., at hc., Flhojas eo eotrhfrhoehc prassura hssmfehta` wetl flastplysemtlarhpy.Oaurmfret Fhra, >22:. 9(>); p. 822-6


10/68

Pla supeoa pmsetemo ho` Yhcshcvh dhoauvars,

lmwavar, slmuc` na hvme`a`, ho` EFR slmuc`

na dmoetmra` fcmsacy eo phteaots wetl savara

eotrhfrhoehc lypartaosemo.W6T

6.Varja Nredemucca, K.-K.D., @hoeacca,Omrraonarj ho` ^mnart K Ghlo, Aiiafts mi Rmsetemoeoj ho` Axarfesa mo

Eotrhfrhoehc Rrassura eo h Oaurmsurjefhc Eotaoseva Fhra Qoet.Kmurohcs mi Hdarefho plysefhc tlarhpy hssmfehtemo,

855:. ::; p. 89-89


11/68

Eo setuhtemo mi lejl EFR mr uosthnca EFR usa

eomtrmpef tm dheotheo DHR


12/68

L^(Lahrt rhta ho` rlytld)

Omrdhc vhcua 12-822npd

Nrh`yfhrèh 312

Phflyfhrèh ?822

Hssass lahrt rhta ho` nhsef rlytld ny cmmgeoj

ht AFJ rahèoj mr thgeoj h pucsa dhouhccy


13/68

Veous nrh`yfhr`eh (3 92 npd) fhra slmuc` na

thgao. Rhteaot slmuc` na pra-mxyjaohta` premr

tm suftemo.

Vuftemoeoj fho fhusa vhjhc steduchtemo ho`

`afrahsa L^ iurtlar. Rra-mxyjaohtemo lacps tm

cassao aiiafts mi VN ho` vhjhc steduchtemo


14/68

Veous thflyfhrèh (?822npd) fhra slmuc` na

thgao wetl dhouhc tafloequas ho` axarfesa.

Eofrahsa` L^ dhy na ùa tm pheo/hoxeaty mr

sapses eo raspmosa tm àfrahsa` NR.

Iucc axpchohtemo mi trahtdaot ho` hàquhta

hohcjaseh slmuc` na jevao


15/68

Vcmw HI es assaotehccy sthnca ihst HI (? 8>2 npd)dhy fmotrheo`efhta trahtdaot.

Ei phteaot es eo VYP mr YP trahtdaot esfmotrheo`efhta`

Ei tla phteaot es naeoj axtarohccy phfa`, fhra dustna thgao tm mnsarva tla eosartemo pmeot mi tlaweras


16/68

Ncmm` Rrassura

Hssass NR useoj hrtarehc ceoa (usa tla rafaot traoèo NR rafmrèojs) mr OENR rahèoj. Ei NR 3 52/92 mrphteaot es lypmtaoseva eo rachtemo tm omrdhc NR,fhra es raquera` wetl trahtdaot.

Rhteaot dhy na lypmvmchadef, saptef sa`hta` mrlhva eosuiiefeaot fhrèhf iuoftemo

Prahtdaot tafloequas fmuc` fhusa NR tm àfrahsaiurtlar


17/68


18/68

Fhra wetl suftemo slmuc` na thgao lypmtaoseva

phteaots slmuc` na pramxyjaohta` premr tm

suftemo.

Vuftemo fho seduchta h vhsm-vhjhc raspmosa

iurtlar ra`ufeoj NR


19/68

Ei NR es ?801/52 mr phteaot es lypartaoseva eo

rachtemo tm omrdhc fhra wetl trahtdaot es

raquera`.

Rhteaots dhy na eo pheo, lhva hoxeaty mr lhva

fhr`ehf `ysiuoftemo. Play dhy omt na

h`aquhtacy sa`hta`.


20/68

Ei NR su`àocy eofrahsas mr àfrahsas

sejoeiefhotcy ùreoj trahtdaot stmp ho`

eoimrd ourseoj sthii ei tlay `m omt sattca wetleo

h iaw deoutas ho`/mr eotarvaotemo es oaaàà.j. eofrahsa eo eomtrmpas

Pm Praht mr omt tm Praht mo Fretefhc Fhra, Jueàceoas imr Rrhftefa >28>---Omtteojlhd Qoevarsety Lmspethcs


21/68

FYR

Ferfuchteoj ncmm` icmws eotm tla rejlt htreud

veh tla eoiaremr ho` suparemr vaoh fhvh. Pla

prassura eo tla rejlt htreud es gomwo hs

faotrhc vaomus prassura (FYR).

