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Samenvatting Cardiorespiratory Physiotherapy 2
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Uitgebreide samenvatting van alle lessen Cardiorespiratory Physiotherapy 2 (Lambeets, Coremans, El Bakkali, De Cock, Hens, Vorlat)
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By: Inagrielens • 3 year ago
By: basvandijck12 • 1 year ago
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Universiteit AntwerpenAcademiejaar 2020 - 2021
Faculteit Geneeskunde en Gezondheidswetenschappen
Master Revalidatiewetenschappen en Kinesitherapie
Cardiorespiratory
Physiotherapy 2
1
,DEEL 1: Physiotherapy in
Intensive Care
2
,INHOUD
0. Korte introductie ................................................................................................................................................. 6
1. Arteriële bloedgassen ......................................................................................................................................... 7
1.1. Bloedgassen?................................................................................................................................................ 7
1.2. Interpretatie van de partieeldruk van koolstofdioxide in arterieel bloed .................................................. 13
1.2.1. Alveolaire hypoventilatie .................................................................................................................... 14
1.2.2. Toename in CO2 productie .................................................................................................................. 15
1.2.3. Ventilatie-perfusie mismatch .............................................................................................................. 15
1.3. Interpretatie van de partieeld ruk van zuurstof in arterieel bloed ............................................................ 16
1.3.1. Gedaalde alveolaire partieeldruk O2 .................................................................................................. 17
1.3.2. Gestegen alveolaire-arteriële zuurstofgradiënt .................................................................................. 18
1.3.3. Gedaalde cardiac output en/ of toegenomen zuurstofconsumptie ................................................... 24
1.4. Respiratoire insufficiëntie .......................................................................................................................... 26
1.4.1. Type 1: Hypoxemische respiratoire insufficiëntie ............................................................................... 27
1.4.2. Type 2: Hypercapnische respiratire insufficiëntie ............................................................................... 27
1.4.3. Type 3: Perioperatief respiratoir falen ................................................................................................ 27
1.4.4. Type 4: Respiratoir falen: shock .......................................................................................................... 27
1.5. Interpretatie van zuren en basen ............................................................................................................... 28
1.5.1. Buffers ................................................................................................................................................. 31
1.5.2. Acid-Base Disorders ............................................................................................................................ 35
2. Hemodynamica ................................................................................................................................................. 44
2.1. Wat is hemodynamica? .............................................................................................................................. 44
2.2. Het hart ...................................................................................................................................................... 46
2.2.1. Cardiale cyclus ..................................................................................................................................... 46
2.3. Hemodynamische parameters ................................................................................................................... 47
2.4. Meetmethoden voor hemodynamische parameters ................................................................................. 48
2.4.1. Niet-invasieve meetmethoden............................................................................................................ 48
2.4.2. Invasieve meetmethoden ................................................................................................................... 48
2.5. Hemodynamische ondersteuning .............................................................................................................. 53
3. Neuromonitoring .............................................................................................................................................. 54
3.1. Klinische neurologische monitoring ........................................................................................................... 55
3.1.1. Coma schaal ........................................................................................................................................ 55
3.1.1.2. Glasgow Coma Scale (GCS) ............................................................................................................... 56
3.1.1.3. Glasgow-Liege Coma Scale (GLCS) ................................................................................................... 58
3.2. Invasief neurologische monitoring ............................................................................................................. 60
3.2.1. Intracraniële drukmeting .................................................................................................................... 60
3
, 3.2.2. Relevantie van ICP metingen............................................................................................................... 62
3.3. Craniocerebraal trauma ............................................................................................................................. 68
4. Respiratoire ondersteuning .............................................................................................................................. 71
4.1. Vrijmaken of vrijhouden van de luchtwegen ............................................................................................. 71
4.1.1. Positioneel maneuver om de luchtwegen te openen ......................................................................... 72
4.1.2. Heimlich-maneuver ............................................................................................................................. 72
4.1.3. Instrumentatie .................................................................................................................................... 73
4.2. Medicatie ................................................................................................................................................... 74
4.3. Zuurstoftherapie ........................................................................................................................................ 74
4.3.1. Nasale cannula .................................................................................................................................... 75
4.3.2. Naso-farangyeale katheter .................................................................................................................. 76
4.3.3. Simpel zuurstofmasker ........................................................................................................................ 76
4.3.4. Venturi masker .................................................................................................................................... 77
4.3.5. Rebreathing mask ............................................................................................................................... 77
4.3.6. Non-rebreathing mask ........................................................................................................................ 78
4.3.7. Tracheotomie masker ......................................................................................................................... 78
4.4. Borst drainage ............................................................................................................................................ 79
4.4.1. Pneumothorax ..................................................................................................................................... 80
4.4.2. Haemothorax ...................................................................................................................................... 81
4.4.3. Pleurale effusie.................................................................................................................................... 81
4.5. Bronchoscopie ............................................................................................................................................ 83
5. Mechanische ventilatie ..................................................................................................................................... 84
5.1. Introductie.................................................................................................................................................. 84
5.2. Verschillende werkingsmechanismen ........................................................................................................ 84
5.2.1. Negative pressure ventilation ............................................................................................................. 84
5.2.2. Positive pressure ventilation ............................................................................................................... 85
5.2.3. High frequency ventilation .................................................................................................................. 90
6. Kinesitherapie op de Intensive Care ................................................................................................................. 91
6.1. Introductie.................................................................................................................................................. 91
6.2. Mortaliteit op de ICU ................................................................................................................................. 91
6.2.1. Risicofactoren voor mortaliteit ........................................................................................................... 91
6.3. Complicaties/ Effecten van verblijf op de ICU ............................................................................................ 93
6.3.1. Spierzwakte ......................................................................................................................................... 94
6.3.2. Atrofie op de ICU ................................................................................................................................. 99
6.3.3. Intensive care unit-acquired weakness (ICUAW) ................................................................................ 99
6.3.4. Gewichtsverlies ................................................................................................................................. 102
6.3.5. Gewrichtscontracturen ..................................................................................................................... 102
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