PMR Cardiopulmonary Rotation
PM&R Residency Program Manual
PM&R Resident Rotation Descriptions
PM&R Cardiopulmonary Rotation
PM&R residents will have the opportunity to evaluate a patient for cardiac rehabilitation, learn the precautions that are appropriate, learn how to write a safe and effective exercise prescription and when an exercise program needs to be stopped. The resident will assess new patients, follow them through the cardiac rehab process, assist staff with patient education and vital signs, rhythm assessments when appropriate, and review lipid studies. The resident will need to review cardiac rhythms and arrythmias before the start of the rotation.
Residents will have the opportunity to observe respiratory therapy in a variety of rehabilitation situations dealing with respiratory therapy treatments and equipment as applied to spinal cord injury, brain injury and general orthopaedic patients. Learning experiences will include but not be limited to such issues as: why tetraplegics have problems with mucus plugs and how they can be decreased; trachs, who is appropriate for a speaking valve, what precautions are necessary with a speaking valve; what takes place when a patient is downsized, what medications are appropriate for neb treatments; and others. Residents will also have the opportunity to observe respiratory therapy in the outpatient/home care setting. Learning experiences will include general home care prescriptions for home oxygen therapy, BIPAP, CPAP, nocturnal pulse oximetry, mask interfaces and machine operation.
This is a two-week rotation where time is divided between several different locations: Pulmonary Rehabilitation at UVa-HealthSouth with Jeanne Bird; Cardiopulmonary Rehabilitation at Martha Jefferson Hospital on Pantops; Roberts Home Medical with Clint Swanson; the UVa Sleep Lab; and, if time permits, the UVa Asthma Clinic; the UVa Cardiac Stress Lab.Residents will tour the UVa Sleep Lab. They will learn about the interpretation of sleep studies, and learn which patients benefit from CPAP and BIPAP. They will also watch the SAFER CD of the American Academy of Sleep Medicine to be able to recognize signs of fatigue, sleep deprivation and sleep apnea.
Goals and Objectives:
- Describe the phases of cardiac rehabilitation.
- Review basic cardiac anatomy and physiology.
- Become familiar with the treadmill evaluation protocols.
- Learn the New York Heart Association Functional Classification System.
- Define a MET and become familiar with the energy costs of common activities.
- Learn how to prescribe an exercise program for the cardiac patient including the specification of cardiac precautions. Cardiac response to various forms of exercise should be reviewed along with basic principles of exercise physiology.
- Learn the contraindications for continuing therapeutic exercise or an exercise tolerance test in the cardiac patient.
- Become familiar with the literature examining the benefits/outcomes in cardiac rehabilitation.
- Describe the Borg ratio of perceived exertion and its use in cardiac rehabilitation.
- Learn how to address resumption of activities in the cardiac patient including sexual, return to work, hobbies and recreational.
- Define pulmonary rehabilitation and describe components of a comprehensive program.
- Become familiar with pulmonary function testing and basic pulmonary physiology.
- Learn the Moser classification of functional pulmonary disability.
- Describe the indications for entry into a pulmonary rehabilitation program.
- Become familiar with the literature examining the benefits/outcomes in pulmonary rehabilitation.
- Learn the compensatory breathing techniques for patients with COPD including diaphragmatic breathing, pursed-lip breathing, and glossopharyngeal breathing.
- Describe the role of conventional pulmonary testing and the 6-minute walk test in estimating exercise tolerance in patients with COPD.
- Learn about the different ventilary assist systems including negative pressure ventilators, positive pressure ventilators, the rocking bed, and pneumobelt.
- Become familiar with the use of different tracheostomy tubes and speaking valves.
- Learn about restless leg syndrome and its treatment.
- Learn the scope of the problem of sleep deprivation among residents, what causes sleepiness, how the circadian clock impacts residents and the consequences of chronic sleep deprivation.
- Recognize untreated sleep apnea or sleep deprivation in patients.
- Become familiar with CPAP, BIPAP and interfaces (masks).
- Become familiar with oxygen administration prescription and equipment in the home setting.
- Learn modalities for airway clearance including applied devices and breathing devices.