Omrdhc vhcua es 6-81fdL>2

lttp;//`mfsd80.wans.fmd/FYR.p`i


22/68

RHR & RFZR

Et jevas eo`eraft dahsuradaot mi cait htrehc

prassura

RHR-82->>dd Lj

RFZR-Omrdhccy


23/68

EO^-eotarohtemohc omrdhceza` rhtem

Pla prmtlrmdneo teda(RP) ho` ets `areva`

dahsuras mi prmtlrmdneo rhtem(R^) ho`

eotarohtemohc omrdhceza` rhtem(EO^) hra

dahsuras mi tla axtreosef phtlwhymifmhjuchtemo

Ples tast es hcsm fhcca` "RrmPeda EO^" ho`

"RP/EO^

lttp;//ao.wegepa`eh.mrj/wege/Rrmtlrmdneo]teda


24/68

Omrdhc rhoja EO^ eo hnsaofa mi

hotefmhjuchtemo tlarhpy es 2.

Ei EO^ es ? 8.1 fhutemo wetl trahtdaot es

raquera`

Flafg wetl phteaots fmosucthot premr tm

eosartemo mi ORH,MH


25/68

âsperhtmry suppmrt/Dmà mi

vaotehctemo

Mxyjao tlarhpy

Mxyjao es jevao tm traht lypmxhadeh. Rhteaotsslmuc` eoetehccy na jevao h lejl fmofaotrhtemo.

Pla hdmuot fho tlao na h`kusta` hffmrèoj tmtla rasucts mi pucsa mxedatry ho` hrtarehcncmm` jhs hohcyses.

Mxyjao rhoja vhry irmd>8%(IeM> 2.>8)tm822%(IeM> 8.2)*

LACCU, D. R. & OEJLPEOJHCA, R. 8555. HNF mi eotaoseva fhra âsperhtmry suppmrt. Nretesl Daèfhc Kmurohcs,685,89:089::.RÛM^, K. H. & R^HVH@, H. V. >22


26/68

Vp2>omrdhc 50%-822%

lttp;//www.hdparmr`eraft.fmd/pf/lacp-pucsa-mxedatar/z-eotarprateoj-

rasucts.ltdc


27/68

Mxyjao es usuhccy jevao

8. Iexa` parimrdhofa `avefa-Yaoture Dhsg

>. Yhrehnca parimrdhofa avefa-ihfa dhsg,ohshc prmojs mr fhoouchs

lttp;//www.ffdtutmrehcs.fmd/rs/mxyjao/phja86.ltd


28/68

Ie2>; Irhftemo mi Eospera` Mxyjao


29/68

Ohshc fhouch

M> Icmw rhta (c/deo) IeM>

8 >0%

> >%

0 69%

1 02%

9 00%

Mvar 0 c/deo fhusa dufmshc `ryeoj ho` ohshc ncaa`eoj


30/68

Mxyjao ihfa dhsg

sedpca mxyjao dhsg lhs mpao seà pmrts tlht

hccmw rmmd her tm aotar tla dhsg ho` ècuta

tla mxyjao, hs wacc hs hccmweoj axlhca` fhrnmo

èmxeà tm cahva tla fmotheodaot sphfa

Dhry Acezhnatl Dhrtacce ^.O., N.V.Pla JhcaJrmup Eof., Jhca. Jhca Aofyfcmpaèh miOurseoj ho` Hccea` Lahctl, >22>
http://www.healthline.com/directory/consumer-encyclopedias-nursinghttp://www.healthline.com/directory/consumer-encyclopedias-nursinghttp://www.healthline.com/directory/consumer-encyclopedias-nursinghttp://www.healthline.com/directory/consumer-encyclopedias-nursing


31/68

Mxyjao ihfa dhsg -fot`

phrtehc ranrahtlar mxyjao dhsg

sedechr tm h sedpca ihfa dhsg, lmwavar, tla

seà pmrts hra fmvara` wetl moa-why èsfs tm

pravaot rmmd her irmd aotareoj tla dhsg.

Dhry Acezhnatl Dhrtacce ^.O., N.V.Pla Jhca Jrmup Eof., Jhca. Jhca Aofyfcmpaèh miOurseoj ho` Hccea` Lahctl, >22>


32/68


Ples dhsg es fhcca` h ranrahtlar nafhusa et lhs

h smit pchstef rasarvmer nhj fmooafta` tm tla

dhsg tlht fmosarvas tla ierst tler` mi tla

phteaot's axlhca` her wleca tla rast asfhpastlrmujl tla se`a pmrts.



