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Physiotherapy x Surgery BY ALINE SHALEV SURGICAL PHYSIOTHERAPIST LEADThe Muscular System Muscles play a part in every The muscular system is made up function of the body of over 650 muscles These include three muscle Only skeletal muscles are types: smooth, skeletal, and voluntary, Smooth and cardiac cardiac muscles act involuntarily.The Muscular System these functions possible.s also work together to make ü For instance, when you run (skeletal muscles), ü Your heart pumps harder (cardiac muscle), ü Causes you to breathe heavier (smooth muscles).Physiotherapy General overview • “Physiotherapy helps to restore movement and function when someone is affected by injury, illness or disability. • It can also help to reduce your risk of injury or illness in the future” • (NHS 2022)Physiotherapy Surgical team Services We cover: • Emergency Surgical Wards - Isabela and Astor Ward • Elective Surgical Ward - Alex ( Wednesday DSU ) What time: • 0830-1630pm - Weekdays Night on call service 24/7: • 1630 – 0830am the next day - This only covers respiratory physiotherapy referrals (PT ‘s are not on site overnight have a 40min response time) Reduced service on weekends: • contact switchboard and ask for Respiratory Physiotherapy Physiotherapy Rehabilitation: Mobility Assessment o Transfers o Mobility o Balance o Sensation o Proprioception o Strength o Range of movement Physiotherapy Rehabilitation: Mobility Treatment o Provide Safe Aid o Restore mobility baseline o Prevent decondition and increase endurance. o Education and Advice o Personalize Exercise Programs o Referral to : Falls team, OP PT referral ,CPT , Rehab potential o D/C Planning Physiotherapy Rehabilitation: Respiratory Assessment o Chest X-Ray o WOB o Palpation o Auscultation o Cough o Secretions o Bloods - ABGs o Vitals Physiotherapy Rehabilitation: Respiratory Treatment Secretion management o O2 therapy o Nebulizer ( Doctors to prescribe ) o Medication Prior Tx ( carbocisteine ) Secretion clearance o ACBT Breathing cycle o MT ( vibs, percussion) o Cough assist o Bubble PEP o Suction OP ( Yankeur, Soft Catheter, Guedel ) o Suction NP ( Soft Catheter) o Acapella or Flutter ( COPD and Bronchiectasis) o Postural drainage Lung Expansion - Consolidation / Collapse / Atelectasis o DBEs o IPPB o MobilisePhysiotherapy Rehabilitation: Respiratory Physiotherapy Referral - YES o Refer to Patients via CRS, Bleep, MDT , Notes o Concern about retained secretions o Sudden increase in O2 demand due to retained secretions or consolidation/atelectasis o Acute aspiration o Acute rib fractures o Day 1 post-op – Laparotomies Physiotherapy Referral - NO Increased WOB and O2 demand due to; o PE o Pleural effusions o Pulmonary oedema o Pneumothorax o Severe bronchospasm / Wheeze Physiotherapy x Enhance Recovery PathwayElective ERP at Kingston Hospital Colorectal and Theatre Nephrostomy ERP Pre- Assessment Pathway goals : Optimizer Pt. until Surgery day Day 0 Post Day 1 Day 2-7 ( Operative depends on types of Surgery ) Elective ERP an MDT Approach o Doctors o Nurses o Physiotherapist ( Laparotomy or when required ) o Occupational Therapist o Dietician o Pain team o Pharmacist o Stoma Nurse ( if appropriated )ERP Pathway for Emergency Surgeries • A&E Screen Patient • Sepsis Screen • CT Scan • Theatre Within 6 hours of decision to Operate • ICU/HDU Post-SurgeryEmergency Laparotomy National 21.846 2019 – 2020 Kingston hospital 132 2019 - 2020 (NELA, 7 annual report) 10/9/2021 PRESENTATION TITLE 17National vs Kingston Hospital stats Average length of hospital stay Mortality rate (days) 20 10% 8,70% 17 8,00% 15 8% 15 6% 10 4% 5 2% 0 0% National Kingston Hospital National Kingston Hospital th (NELA, 7 annual report) 18Physiotherapy Post Emergency Laparotomy Respiratory + Rehab Physiotherapy promote: 1.Increase in lung volumes, optimization of ventilation to perfusion ratio (VA/Q) and better airway clearance; 2. Reduction of risk of immobility associated with PPC; 3. Improvement in level of consciousness; 4. Increase in functional independence; 5. Improvement in cardiovascular fitness; 10/9/2021 PRESENTATIONTITLE 19 6. Psychological benefit. Nicolino Ambrosino 8:4 2013, multidisciplinary respiratory medicine. Dewi Nurul Makhabah , Federica Martino andThank ou