Surgical patient management

• Analgesia:

  • Intravenous – continuous infusion via pump
  • Patient controlled analgesia
  • self administered
  • demand Vs delivered
  • Epidural - sited in theatre
  • Oral or sublingual
  • Intramuscular
• Physiotherapy Techniques to Increase Lung Volumes:

  • Sitting up in a chair
  • March on spot if unable walk (+ Lower Thoracic Expansion Exercises)
  • Mobilisation (+ Lower Thoracic Expansion Exercises)
  • Lower Thoracic Expansion Exercises (+ inspiratory hold / sniff to recruit collateral channels and allow alveolar interdependence)
  • Intermittent Positive Pressure Breathing
• ACBT for the Surgical Patient:

  • ACBT can be used if the patient is retaining secretions
  • How should the ACBT be adapted to suit the surgical patient?
  • focus on lower thoracic expansion exercises + hold and sniff
• Supported Huff / Cough:

  • Use a rolled up clean towel or pillow
  • Use the patients/therapists hands (gloves if in direct contact with the skin)
  • Caution with pillows as may dislodge drains