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ICU and Acute Care: From Early Mobilization to Discharge Decisions

Education Resources, Inc.

Objectives

Integrate the medical and environmental of the ICU to promote an effective therapy session.
Apply current literature and trends to progress functional recovery for patients that suffer critical illness.
Apply basic exercise physiology principles to prescribe an effective exercise prescription
Implement an integrative rehabilitation plan to address pulmonary dysfunction.
Analyze the complexity of critical illness via a case scenario to develop an evaluation and intervention approach to provide comprehensive care.

Target Audience

Physical and Occupational Therapists working in an acute care setting with primarily adults. The focus will be on cardiovascular and pulmonary critical illness.

It is recommended that participants have a basic knowledge of lines, tubes and ventilators. If not, it is recommended you review this online course: "Lines, Tubes, Ventilators and Diagnostic Screening for Stability vs Instability: Cardiopulmonary Examination and Monitoring." Available on the Education Resources, Inc. website.

Confirmation Notes

This course meets the criteria for 13.5 contact hours (1.35 CEU's).

Approved by the NJ Board of Physical Therapy Examiners and the PA State Board of Physical Therapy.

ERI is an approved agency by the PT Board of CA.

NY: Approved provider by the NY State Board of Physical Therapy for 16.2 contact hours.

Approved provider of continuing education by the American Occupational Therapy Association #3043, for 13.5 contact hours - Intermediate Level Occupational Therapy Process: assessment, intervention. The assignment of AOTA CEU's does not imply endorsement of specific course content, products or clinical procedures by AOTA NBCOT professional development provider-13.5 PDU's
Participants are asked to bring a Stethoscope, linens, (towels, sheets), pillows and a tape measure.

Agenda

Day One:
7:30-8:00 Registration/Continental Breakfast 8:00-9:30 Effects of Acute and Critical Illness: adverse effects on various systems and the impact on rehabilitation process. • Hospital acquired weakness, chronic critical illness and post ICU syndrome. • The ABCDEF bundle and interdisciplinary collaboration. 9:30-10:30 Review of System as it relates to medical stability • Medications, labs and diagnostics to guide the rehabilitation session. 10:30-10:45 Break 10:45-11:45 Interpretation of vital signs • Normal ranges and general responses (heart rate, blood pressure, oxygen saturation, respiratory rate) relative to the patient’s fitness level at a given workload. • Pulse pressure, rate pressure product, heart rate reserve, percentage of expected exercise capacity and breathing pattern to assess physiological tolerance 11:45-1:00 Lines and Tubes Function, Precautions and Mobility •Safe mobility with effective clinical decision making. 1:00-2:00 Lunch (on your own) 2:00-3:00 Applied Exercise Physiology and Assessment for the hospitalized patient • Exercise testing protocols and out comes measures to document impair ment andresponse to rehabilitation • Exercise prescription and goals to optimally treat the medically complex patient. 3:00-3:30 The Dyspnea and Fatigue Barrier • Heart failure and COPD • Clinical tools to measure the subjective reports 3:30-3:45 Break 3:45-4:30 Case study; Clinical Integration and decision making. This case study will integrate the medical history of a patient who has a past medical history of IPF due to JRA, suffering pulmonary infection leading to prolonged respiratory failure requiring lung transplantation.

Day Two:
7:30-8:00 Continental Breakfast 8:00-9:30 Clinical Application of EKG • Rate and rhythm: effects on perfusion, filling and cardiac output • Common dysrhythmias: formulating clinical decisions 9:30-10:30 Pulmonary assessment including mechanical ventilation • Basic modes of ventilation • Utilizing the mechanical ventilator to set goals and to advance patient exercise tolerance 10:30-10:45 Break 10:45:12:00 Pulmonary Lab • Auscultation and palpation of the pulmonary system: breathing mechanics and chest wall mobility 12:00-1:00 Lunch (on your own) 1:00-2:00 (Continue) Pulmonary lab • Neuromuscular facilitation techniques to promote an effective breathing pattern andbreath control • Musculoskeletal mobilization techniques to decrease work of breathing and to progress functional recovery 2:00-2:45 Advanced ICU device support • VADs and ECMO devices: safely mobilizing patients • Rehabilitation program and goals for patients on these advance life support devices. 2:45:3:00 Break 3:00-4:00 Case Study and Clinical Decision Making This case study will integrate the medical history of a patient who has past medical history obesity, HTN and type II DM diet controlled. She suffered a myocardial infarction that led to heart failure and limb amputation

Description

In this course the speaker will first discuss the multisystem adverse effects of critical illness and the impact the sequelae have on the rehabilitation process. This is critical for the clinician to understand because individuals who suffer a critical illness have high morbidity rates. The current philosophy is for early mobilization to decrease the rate of functional deficits and disability. In this medical model the therapist needs to have a sharp set of skills in assessment and optimal interventions given the activity tolerance of the patient. This discussion will establish the framework for the remainder of the course by addressing pertinent evaluation skills and intervention plans with the goal to restore function across the continuum of care. This course will discuss the interpretation of vital signs beyond the basics and system review as it relates to critical illness. The participants will gain a clinical decision framework to determine medical stability and exercise tolerance that will improve the exercise prescription of patients recovering from critical illness. Another section of this course will focus on understanding dyspnea and fatigue which are two common barriers to activity tolerance. The participants will learn how to examine chest wall mechanics, breathing pattern, cough effectiveness and incorporate interventions to improve function. This course will explore the evidence for advanced intervention for patients on advanced medical support devices and who are suffering from the common iatrogenic effects of hospitalization. Finally the participants will be engaged in a case study to discuss integration of clinical information and problem solving for a successful patient encounter.

Date And Locations
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