Cardiopulmonary Physiotherapy
What is tested
Assessing breathlessness and chest signs, selecting airway clearance technique, measuring exercise capacity, and mobilising cardiac and respiratory patients safely.
Core rules
- Auscultation. Crackles suggest secretions or fibrosis; wheeze suggests narrowed airways; absent sounds suggest poor air entry or pneumothorax; pleural rub suggests inflammation.
- Spirometry. Obstructive: FEV1/FVC below 0.70. Restrictive: both values reduced with a normal or raised ratio.
- ACBT. Breathing control → thoracic expansion exercises → forced expiration technique (huff) → repeat. Huff from mid-lung volume for secretions; avoid prolonged huffing during bronchospasm.
- PEP and oscillators. Positive expiratory pressure splints airways and helps secretion clearance in bronchiectasis and cystic fibrosis.
- Positioning. Sit upright, or side-lying with the affected lung uppermost for drainage; positioning also reduces work of breathing.
- Exercise capacity. 6-minute walk test (distance, SpO2, dyspnoea), shuttle walk test, Borg 6–20 scale; age-predicted HRmax = 220 − age; Karvonen uses heart rate reserve.
- Cardiac rehabilitation. Early mobilisation, then supervised outpatient sessions from 3–8 weeks, 20–40 minutes of moderate aerobic work. Sternal precautions after CABG for 6–8 weeks: no lifting above about 5–10 kg, no pushing or pulling with the arms.
- Oxygen targets. COPD with hypercapnia risk: 88–92%; most other patients: 94–98%.
Worked example
Day 2 after lobectomy: SpO2 91% on room air, weak cough, coarse crackles at the base. Reasoning: atelectasis with retained secretions. Sit the patient upright, support the wound, teach a supported huff and thoracic expansion, then mobilise; reassess SpO2 and breath sounds. If SpO2 stays low with tachycardia and fever, escalate.
Traps
Vigorous percussion over a rib fracture or tumour; mobilising before checking resting observations; assuming every crackle needs suction; ignoring calf pain and swelling after prompting ankle pumps.