Cardiopulmonary Physiotherapy

Transcription

1 Cardiopulmonary Physiotherapy in Trauma An Evidence-based Approach

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3 Cardiopulmonary Physiotherapy in Trauma An Evidence-based Approach Editors Heleen van Aswegen Department of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa Brenda Morrow Department of Paediatrics and Child Health, University of Cape Town, South Africa ICP Imperial College Press

4 Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co. Pte. Ltd. 5 Toh Tuck Link, Singapore USA office: 27 Warren Street, Suite , Hackensack, NJ UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Cardiopulmonary physiotherapy in trauma : an evidence-based approach / edited by Heleen van Aswegen, Brenda Morrow. p. ; cm. Includes bibliographical references and index. ISBN (hardcover : alk. paper) I. Van Aswegen, Heleen, editor. II. Morrow, Brenda, 1973, editor. [DNLM: 1. Wounds and Injuries--therapy. 2. Heart Diseases--therapy. 3. Physical Therapy Modalities. 4. Respiratory Tract Diseases--therapy. 5. Wounds and Injuries--complications. WO 700] RE '13--dc British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. Copyright 2015 by Imperial College Press All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher. For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy is not required from the publisher. Typeset by Stallion Press enquiries@stallionpress.com Printed in Singapore

5 Preface List of Contributors Contents Chapter 1 Physiological Response to Trauma 1 Written by H. van Aswegen 1.1. Human Immunity and its Response to Injury and Inflammation Shock and its Effects on the Human Body Factors that Influence Blood Oxygen Content Effect of Trauma on Blood Glucose Levels Clinical Case Scenario Classification of Patients with Traumatic Injuries Conclusion 24 Bibliography 24 xi xv Chapter 2 Not Just Small Adults : Paediatric Anatomy and Physiology in Relation to Trauma 29 Written by B.M. Morrow 2.1. Introduction 30 v

6 vi Contents 2.2. Anatomical and Physiological Differences between the Adult and Child Conclusion 45 Bibliography 45 Chapter 3 Trauma and Immunosuppressive Diseases 47 Written by H. van Aswegen and B.M. Morrow 3.1. Introduction Pathogenesis of HIV and AIDS HIV and AIDS and the Pulmonary System Extrapulmonary Complications Associated with HIV and Antiretroviral Therapy Conclusion 60 Bibliography 61 Chapter 4 Physiotherapy Modalities, Markers and Outcome Measures 65 Written by B.M. Morrow and H. van Aswegen 4.1. Early Mobilisation and Graded Exercise Therapy Cardiopulmonary Physiotherapy Techniques Markers and Outcome Measures Conclusion 137 Bibliography 140 Chapter 5 Blunt and Penetrating Injuries 151 Written by H. van Aswegen, B.M. Morrow and E. van Aswegen 5.1. Causes and Mechanisms of Injury Causes of Fatality after Abdominal or Thoracic Injuries Medical and Surgical Management of Survivors of Abdominal or Thoracic Trauma Physiotherapy Aims of Management 185

7 Contents vii 5.5. Precautions and Contraindications related to Physiotherapy Management Physiotherapy Interventions Clinical Case Scenarios Suggested Reading Material for Further Study Conclusion 220 Bibliography 220 Chapter 6 Burn Injuries 229 Written by S. Hanekom, M. Wilson, B.M. Morrow and H. van Aswegen 6.1. Causes and Mechanisms of Burn Injury Types of Burn Injuries Systemic Effects of a Burn Injury Classification of Burn Injuries Medical and Surgical Management Physiotherapy Aims of Management Precautions and Contraindications Related to Physiotherapy Management Physiotherapy Interventions Clinical Case Scenarios Suggested Reading Material for Further Study Conclusion 301 Acknowledgement 301 Bibliography 302 Chapter 7 Multiple Orthopaedic Injuries 309 Written by N. Plani, H. van Aswegen and B.M. Morrow 7.1. Causes and Mechanisms of Injury Types of Fractures Orthopaedic Injuries Commonly Encountered in the Polytrauma Patient Classification of Fractures 324

