Quote Originally Posted by Dr Damien View Post
Dear Inty

I have very little clue about acute management of immediate post surgical cardiac rehab. But my little experience with the elderly suggests to me that some form of cardiac funstion test would be done prior to any rehab, e.g ejection fraction, heart rate, blood pressure, SPO2 etc...
Any patient who is having to push through his arms fully cardiac patient or not is not sitting to stand properly... in this case I would suspect that some assistance will be needed...or sit to stand training from a high surface might be needed...they probably will be walking with some walking aid and supervision or assistance of one or two...the rehab of this client will depend on previous comorbidities e.g age, motivation, history of COPD, diabetes, chronic fatigue syndrom, hypertension, previous strokes, arthritis, O2 use during hospitalization , previous surgeries etc will all determine what the functional recovery will look like... some patients with little or no comorbidities will recover faster than those with a lot of issues.

...rehab can start on the first day with just sitting out of bed, or even bed exercises...I suspect that cardiac function tests will guide what is expected, In this case, I would work closely with a nurse (preferrably someone with cardiac specialty interests).

I my be wrong but guidelines may not be appropriate for all patients. I have a friend who works in as an ICU specialist physiotherapist in Canada and when we discuss cases, he always emphasizes early mobilization. The only way the heart can pick up its function is for it to experience the stress it needs to work the whole body...I would focus on mobilizing early but I would let the results of the cardiac function test guide me...

Like I said, I am not a cardiorespiratory specialist...but this is how I would manage these patients...I wouldnt think that trying to get them to sit to stand will be a contraindcation, the question will be how they are doing it and how much assistance is required...

Lets hear from the cardiorespiratory specialists, they might have better reasoning

cheers
Hi,

Thanks for the input. I am not a specialist in this area too but I definitely agree. Without set guidelines my personal approach would be to initially reduce/minimise anything that is likey produce a Valsava manouvre or overly strain the patient therefore that means high seats initially for sit-to-stand, sit to stand with assitance etc (all of this is totally dependent on the patient's INDIVIDUAL capacity). Post surgery it is essential to get the patient up and about as early as is possible. The first step is really sitting up in bed, the usual bed exercises to sitting out in a chair and so on.Guidelines are good but are just that, guidelines.

Cheers