33/68


Omo-ranrahtlar mxyjao dhsg

sedechr tm h sedpca ihfa dhsg nut lhs ductepca

moa-why vhcvas eo tla se`a pmrts. Plasa vhcvas

pravaot rmmd her irmd aotareoj tla dhsg nut

hccmw axlhca` her tm cahva tla dhsg.



34/68


Et lhs h rasarvmer nhj cega h phrtehc ranrahtlar

dhsg nut tla rasarvmer nhj lhs h moa-why

vhcva tlht pravaots axlhca` her irmd aotareoj

tla rasarvmer.



35/68


Ples hccmws chrjar fmofaotrhtemos mi mxyjao tm

fmccaft eo tla rasarvmer nhj imr tla phteaot tm

eolhca.



36/68

FRHR/Ne RHR

Fmoteoumus pmseteva herwhy prassura(FRHR) es

tla usa mi fmoteoumus pmseteva prassura tm

dheotheo h fmoteoumus cavac mi pmseteva herwhy

prassura. Et es iuoftemohccy sedechr tm pmsetevaao`-axperhtmry prassura (RAAR),


37/68

FRHR hcsm dhy na usa` tm traht pratard

eoihots wlmsa cuojs lhva omt yat iuccy

`avacmpa`.

Aj-sajdaothc cuoj fmcchpsa, H^@V, Roaudmoeh


38/68

FRHR es usa` wlao cuoj vmcudas hra ra`ufa`

spafehccy I^F

Et wecc edprmva tla cuoj fmdpcehofa ho`

ra`ufa tla wmrg mi nrahtleoj


39/68

Fmovaotemohc daflhoefhc vaotechtemo

Fmoteoumus dho`htmry vaotechtemo

Hssest-fmotrmc vaotechtemo

Eotardettaot dho`htmry vaotechtemo

Vyoflrmomus eotardettaot dho`htmry

vaotechtemo

Rrassura suppmrt vaotechtemo


40/68

FDY

Nrahtls hra `acevara` ht prasat eotarvhcs,rajhr`cass mi phteaot aiimrt.

Ples dm`a es usa` dmst mitao eo tla phrhcyza`mr hpoaef phteaot nafhusa et fho eofrahsa tlawmrg mi nrahtleoj ei rasperhtmry aiimrt esprasaot.

Pla lhccdhrg mi FDY es tlht tla vaotechtmrdhgas om aiimrt tm saosa phteaot aiimrt


41/68

Hssest-fmotrmc vaotechtemo

Pla vaotechtmr àcevars prasat nrahtls eo

fmmrèohtemo wetl tla rasperhtmry aiimrt mi tla

phteaot.

Zetl ahfl eosperhtmry aiimrt, tla vaotechtmr

àcevars h iucc hssesta` te`hc vmcuda.

Vpmothoamus nrahtleoj eoàpaoàot mi tla

vaotechtmr natwaao H/F nrahtls es omt hccmwa`

lttp;//www.chgaseàprass.fmd/pucdmohry/nmmgs/plysemcmjy/flhp82n.

ltd


42/68

EDY

Zetl eotardettaot dho`htmry vaotechtemo

(EDY), nrahtls hra `acevara` ht h prasat

eotarvhc

Vpmothoamus nrahtleoj es hccmwa` natwaao

vaotechtmr-h`deoestara` nrahtls.

Vpmothoamus nrahtleoj mffurs hjheost tla

rasesthofa mi tla herwhy tuneoj ho` vaotechtmrvhcvas, wlefl dhy na imrde`hnca.

lttp;//www.chgase`aprass.fmd/pucdmohry/nmmgs/plysemcmjy/flhp82n.ltd


43/68

VEDY

Pla vaotechtmr àcevars prasat nrahtls eo

fmmrèohtemo wetl tla rasperhtmry aiimrt mi tla

phteaot.

Vpmothoamus nrahtleoj es hccmwa` natwaaonrahtls.

Vyoflrmoezhtemo httadpts tm cedet nhrmtrhudh

tlht dhy mffur wetl EDY wlao h prasat nrahtl esàcevara` tm h phteaot wlm es hcrah`y dhxedhccy

eolhca` (nrahtl sthfgeoj) mr es imrfaiuccy axlhceoj.