8 viii Contents 7.5. Complications Associated with Orthopaedic Injuries Mechanism of Bone Healing Medical and Surgical Management Physiotherapy Aims of Management Precautions and Contraindications Related to Physiotherapy Management Physiotherapy Intervention Clinical Case Scenarios Suggested Reading Material for Further Study Conclusion 365 Bibliography 366 Chapter 8 Spinal Cord Injury 371 Written by W. Mudzi, H. van Aswegen and B.M. Morrow 8.1. Structure of the Spinal Cord Causes and Mechanisms of Injury Spinal Cord Lesions and Classification of the Level of Injury Respiratory System Complications following Spinal Cord Injury and Changes in Respiratory Muscle Function Complications Related to Other Bodily Systems following Spinal Cord Injury Medical and Surgical Management Physiotherapy Aims of Management Precautions and Contraindications Related to Physiotherapy Management Physiotherapy Interventions Clinical Case Scenarios Suggested Reading Material for Further Study Conclusion 444 Bibliography 445

9 Contents ix Chapter 9 Traumatic Brain Injury 453 Written by R. Roos, B.M. Morrow and H. van Aswegen 9.1. Causes and Mechanisms of Injury Types of Traumatic Brain Injury Primary and Secondary Injury Associated with Traumatic Brain Injury Severity of Injury Medical and Surgical Management Physiotherapy Aims of Management Precautions and Contraindications Related to Physiotherapy Management Physiotherapy Interventions Clinical Case Scenarios Suggested Reading Material for Further Study Conclusion 505 Bibliography 505 Chapter 10 Quality of Life of Survivors of Trauma 511 Written by H. van Aswegen Definition of Quality of Life Assessment of Quality of Life Quality of Life of Survivors of Critical Illness Quality of Life of Survivors of Trauma and Critical Illness Rehabilitation of Survivors of Critical Illness Suggestions for Exercise Rehabilitation for Survivors of Trauma and Critical Illness Potential Challenges Associated with Exercise Rehabilitation of Survivors of Trauma Conclusion 542 Bibliography 543

10 x Contents Appendix I 551 Normal Values for Paediatrics 551 Appendix II 553 Bedside Measures to Establish the Oxygenation Status of Critically Ill Patients 553 Appendix III 555 Functional Recovery of Patients with Spinal Cord Injury 555 Bibliography 558 Index 559

11 Preface Trauma in its various forms remains a serious public health problem worldwide and is the leading cause of death among adults and children, particularly those between the ages of one and nine years. The Global Status Report on Road Safety (2009) states that million people worldwide sustain injuries related to motor vehicle accidents annually. The Global Burden of Armed Violence (2011) reported that 526,000 people worldwide lose their lives due to violence each year and that many more people suffer from a range of physical and mental health problems due to violence. According to the World Health Organisation (2014), the majority of trauma occurs in low-income and middle-income countries. Burns, sustained as a result of interpersonal violence or suicidal attempt, remain a serious public health problem in some countries, and fire-related deaths rank among the 15 leading causes of death worldwide. Motor vehicle accidents and war injuries are among the top ten projected leading causes of disability-adjusted life years in In light of these facts, trauma-related injuries are likely to remain one of the leading causes of high hospital admission rates and health care costs associated with care provided to patients in acute care settings worldwide. For the purpose of this book, trauma is defined as damage to any body part as a result of physical impact or accident. Such injuries can range xi

