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Clinical algorithm for the passive mobilization of an unresponsive patient

Clinical algorithm for the passive mobilization of an unresponsive patient. Next step in the algorithm. On admission to unit. Develop an individually designed mobility plan with outcomes for each patient in consultation with rest of the team. Monitor daily and provide feedback

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Clinical algorithm for the passive mobilization of an unresponsive patient

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  1. Clinical algorithm for the passive mobilization of an unresponsive patient Next step in the algorithm

  2. On admission to unit • Develop an individually designed mobility plan with outcomes for each patient in consultation with rest of the team. • Monitor daily and provide feedback (Nava 2000; Nava 2002; Thomas 2002; Vollman 2004) Recommendation 1 Next step in the algorithm

  3. Does patient present with any • Neurological contra indications? • Orthopedic contra indications? • Recent SSG? NO YES

  4. Discuss with interdisciplinary team • Decide on a specific mobility plan for the patient including outcome measures and monitor accordingly Back to algorithm

  5. Patient has sufficient cardiovascular reserve? • MAP > 60mmHg • No new cardiac arythmias visible on ECG; • HR < 75% APM • Low dose inotrope support: • Dopamine <10mcg/kg/min; • Nor/adrenaline<01mcg/kg/min EXPERT OPINION Thomas et al 2006 NO YES

  6. Initiate basic elements of a mobility plan • Two hourly change of position supine – quarter turn (Topp 2002; Thomas 2006; Krishnagopalan et al 2002) • Nurse in 30-45 degrees head up position (supine) (I RCT Dodek et al 2004) • Passive movement of upper and lower extremities once daily through full range (Morris 2007; Winkelman 2007; Nava 2002) EXPERT OPINION Topp et al 2002; Thomas et al 2006; Krishnagopalan et al 2002; Morris 2007; Winkelman 2007; Nava 2002 Previous step in the algorithm

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