Patients with Myocardial infarction, Congestive heart failure, Coronary artery disease, Hypertension, Cardiac arrhythmia, Scoliosis, Kyphosis, Cystic fibrosis, Bronchiectasis, Lung abscess, Neuromuscular disorder, Pleural effusion, COPD, Pneumonias etc.
They may cause due to Injury, Trauma, Bacterial & Viral infections, Hereditary, Tumors, Allergy, Chemical irritants, Habits like smoking alcohol, Obesity, High fat diet, Diabetes mellitus, lack of physical activity.
Chest pain, Shortness/Difficulty in breathing, Cough, Fever, Facial numbness, Dizziness, Sweating, Nausea, Palpitations, Chest discomfort.
X ray , CT scan, MRI(magnetic resonance imaging)
Treatment (CHEST PHYSIOTHERAPY):
1. Improve respiratory efficiency
2. Promotes expansion of the lungs
3. Strengthen respiratory muscles
4. Eliminate secretions from the respiratory system.
Mostly the techniques are done by a respiratory therapist, although sometimes taught to family members also.
• Contraindications (should not be done to these patients)
1. Neck and head injuries
2. Fractured ribs
3. Collapsed lungs
4. Acute asthma
6. Heart attacks
7. Pulmonary embolism
8. Lung abscess
10. Spine injuries
11. Untreated angina
12. Left ventricular dysfunction
13. Recent surgery
14. Open wounds
15. Rib/vertebral fractures
17. Recent hemoptysis
19. Bleeding lungs etc.
• Before starting chest physiotherapy, evaluate the patient's condition and determine whether the techniques would be beneficial/not.
1. Turning: Patient is to be turned side to side on his own or by a caretaker as this permits lung expansion. Head of the bed may also be elevated if patient feels comfortable as it promotes drainage. Done once in 2-3 hrs.
2. Coughing: Patient is made to sit straight and inhale deeply through nose, then exhale in short huffs and coughs. This clears secretions in the lungs by suctioning/expectorating. Done many times in a day with in comfort level.
3. Deep breathing: Sit straight in chair/bed. Inhale, pushing abdomen to fill maximum amount of air into the lung. Then exhale, contracting the abdomen slightly. This is useful in expansion of lungs and better distribution of air into all lung parts. Done many times for short periods.
4. Postural drainage: This is done by placing the patient in a head/chest down position for 15 minutes. This technique includes gravitational force assistance in draining secretions so that they can be either suctioned/coughed. Done in critical care patients, ventilated patients for 4-6 times a day under respiratory therapist supervision.
5. Percussion: Rhythmically tapping/clapping the chest wall with cupped hands to break up the thick secretions in lungs so that they can be easily removed. Done on each lung segment for 1-2 min while doing postural drainage.
6. Vibration: Tell the patient to inhale deeply. Place hand against patient’s chest and create vibrations by quickly contracting and relaxing the shoulder muscles as the patient is exhaling. This technique also breaks up the thick lung secretions. Done many times each following five exhalations.
7. Shaking technique, coughing and huffing techniques used.
• Risk factors associated with chest physiotherapy are head lowering may cause increased intracranial pressure, temporary low BP, vomiting, injury to ribs, heart irregularities, bleeding in lungs.