Rmseteva ao`-axperhtmry prassura


44/68

Rmseteva ao` axperhtmry prassura(RAAR)

RAAR fho na usa` tm eofrahsa mxyjaohtemo eo

aetlar HF mr VEDY dmà. Pla aiiaft mi RAAR mo

tla cuojs es sedechr tm ncmweoj up h nhccmmo

ho` omt catteoj et fmdpcatacy àichta naimra.

lttp;//www.dmàrodaèfeoa.fmd/dmàro-daèfeoa/oaws/quefg-jueà-vaot-

assaotehcs#stlhsl.:ckj96Zm.`pui


45/68

Rrassura suppmrt

Imr tla spmothoamuscy nrahtleoj phteaot, prassurasuppmrt vaotechtemo (RVY) lhs naao h`vmfhta` tm cedetnhrmtrhudh ho` tm àfrahsa tla wmrg mi nrahtleoj.

Qsa` hcmoa mr h`à` tm VEDY, tles prmveàs h sdhcchdmuot mi prassura ùreoj eosperhtemo tm lacp tlaphteaot `rhw eo h spmothoamus nrahtl.

lttp;//www.dmàrodaèfeoa.fmd/dmàro-daèfeoa/oaws/quefg-jueà-vaot-assaotehcs#stlhsl.:ckj96Zm.`pui


46/68

husfucthtemo

Ei phteaot es vaotechta` omrdhc nrahtl smuo`s

tao` tm na lhrsl


47/68

Rarfussemo omta

Rcurhc aiiusemo-stmoy `ucc

Htacafthses- fmosmce`htemo `ucc

Roaudmtlmrhx - Lyparrasmohot
http://percussion%20technique.mp4/


48/68

Flast axphosemo

De``ca cmna & ceojuch dmtemoQppar cmna dmtemo

Cmwar cmna dmtemo

(?1fd)


49/68

Rmsetemo mi trhflah

Y c I e ( ec )
http://tracheal%20deviation%20technique.mp4/


50/68

Ymfhc Iradetus(thfteca)

Lho` pchfadaot shda hs flast axfursemo.

Fmdphra nechtarhccy

Hsg pt tm shy g mr 55

Omta smuo` trhosdessemo uo`ar phcd

@afrahsa trhosdessemo 4 her/adplysadh

Eofrahsa trhosdessemo 4 fmosmce`htemo, icue`


51/68

HNJ-hrtarehc ncmm` jhs

Et es h ncmm` tast tlht es parimrda` useoj ncmm`

irmd ho hrtary.

Ho HNJ es h tast tlht dahsuras tla hrtarehc

mxyjao taosemo (RhM>), fhrnmo èmxeà taosemo

(RhFM>), ho` hfeèty (pL).

lttp;//ao.wegepaèh.mrj/wege/Hrtarehc]ncmm`]jhs


52/68

Vputud hohcyses

Ncmm`y

eoichddhtemo mi tlrmht, nrmofle7 cuoj fhofar7

sputud avaocy dexa` wetl ncmm`, irmd hcvamce, sdhcc

nrmofle7

dhsseva ncmm` tunarfucmses mi cuoj, cuoj hnsfass,

nrmofleafthses ,eoihrftemo, adnmcesd.

^usty fmcmra` - usuhccy fhusa` nypoaudmfmffhc nhftareh (eo poaudmoeh)


53/68

Rurucaot- fmotheoeoj pus.

Imhdy wleta - dhy fmda irmd mnstruftemo mr

avao a`adh.

Irmtly peog - pucdmohry a`adh


54/68

DLE-Dhouhc Lypar Yaotechtemo

DLE smdatedas gomwo hs "nhjjeoj" es htafloequa tlht fho na usa` hs phrt mi tladhohjadaot mi daflhoefhccy vaotechta` ho`trhflamstmdy phteaots.

Pla plysemtlarhpautef tafloequa eovmcvas tla usami h > cetar, seojca phteaot usa rasusfethtemo nhjtlht es squaaza` wetl h sareas mi chrjar tlho

nhsaceoa pahg herwhy prassuras ho` te`hc vmcudaht h scmw eoichtemo rhta, wetl tla h``etemo mi hphusa


55/68

H nhj vhcva dhsg, hnnravehta` tm NYDho`

smdatedas gomwo ny tla prmpreathry ohda

Hdnu nhjmr jaoarefhccy hs h dhouhc

rasusfethtmrmr saci-eoichteoj nhj

Hn c t F t e `e te


56/68

Hnsmcuta Fmotrheo`efhtemos

8. Axtrh-hcvamchr her a.j. Nuccha mr Qo`rheoa`

Roaudmtlmrhx

>. Vunfuthoamus adplysadh mi uogomwo

fhusa

6. Vavara/we`asprah` nrmoflmsphsd


57/68

Rrafhutemos

Roaudmtlmrhx, wetl h nunnceoj flast `rheo Cmw, lejl mr chneca ncmm` prassura

Chneca EFR

Vmda cuoj `esahsas, aspafehccy adplysadh/lypareoichta` cuojs

Fhr`ehf hrrlytldehs

Rmst Cuoj surjary

Lejl RAAR raqueradaots fmdneoa` wetl lejl Ie2>raqueradaot

RAAR ? 82fdL>2 mo daflhoefhc vaotechtemo


58/68

Aiiafts

Mptedesa hcvamchr vaotechtemo. Ny ra`ufeojhtacafthses, tles ra`ufas vaotechtemo pariusemodesdhtfl ho` edprmvas jhs axflhoja (^mtlao athc., 8556 ho` 8551)

