Little things also make the difference!

Hi guys,

I had a 56 y.o patient on the ward who came in for surgery for his spleen, however in the process, he experienced a traumatic pneumothorax to the left side. This was treated medically with the pigtail ICC. The result was left sided basal atelectasis with pleural effusion. My supervisor saw him initially in the acute stage, and carried out the routine chest checks (SMIs and supp cough). Once the ICC was taken out, he began to use the 'bird' to help re-expand the collapsed lung. This helped to increase the airflow to the atelectatic areas and splint the airways open - however progress was slow. Ambulating him about the ward did help slightly, but as the patient recovery plateaued, I decided to push him a little harder (within his capability of course). We then walked a good 280 metres with ease, and walked 4 flights of stairs. After which, on reauscultation, the air entry into the problematic side was significantly improved!

What I have learnt from this is that it may look so simple, but mobilising a patient and getting them to increase their respiratory demand can actually help them so significantly and quickly. If you can spare the extra few minutes, don't just walk your "respiratory" patients for the sake of it, make sure it's worth while, and you'd see the benefits right away.

Oh - and don't forget positioning as well! This patient's Sp02 was 93 semi-recumbent, and when sat out of bed it jumped to 98%.