Case 1 : ICU post-op

Clinical Scenario:

You are called at home at 9pm: the patient is a 40 yr old man with autism who was admitted 2 days ago with a large pericolonic abscess. He developed peritonitis and sepsis & had an emergency laparotomy for a perforated jejunum yesterday.

He had significant desaturation today, is suspected to have aspirated post-op and was moved to ICU this evening. He has been requiring 60% FiO2 at 50L/min via HFNP to maintain SpO2 in high 80s.

Stage 1 – Assessment information:

Build further understanding of patient’s clinical picture through the following:

View Clinical notes history of current condition

View Obs Chart

View Drug Chart

View Blood results

View Chest X-ray

Listen to Auscultation

Watch video of patient (actor) not done yet, written details instead:- patient slumped sitting in bed, has midline laparotomy wound, NG tube, awake but unable to communicate, not coughing, doesn’t appear to be in pain

Stage 2 -Treatment Options:

Q: What physiotherapy techniques would you try, to benefit this patient’s situation?

Select options from a standard list of respiratory physiotherapy interventions below: (only some links created so far, others to be created to show possible outcomes to patient’s benefit or detriment)

Active Cycle of Breathing exercises

Bird IPPB

Breathing pattern correction / breathing control

Cough Assist Machine

Expiratory chest wall vibrations / stretch facilitation

Manual hyperinflation

Manually-assisted cough

Mobilisation

Modified postural drainage

Non-invasive ventilation

Percussion

Positioning to affect ventilation

Positive Expiratory Pressure

Suction

Supported cough

ICU pic       Back to Cases