12 xii Preface from mild (not requiring hospitalisation) to life threatening. The interdisciplinary health care team usually involved in the management of patients who have sustained life-threatening trauma-related injuries includes physiotherapists who work in the acute care and rehabilitation settings. In the acute care setting (intensive care unit, high care unit, hospital ward), the main roles of the physiotherapist are the prevention or management of respiratory complications or existing respiratory conditions and the prevention of musculoskeletal complications that may develop secondary to injury and immobility. This book has been written by physiotherapists for physiotherapists and physiotherapy students to encourage evidence-based cardiopulmonary physiotherapy management of adult and paediatric survivors of trauma in the acute care setting. The elements of evidence-based clinical practice are often described as a combination of: (a) best available research evidence; (b) professional expertise and judgement; and (c) the needs and preferences of the patient. In this book, information obtained from published research is shared with the reader as well as the clinical expertise of the writers in cases where evidence to support the use of certain treatment interventions in the management of patients with trauma is still lacking. This book provides information on physiological responses to trauma to provide the physiotherapist with a better understanding of the mechanisms behind muscle protein breakdown and weakness and delayed recovery, so often observed in patients who suffer critical illness due to trauma-related injuries. A chapter that describes the anatomical differences between children and adults is included to demonstrate that children are not just small adults and illustrates how their management differs. Immunosuppressive diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are prevalent worldwide; the chapter on trauma and immunosuppressive diseases describes the pulmonary and extrapulmonary complications associated with HIV and AIDS and antiretroviral therapy, and highlights important points to be considered in the management of patients with HIV or AIDS who are involved in trauma. This is followed by a chapter that provides an overview of various cardiopulmonary physiotherapy treatment interventions, subjective and objective markers and outcome measures that may be used in the care of patients with traumatic injury. The clinical chapters are dedicated to specific types of

13 Preface xiii life-threatening trauma commonly encountered in patients in the acute care setting. These chapters are structured in a similar format and include: an overview of causes and mechanisms of injury; medical and surgical management; physiotherapy treatment aims; suggested treatment interventions; contraindications and precautions to physiotherapy intervention; and clinical case scenarios and suggested further reading. Differences in management between adults and children involved in trauma are highlighted. Towards the end of the book, quality of life of patients who survived trauma is discussed, as well as the role of exercise therapy to aid such survivors recovery. Key messages boxes, which contain important clinical information for the reader to be aware of, appear throughout many of the chapters. The focus of this book is mainly on the physiotherapy treatment of adults, children and infants with trauma-related injuries in the acute care setting. The reader is referred to other published medical, physiological and physiotherapy texts for detailed information on the assessment of patients in the acute care setting. The reader is also referred to other published physiotherapy texts for detailed information on rehabilitation of trauma survivors in the chronic health care setting. H. van Aswegen B.M. Morrow Bibliography Global Burden of Armed Violence (2011). Chapter 2: Trends and patterns of lethal violence. [Online]. Available at: docs/gbav2/gbav2011-ch2-summary.pdf [Accessed 13 November 2014]. World Health Organisation (2009). Global Status Report on Road Safety: Time for Action. [Online]. Available at: prevention/road_safety_status/2009/en/ [Accessed 01 August 2014]. World Health Organisation (2014). Violence and injury prevention: injury-related disability and rehabilitation. [Online]. Available at: violence_injury_prevention/disability/en/ [Accessed 13 November 2014].

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15 List of Contributors Heleen van Aswegen (PhD) Associate Professor Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Brenda Morrow (PhD) Associate Professor Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. Susan Hanekom (PhD) Associate Professor Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa. xv

16 xvi List of Contributors Witness Mudzi (PhD) Associate Professor Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Natascha Plani (MSc Physiotherapy) Senior Physiotherapy Clinician Sklaar, Laidler and Associates Physiotherapists, Netcare Union Hospital, Alberton, South Africa. Ronel Roos (PhD) Lecturer Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Elizna van Aswegen (MBBCh; DipPEC (SA)) Medical Doctor Head Emergency Centre, Mediclinic Bloemfontein, Bloemfontein, South Africa. Moira Wilson (Diploma in Physiotherapy) Senior Physiotherapy Clinician Netcare Milpark Hospital, Johannesburg, South Africa.