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<thread>Y</thread>
<threadtitle>Optimum Treatment Plan for ICU patient?</threadtitle>
<threadviews>157</threadviews>
<threadsticky>0</threadsticky>
<poll></poll>
<username>DubleDutch</username>
<dateline>1110690480</dateline>
<title>Optimum Treatment Plan for ICU patient?</title>
<pagetext>To one an all,,,

I am a student physio that has been given the following Cardio Respiratory assignment to consider,,, but because the background research that I have conducted to date appears to vary, (and whilst I appreciate that there may be varying ways in which this patient could be treated),,, I wanted to know if anyone could add thier suggestions for an appropriate, safe and effective physiotherapy treatment plan for the following patient,,, so that I may then fully consider the options and where required, research for the appropriate literature to substantiate my overall treatment plan.

Hence,,,

A 73-year-old gentleman was admitted to ICU for close monitoring after being involved in RTA the last night. He has sustained fractures to his 4th through to 9th ribs on the right,,, as well as a haemopneumothorax.

He is currently positioned ½ lying in bed,,, spontaneously breathing,,, but complaining of a lot of pain. He has a right intercostal drain in situ,,, that is swinging and draining blood stained fluid. His observations have deteriorated in the last 30 minutes,,, and currently read,,,

• Heart Rate - 128
• Blood Pressure - 140/95;
• Temp - 38.1
• Respiratory Rate – 32

• SpO2 85% on FiO2 0.60

• Arterial Blood Gases (ABG’s)
- pH - 7.45
- pO2 - 8.1 kPa (56.7 mmHg)
- pCO2 - 04.8 kPa (36 mmHg)
- HCO3 - 25 mmol/L

CXR shows a resolving pneumothorax and right lower lobe collapse.

Auscultation: reduced breath sounds in the right lower lobe,,, with more scattered crackles in the right > (than) left

Prior to admission Mr Hills mobility was limited due to osteoarthritis. He has smoked 30 cigarettes/day for 50 years. He has no other medical problems.


Many thanks in advance to all that are able to offer their time and help,,,

DD