00:01
It's also important to note that respiratory
muscles can fatigue and as they fatigue the
way a person breathes changes.
00:09
In the emergency room, this is a particular
issue because it can foreshadow respiratory
failure. You can tell when somebody is
tiring out and having severe changes,
and you can also feel the bogginess and feel
the changes to the muscles as they lose
their ability to function.
00:26
Muscle fatigue is a factor in respiratory
failure, particularly
in severe asthmatics.
00:32
And most signs of respiratory failure are
actually signs of respiratory muscle failure.
00:37
That's how we predict it.
00:39
We do know when people start to breathe
quicker, when they are driven by
hypoxemia or hypercarbia.
00:45
But the fatigue and the failure itself is a
failure of the
musculoskeletal system.
00:52
So respiratory muscle fatigue has been
identified in COPD and this is what drives
people to hospitalization and need for
assistance on occasion, aiding intubation and
taking over of the respiratory function of
the body.
01:07
And respiratory fatigue also worsens
pulmonary edema and
other secondary conditions from the
respiratory issues.
01:16
We want to treat the thoracic cage and treat
the lungs to improve compliance.
01:21
It does help reduce the workload of
breathing and will
decrease the incidence of fatigue of the
respiratory system.
01:29
You may also affect the functioning of the
lung itself.
01:33
And again, I refer people to the MOPSE
study, M-O-P-S-E done by Kendi Hensel at the
University of North Texas as a good sign of
what can be done to help
people with respiratory conditions, with OMM
and what the benefit is and where it
is. Because we know that when we look at
breathing, you're looking
at the relationship of the skeletal muscles
and oxygen
exchange. The longer the muscle, the better
off you are.
02:01
Typical findings in obstructive lung disease
produce inefficient
muscle contractions because the diaphragm
becomes flattened, and you have short
hypertrophied accessory muscles that aren't
functioning well.
02:14
When people have long-term pulmonary
problems, it changes the shape of the
thoracic cage.
02:20
You're going to see barrel chest developing
patients with COPD.
02:24
Just from the work of breathing and the
remodeling of the bones secondary
to the changes in muscle functioning, you
may have shortened respiratory
muscles and somebody who develops a barrel
chest that maintains the barrel
shape and just has it continually worsen and
the increased resting
tone interfaces with the blood supply to the
muscles.
02:46
So it's going to maintain this dysfunction.
02:49
The reason blood supply matters is when you
have an increased oxygen demand and
decreased supply of blood, you're going to
go into an anaerobic metabolism,
you're going to become more acidic and the
risk of respiratory failure increases.
03:03
A good part of what OMM does is maintain
aerobic metabolism and
prevent deterioration tissue breakdown by
preventing you from going into an anaerobic
metabolism.
03:14
Because anaerobic metabolism is less
efficient and more caustic and becomes a
downward spiral.
03:20
So OMT is going to increase the aerobic
metabolism,
increase return of fluids into the vascular
system and help people
function better.
03:31
So the way we do this is by enhancing the
overall movement of the thorax and allowing
the motion to be fluid and allowing the
increased intra thoracic pressure to
allow for oxygen exchange.
03:43
Here we have a good picture of the diaphragm
showing how the diaphragm is pulling down and
where it's pulling down and where are you
going to see the motion, both anterior and
lateral of the lungs so that you have good
motion of the ribs to
enhance respiration.
03:59
The contraction of the muscle is what's,
what is the work of breathing and
is what is the energy expenditure.
04:06
And it's a complex interplay of forces
that's coordinating this.
04:11
It's sometimes difficult to focus on one
aspect of it, but
looking at the overall end result and
looking at oxygen saturation levels
are a good sign of what's going on and a
good secondary marker.
04:25
Because when you're breathing and when you
do have the diaphragm pulling down, you can
see that the orientation of the ribs change,
the orientation of the accessory
muscles change, and it affects all the
functioning of the breathing.
04:39
And that's why the work of breathing enhances
so tremendously when you
get breathing pathology, when you develop
COPD and when the diaphragm starts to
change, it's no longer as efficient and the
work of breathing becomes centered more in
the interosseous muscles and more in the
larger secondary muscles than in the
primary muscle. The diaphragm here's just a
representation of what's
going on with the ribs, with motion, and how
the ribs are going to help
enhance the space.
05:10
And by enlarging the thoracic cavity,
pulling oxygen into the
lungs so the contraction of multiple muscle
groups at once is
much more efficient than having an
asynchronous contraction.
05:23
And that's part of why fluidity of motion
and
synchronicity of breathing matters, another
representation of the diaphragm, and
how the diaphragm working with the ribs is
the most effective form of breathing.
05:36
So when you're monitoring a patient with
breathing problems, look for neutral
mechanics, look for fluidity of motion, and
make sure that.
05:45
You're being efficient and helping the
person efficiently breathe.
05:49
If you don't have the rib cage working with
the diaphragm, that's called
paradoxical motion.
05:55
When you have them working in opposite
directions, the paradoxical motion is a sign
that the person is decompensating
deteriorating and an intervention is needed
to help the patient, or they will continue
to get worse.