Dmnecesa pucdmohry safratemos (Kmoas at hc.,855>)

Edprmva cuoj fmdpcehofa (Lm`jsmo at hc., 8559)


59/68

H RAAR vhcva dhy na usa` wlao tla phteaot esmo h RAAR ? 82fdL>M ho` slmws fceoefhc sejosmi `ashturhtemo.

@esfmooaft phteaot irmd tla vaotechtmr, htthfltla nhjjeoj ferfuet tm tla fhtlatar dmuot,htthfl tla rasarvmer nhj tm tla vaotechtmrtuneoj ho` duta tla hchrd mr swetfl tla

vaotechtmr tm stho`ny hs par cmfhc pmcefy eo tlaQoet


60/68

Qseoj 8 mr > lho`s, fm-mrèohta tla àcevary mi

tla nrahtls wetl hoy rasperhtmry aiimrts mi tla

phteaot. Hccmw tla phteaot tm hffcedhtesa ny

useoj sdhcc PYs eoetehccy

Fhra slmuc` na thgao tm deoedesa dmvadaot

mi tla ao`mtrhflahc mr trhflamstmdy tunaùreoj DLE


61/68

Qsa 82-81c mi M>

Fmddmo tafloequa es scmw eosperhtemo ho`

eosperhtmry lmc` imccmwa` ny quefg axperhtmry

racahsa.

Cmoj eosperhtmry lmc` es fmotrheo`efhta` eo h

phteaot wlm es hcrah`y lypareoichta`


62/68

Ei eoèfhta` hppcy dhouhc tafloequas sufl hs

slhgeoj mr venrhtemo ht tla ao` mi axperhtemo

ho` ùreoj axperhtemo

âpaht tla prmfaùra savarhc tedas hs

eoèfhta`(9-< tedas)


63/68

Vuftemoeoj


64/68

Cedn plysemtlarhpy

Rhsseva/Hfteva dmvadaot


65/68

Rmsetemoeoj

Rmsetemoeoj imr plysemtlarhpy wetl tla jmm`cuoj `mwo es hssmfehta` wetl edprmva`vaotechtemo pariusemo rhtems ho` mxyjaohtemo

Ve`a tm se`a turoeoj edprmvas mxyjaohtemo

Rrmoa pmsetemoeoj edprmvas mxyjaohtemo eophteaots wetl htacafthtef suparemr ho`pmstaremr cmwar cmna sajdaots


66/68

Yaotechtemo/pariusemo rhtem


67/68

Yaotechtemo/pariusemo rhtem

Et es `aieoa` hs; tla rhtem mi tla hdmuot mi herrahfleoj tla hcvamce tm tla hdmuot mi ncmm`rahfleoj tla hcvamce.

"Y" vaotechtemo tla hertlht rahflas tla hcvamce

"X" pariusemo tla ncmm`tlht rahflas tla

hcvamce

lttp;//ao.wegepa`eh.mrj/wege/Yaotechtemo/pariusemo]rhtem
http://en.wikipedia.org/wiki/Ventilation_(physiology)http://en.wikipedia.org/wiki/Airhttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Perfusionhttp://en.wikipedia.org/wiki/Pulmonary_alveolushttp://en.wikipedia.org/wiki/Airhttp://en.wikipedia.org/wiki/Ventilation_(physiology)


68/68

8 cetar mi ncmm` fho lmc` hnmut >22 dC mi mxyjao78 cetar mi `ry her lhs hnmut >82 dC mi mxyjao.Plaraimra, uoàr tlasa fmoètemos, tla eàhcvaotechtemo pariusemo rhtem wmuc` na hnmut 8.21.

Y/X rhtem-8.21

Pla hftuhc vhcuas eo tla cuoj vhry àpaoèoj motla pmsetemo wetleo tla cuoj. Ei thgao hs h wlmca,tla typefhc vhcua es hpprmxedhtacy 2.

role of physiotherapy in icu

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