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Raising the Bar in Rehab

Cardiopulmonary Physical Therapy

Published July 2, 2010 10:31 AM by

A big portion of the patients I work with are diagnosed with cardiopulmonary impairments. CHF, STEMI, cardiac tamponade, respiratory distress, lung collapse - the list goes on and on. Checking lab values for BNP and troponin is an essential part of my chart review.

However, this is probably the one subject in school I struggled with. A lot of anatomy and physiology is difficult to understand. I remember many endless nights of reviewing bronchioles, myocardial functions and cardiac vessel anatomy. Most PT students find orthopedic injuries easier to comprehend and treat versus sternal precautions and tidal volumes for a patient post-CABG.

I wish I would have emphasized more of my studying in this area while I was in school and had the time to do so. I would like to get into the habit of recognizing arrhythmias, and their implications, at first glance of an EKG. I want to feel more comfortable with improving trunk mobility, and therefore inspiratory volume for my patients who have difficulty breathing.

In the great state of Wisconsin, there are two cardiac clinical specialists (CCS), compared to 68 orthopedic clinical specialists (OCS). Numbers don't lie - there is obviously a heavier emphasis on ortho-based practices in our PT practice.

Which leads me to a question - how do you feel about treating patients with cardiac impairments? Is this a frequent occurrence in your practice, or are cardiopulmonary diagnoses more of a rare comorbidity for your patients? Do you wish you knew more about cardiology?


I was in a similar situation as you and Dean my first year out of school, but it wasn't cardiopulmonary, it was burns.

We had one class - ONE class - on burns in PT school.  I remember thinking after the class, "This is one type of patient I hope I never have to treat."

When I got my first job, I spent half my day on burns and half on ortho.  I was hired to be half neuro and half ortho.  I think they call that the bait and switch.

The burns therapist was pregnant and due to go on maternity leave, but didn't return as her husband got transferred.  So I was the burn therapist.  Next to no training and I was all these folks had.  I learned all I could from the PT before she left and then I saddled up next to the OT to soak in as much wisdom as I could.  We did all of the pediatric dressing changes and debridement, so the techs were an invaluable resource.  There was one tech there who could out-bandage any medical professional in the hospital.  She taught me the art.  Whenever the opportunity presented itself I would sit in on medical procedures to learn the dynamics of what they were doing and relate it to the therapy component.

I came to love treating burns and wounds.  Turned out to be my favorite population.  A year plus later, I was training the new burn therapist who had no experience with the population.

Dean is absolutely right...soak up every opportunity you have.  The more you learn, the less overwhelming it is.  The more you do, the more automatic it becomes.  Before you know it you'll be teaching others!  

Janey Goude July 29, 2010 2:46 AM

Hey Lisa, I worked on a cardio-thoracic unit half of each day for a year my first year out of school. I learned so much from the nurses and PAs that were part of the MDT. I wound up not becoming a specialist in that area, but working with geriatrics has made that experience invaluable. I really believe that we NEED to get a well rounded base before we specialize (if we choose to specialize). Everything really is contingent upon an adequately functioning cardiorespiratory system. Enjoy the experience and soak up as much as you can.

Cheers, Dean

Dean Metz July 2, 2010 11:31 AM

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July 2, 2010 10:57 AM

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