Cardiorespiratory Physiotherapy
Domain focus
This domain tests respiratory assessment, airway clearance, exercise prescription, intensive care and pulmonary rehabilitation. The examiner expects safe interpretation of observations, auscultation, chest imaging and arterial blood gases, plus recognition of when physiotherapy is unsafe or needs medical escalation.
Core rules and concepts
- Assess work of breathing, respiratory rate, oxygen saturation, heart rate, blood pressure, breath sounds and sputum. Trends matter more than one reading.
- Oxygen is a prescribed therapy. In COPD with chronic hypercapnia, target saturations are set individually; do not assume high-flow oxygen is always benign.
- Airway clearance techniques include positioning, breathing exercises, assisted cough, positive expiratory pressure and mechanical insufflation-exsufflation in selected patients. Match technique to secretion location and patient effort.
- Early mobilisation in intensive care requires stability checks, lines and airway security, sedation level and team agreement.
- Pulmonary rehabilitation combines supervised exercise, education and self-management. Use tests such as six-minute walk distance and symptom scores, with appropriate safety monitoring.
- Arterial blood gases show oxygenation and ventilation; interpret with clinical status, not in isolation.
Worked example
A 68-year-old with COPD attends pulmonary rehabilitation. Resting saturation is 91 percent on room air, and during a six-minute walk it falls to 85 percent with dyspnoea. Reasoning: desaturation is significant and the test should stop; sit the patient upright, monitor, give prescribed oxygen and escalate if recovery is incomplete. Do not simply push through the walk. Review the exercise prescription, consider oxygen assessment and adjust intensity using symptoms and saturation trends.
Traps that cost marks
Ignoring a falling saturation trend; using auscultation alone to diagnose; treating all sputum with the same technique; mobilising an unstable intensive care patient without team agreement; and confusing arterial oxygen with ventilation. Another trap is prescribing exercise without considering cardiac, musculoskeletal or cognitive comorbidity.
Key points
- Assess trends, not single observations.
- Oxygen is prescribed and monitored.
- Match airway clearance to the patient and secretions.
- Intensive care mobilisation needs stability and team agreement.
- Pulmonary rehabilitation uses supervised, measured exercise.